Bicol Univeristy

OFFICE OF ADMISSIONS
Legazpi City

APPLICATION FORM Staple/Paste

BICOL UNIVERSITY COLLEGE ENTRANCE TEST 2pcs.
(BUCET) 2x2 photo
(recent)
SY 2020 - 2021

Instructions to Students and Parents: Application Form No. ____________

THIS FORM IS ONLY FOR APPLICANTS WHO HAVE NOT ENROLLED IN ANY COURSE/ Application & Testing Fee: P 250.00 (free)
SUBJECT BEYOND SENIOR HIGH SCHOOL. Reference Code: 15786
CAREFULLY READ THE GENERAL INFORMATION FOR BUCET applicants and the contents Queue Date: Oct 28, 2019
of this form before filling in the information asked. Queue Time: (8:00AM-12:00PM)
ONLY CORRECTLY AND COMPLETELY FILLED OUT FORMS will be issued a TEST PERMIT.
This application is valid only for entrants during the school year indicated above. Permit No. ___________________________
PRINT ALL ANSWERS. Verified by: ___________________________

1. Intended Course. Print your Course Choice and CODE number on the box provided below. Please refer to the BUCET GENERAL INFORMATION on
College Freshmen Admission. Course indicated in this form are final. Changing of course is strictly not allowed.
COURSE CODE COURSE NAME CAMPUS

1st Choice A-13 BS Entrepreneurship CBEM

2nd Choice A-05 BS Psychology CSSP

2. PRINT OR TYPE YOUR NAME IN THE FOLLOWING SEQUENCE: Last Name, First Name, Middle Name. Place one letter in each box.
Check one box only:
Last Name SIAPNO
3. SEX Male ✓ Female
First Name MA FRANCESCA MAY ✓ Filipino
4. CITIZENSHIP:

Non-Filipino
Middle Name GREGORIO
5. RELIGION: ROMAN CATHOLIC
6. PERMANENT HOME ADDRESS

Number and Street 010 SAN PEDRO ST

Subd./Village, Brgy. SAN PEDRO

City/Town & Province SANTO DOMINGO, ALBAY

Postal/Zip Code 4508 Email Address francescasiapno@gmail.com

Tel./Cell. Phone No. 09569841421

7. Senior High School graduated or graduating from: LEGAZPI CITY SCIENCE HIGH SCHOOL Expected/date of graduation 2020
School Address LEGAZPI CITY, ALBAY Learner's Reference No. 310202140010
8. Junior High School Completed from LEGAZPI CITY SCIENCE HIGH SCHOOL
School Address LEGAZPI CITY, ALBAY
9. Applicant's Date of Birth: 2001 MAY 29 10. Civil Status (Check one box only)
Year Month Date ✓
Single    Married    Other (specify)
11. Applicant's Place of Birth: STO. DOMINGO, ALBAY
12. Occupation of Father/Guardian: SELF EMPLOYED Occupation of Mother/Guardian: SELF EMPLOYED

✓
13. Do you have any PHYSICAL DISABILITY or CONDITION that would make it difficult for you to take a regular test?   No   Yes
(Please attach Certification of Disability and Submit to the BUAO).
14. Monthly Family Income:

  Less than P 10,999.00 (attach Certificate of Indigency)   P 15,000.00 - P 20,000.00   P 31,000.00 - P 49,000.00
✓   P 11,000.00 - P 14,000.00   P 21,000.00 - P 30,000.00   Exceeding P 50,000.00
15. Is your family a member of:

15.1 4 P's   Yes ✓   No 15.2 Indigenous People   Yes ✓   No

APPLICANT'S CERTIFICATION

I HEREBY CERTIFY ON MY HONOR THAT I HAVE UNDERSTOOD THE HEREIN INSTRUCTIONS AND THAT ALL THE INFORMATION HEREIN
CONTAINED IS TRUE AND CORRECT. FURTHER, I ATTEST THAT I HAVE NOT ENROLLED IN ANY COLLEGE COURSE/SUBJECT BEYOND SENIOR
HIGH SCHOOL, OTHERWISE MY APPLICATION FOR ENTRANCE IN BICOL UNIVERSITY WILL BE RENDERED INVALID.

Signature of Applicant Signature of Parent/Guardian over Printed Name

NOTE: Please submit P 45.00 worth of stamps and (1) long window envelope, for mailing your BUCET Result.

BU-F-ADMISSION-29 Not for Sale. Reproduction is allowed. Rev. 1

Effectivity date: July 17, 2018 Page 1 of 2