FM-AA-AGT-01

Rev. 01
01-Jan-2018

APPLICATION FOR COLLEGE ADMISSION TEST

PANGASINAN STATE UNIVERSITY

FRESHMAN TRANSFEREE

PLEASE READ BEFORE FILLING UP!

1. Fill up this form COMPLETELY and CORRECTLY
2. Submit this form together with 2X2 ID picture with plain background and nametag and Copy of Grades
3. Wait for the examination permit to be given indicating your schedule of examination.

Last Name

First Name

Middle Name

Complete Address
Date of Birth Birthplace
Religion Single Married
Civil Status
Sex Male Female Others, specify________________

Citizenship Cellphone Number

Name of Spouse Contact No. of Spouse

FATHER MOTHER
(indicate  after the name if deceased) (indicate  after the name if deceased)
Name
Address
Contact Number
Occupation
Educational Attainment
Guardian’s Name Relationship w/ Guardian
Guardian’s Address
Contact Number No. of Children in the family 1 2 3 4 5 or more

Senior High School General

Year Graduated
(do not Abbreviate) Average

SHS Track and Strand Completed

Last Sem &
College/University Year level
School Year
(for transferees) and Course
Attended
DO NOT FILL UP THIS PORTION
I hereby attest that the above answers are factual about my personal
information which may be checked against original documents and if that OR No.
false information could disqualify me for admission. It is understood that my Date
final acceptance in the college will depend on the requirements and
guidelines imposed by the different colleges relative to the degree program Issued by
I intend to take.
Date of Examination
Signature:______________________ Date:_________________________ Time of Examination

PANGASINAN STATE UNIVERSITY

VISION MISSION
To become an The Pangasinan State University through
ASEAN Premier instruction, research, extension and
State University in production commits to develop highly
2020. principled, morally upright innovative and
globally competent individuals capable of
meeting the needs of the industry, public
service and civil society.
CORE VALUES
Accountability and Transparency
Credibility and Integrity
Competence & Commitment to Achieve
Excellence in Service Delivery
Social & Environmental Responsiveness
Spirituality
QUALITY POLICY
The Pangasinan State University shall be recognized
as a ASEAN premier state university that provides
quality education and satisfactory service delivery
through instruction, research, extension and
production.
We shall commit our expertise and resources to
produce professionals who meet the expectations of
the industry and other interested parties in national
and international community.
We shall continuously improve our operations in
response to the changing environment and in support
of the institution’s strategic direction.
 FM-AA-AGT-01
Rev. 01
01-Jan-2018

Please put a check mark () on the campus you intend to enroll in and rank 3 courses of your choice to enroll using the numbers 1, 2 and 3
(only) with 1 as the top priority
ALAMINOS CITY CAMPUS
BS Business Administration maj. in Operations Management Bachelor of Elementary Education
BS Hospitality Management Bachelor of Secondary Education maj in Mathematics,
Communication Arts - English
BS Information Technology

ASINGAN CAMPUS
BS Business Management maj in Marketing Management
BS Information Technology
Bachelor of Elementary Education maj in General Education
Bachelor of Secondary Education maj in
Mathematics,Communication Arts - English, Physical Science,
TLE
Bachelor of Industrial Technology maj in Automotive Tech.,
Computer and Electronics Tech., Electrical Tech., Food Tech.,
Mechanical Technology, Drafting Tech., Garments Tech.

BAYAMBANG CAMPUS
BS Business Administration BS Nursing
Bachelor in Public Administration Bachelor of Elementary Education maj in Enhanced General
Education, Pre-Elementary Education
AB English Language Bachelor of Secondary Education maj in Biological Science,
Chemistry, Communication Arts - English, Communication Arts
- Filipino, Mathematics, MAPEH, Physical Science, Physics,
BS Information Technology Social Studies, TLE
BINMALEY CAMPUS
BS Fisheries BS Criminology

BS Environmental Science Bachelor of Secondary Education maj in Biological Science,

Fisheries Technology
INFANTA CAMPUS
BS Agriculture Bachelor of Secondary Education maj in Social Studies
Bachelor of Elementary Education

LINGAYEN CAMPUS
AB Economics BS Hospitality Management
AB English Language BS Information Technology
Bachelor in Public Administration BS Nutrition and Dietetics
BS Biology BS Computer Science
BS Mathematics maj in Computer and Information Technology, Pure Bachelor of Secondary Education maj in English, Filipino,
Math, Statistics Physical Science, Social Studies, TLE
Bachelor of Industrial Technology maj in Automotive Tech, Bachelor of Technical Teacher Education maj Automotive Tech,
Ceramics Tech., Civil Tech., Drafting Tech., Electrical Ceramics Tech., Civil Tech., Drafting Tech., Electrical Tech.
Tech. Electronics Tech., Food Service Management, Electronics Tech., Food Service Management, Garments,
Garments, Fashion and Design, Mechanical Tech Fashion and Design, Mechanical Tech

BS Business Administration

SAN CARLOS CITY CAMPUS

BS Agriculture BS Office Administration
BS Business Administration maj in Human Resourse Devt. Bachelor of Elementary Education
BS Hospitality Management BS Information Technology
Bachelor in Secondary Education maj in Filipino, Social Studies,TLE

STA. MARIA CAMPUS

BS Agriculture Bachelor in Elementary Education maj in Enhanced General
Education
BS Agricultural Engineering BS Agri-business Management
Bachelor of Secondary Education maj in English, Mathematics,TLE

URDANETA CAMPUS
BS Architecture BS Information Technology
BS Civil Engineering BS Mathematics maj in Statistics
BS Computer Engineering AB English Language
BS Electrical Engineering Bachelor of Elementary Education
BS Mechanical Engineering Bachelor of Secondary Education maj in Filipino