OSAS-QF-01

Republic of the Philippines

Entry:
CAVITE STATE UNIVERSITY ____ New Student
Carmona Campus ____ Transferee
1x1
Market Road, Carmona, Cavite ____ 2nd Courser
 (046) 430-3509/cvsu.carmonacampus@gmail.com
____ from Branch Campus ID Picture
(___________________)
www.cvsu.edu.ph

APPLICATION FORM FOR ADMISSION EXAM CONTROL NO: _________________

Please Indicate Preferred Courses:

1st choice 2nd choice 3rd choice

Learner’s Reference Number: STRAND (SHS GRAD) ___________________
NAME:
_____________________________________________________________________________________
Last Name First Name Middle Name
Permanent Address: _____________________________________________________________________________
Current Address: ________________________________________________________________________________
Contact number: ___________________________ Email Address: ________________________________________
Sex: Male Female Age: _______ Date of Birth: ____________ Religion: ____________________________
Nationality: ____________________ Civil Status: Single Married, name of spouse: _____________________
FAMILY BACKGROUND
Father Mother Guardian_____________________
(Specify relationship)
Full Name: ________________________ ______________________ _________________________
Contact no: ________________________ ______________________ _________________________
Occupation: ________________________ _______________________ _________________________
Number of Sibling/s: ______ Birth Order: Eldest Second Middle Youngest Only Child
Estimated Monthly Family Income: (Please tick the appropriate box)
below -10,000 11,000 – 20,000 21,000 – 30,000 31,000 – 40,000 41,000– 50,000 above 50,000
EDUCATIONAL BACKGROUND
Name of School Address Year Graduated
Elementary ____________________ ___________________________ ______________
Secondary ____________________ ___________________________ ______________
Senior High ____________________ ___________________________ ______________
College for Transferees ____________________ ___________________________ Course: ____________
For Second Courser: ______________________ __________________________ Course: ____________

MEDICAL HISTORY INFORMATION

To be filled up by the OSAS/Guidance Staff
List any medications you are taking: __________________ Date of Exam and time ___________________________
Do you have any of the following? Kindly put a check (✓) *****SUBMITTED REQUIREMENTS*****
Allergy (specifically, allergic to: __________________)
Asthma □ two copies 1x1 ID Picture
Hypertension □ short ordinary white folder
Diabetes New Student (SHS, ALS, BEC graduate)
Insomnia □ Photocopy of HS or SHS Form138 / Certificate of ALS
Vertigo Rating
Scoliosis or physical condition, specify: _____________ □ Photocopy of Certificate of Good Moral Character
Others, please specify: __________________________ Transferee/ Second Degree Taker
None □ Photocopy of Transcript of Records/ Copy of Grades
□ Photocopy Transfer Credentials/ Honorable Dismissal
□ Photocopy of Certificate of Good Moral Character
□ Photocopy of NBI Clearance/Police Clearance
I hereby attest that all information stated above is true Second Degree Taker
and correct. □ Photocopy of Transcript of Records
□ Photocopy of Certificate of Good Moral Character
______________________________ □ Photocopy of NBI Clearance
Signature over printed name
Assessed by: ________________

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 OSAS-QF-01

PLEASE ATTACH THE FOLLOWING REQUIREMENTS ON THIS APPLICATION FORM:

MUST: All requirements shall be placed in a Long Folder and Long Brown Envelope
SHS GRADUATE/ ALS GRADUATE
1. Certified True Copy of High School Report Card (with LRN for SHS)/Certificate of ALS Rating
2. Certified True Copy of Certificate of Good Moral Character
3. Two copies 1x1 recent ID Picture with name tag and white background

TRANSFEREES
1. Certified True Copy of TOR or Certificate of Grades signed by the Registrar
2. Certified True Copy of Transfer Credentials or Honorable Dismissal
3. Certified True Copy of Certificate of Good Moral Character
4. Photocopy of NBI Clearance (for 18 years old and above) or Police Clearance (for 17 years old and
below)
5. Two copies 1x1 recent ID Picture with name tag and white background

If from other Branch Campuses

*No need to take entrance examination, unless special condition.
1. Photocopy of TOR or Certificate of Grades signed by the Registrar
2. Photocopy of Transfer Credentials or Honorable Dismissal
3. Photocopy of Certificate of Good Moral Character
4. Two copies 1x1 recent ID Picture with white background

SECOND COURSER
1. Photocopy of TOR or Certificate of Grades signed by the Registrar
2. Two copies 1x1 recent ID Picture with white background

UNDERGRADUATE PROGRAMS
- Bachelor of Secondary Education (BSE) – For HUMSS, GAS and STEM
Mathematics
English
Science
- Bachelor of Science in Industrial Technology (BSIndT) – For TVL (Related specialization), STEM and
GAS
Electronics Technology
- BS Business Management (BSBM) – For ABM and STEM
Marketing
Human Resource Management

- BS Hospitality Management (BSHM) – For ABM and TVL (Related specialization)

- BS Computer Engineering (BSCpE) – For STEM
- BS Computer Science (BSCS) – For STEM and TVL (Related specialization)
- BS Information Technology (BSIT) – For TVL (Related specialization)

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