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: 17628

CAREFULLY READ THE GENERAL INFORMATION FOR BUCET applicants and the contents Queue Date: Sep 16, 2019

of this form before lling 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. VeriVed 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 nal. Changing of course is strictly not allowed.

COURSE CODE COURSE NAME CAMPUS

1st Choice A-73 BS Electrical Engineering CENG

2nd Choice A-144 BS Computer Engineering PC

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 GERALD

3. SEX ✓ Male Female

First Name LEGISNIANA ✓

4. CITIZENSHIP: Filipino

Non-Filipino
Middle Name

5. RELIGION: ROMAN CATHOLIC

6. PERMANENT HOME ADDRESS

Number and Street PUROK 1

Subd./Village, Brgy. BRGY. MULADBUCAD PEQUEñO

City/Town & Province GUINOBATAN, ALBAY

Postal/Zip Code 4503 Email Address legesniana.gerald@gmail.com

Tel./Cell. Phone No. 09755068018

7. Senior High School graduated or graduating from: MASARAWAG NATIONAL HIGH SCHOOL Expected/date of graduation 2020

School Address GUINOBATAN, ALBAY Learner's Reference No. 1008772120276

8. Junior High School Completed from GUMACANATIONAL HIGH SCHOOL

 School Address GUMACA, QUEZON

9. Applicant's Date of Birth: 2000 MARCH 13 10. Civil Status (Check one box only)

Year Month Date ✓

Single Married Other (specify)

11. Applicant's Place of Birth:BRGY.MULADBUCAD PEQUEñO,GUINOBATAN,ALBAY

12. Occupation of Father/Guardian: DECEASED Occupation of Mother/Guardian: HOUSE WIFE

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

Less than P 10,999.00 (attach Certi cate 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