Bicol Univeristy

OFFICE OF ADMISSIONS
Legazpi City
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1pc.
PERSONAL INFORMATION SHEET
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BICOL UNIVERSITY COLLEGE ENTRANCE with nametag
SCORING SYSTEM (BUCESS)
SY 2021 - 2022
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: 11624
CAREFULLY READ THE GENERAL INFORMATION FOR BUCESS applicants and the Date of Appointment: Mar 10, 2021
contents Time of Appointment: (1:00PM-5:00PM)
of this form before 摌�lling in the information asked.
This application is valid only for entrants during the school year indicated above. Permit No. ___________________________
PRINT ALL ANSWERS. Veri摌�ed by: ___________________________

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

Course Choice A-41 BS Nursing CN

SHS Track HUMSS

2. PRINT OR TYPE YOUR NAME IN THE FOLLOWING SEQUENCE: Last Name, First Name, Middle Name.
Check one box only:
Last Name HEJI
3. SEX Male ✓ Female
First Name JULIE ANNE ✓ Filipino
4. CITIZENSHIP:

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

Number and Street P-5, ML. QUEZON ST.

Subd./Village, Brgy. SAN AGUSTIN

City/Town & Province IROSIN, SORSOGON

Postal/Zip Code 4707 Email Address 77julieanne@gmail.com

Tel./Cell. Phone No. 09072741845

7. Senior High School graduated or graduating from: GALLANOSA NATIONAL HIGHSCHOOL Expected/date of graduation 2021
School Address IROSIN, SORSOGON Learner's Reference No. 114235080261
8. Junior High School Completed from GALLANOSA NATIONAL HIGHSCHOOL
School Address IROSIN, SORSOGON
9. Applicant's Date of Birth: 2002 JULY 7 10. Civil Status (Check one box only)
Year Month Date ✓ Single   
Married    Other (specify)
11. Applicant's Place of Birth: IROSIN DISTRICT HOSPITAL

12. Occupation of Father/Guardian: BJMP OFFICER Occupation of Mother/Guardian: HOUSEWIFE

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

  Less than P 10,999.00 (attach Certi摌�cate of Indigency)   P 15,000.00 - P 20,999.00   P 31,000.00 - P 49,999.00

  P 11,000.00 - P 14,999.00 ✓   P 21,000.00 - P 30,999.00   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 BUCESS Result.

BU-F-ADMISSION-29 Not for Sale. Reproduction is allowed. Rev. 2

Effectivity date: January 11, 2021