THIS FORM IS NOT FOR SALE.

REPRODUCTION IS ALLOWED

TARLAC STATE UNIVERSITY

ADMISSION AND REGISTRATION OFFICE
ora@tsu.edu.ph / www.tsu.edu.ph
(045) 606-8182
2 x 2 picture
taken within the
APPLICATION FORM FOR COLLEGE ENROLLMENT last six months

STUDENT NUMBER: TSU-CAT RATING:

COURSE & MAJOR:

Example: "BS Business Administration major in FM", or "BSBA-FM"
PERSONAL INFORMATION

LAST NAME FIRST NAME MIDDLE NAME (Jr./I/II/III)

DATE OF BIRTH: PLACE OF BIRTH:
Month Day Year City / Town / Province

SEX: FEMALE MALE CIVIL STATUS: SINGLE MARRIED WIDOW/ER RELIGION:

CITIZENSHIP: CONTACT: EMAIL ADDRESS:

PERMANENT ADDRESS: POSTAL CODE:

FAMILY BACKGROUND
FATHER MOTHER GUARDIAN IN CASE OF EMERGENCY

CONTACT PERSON

OCCUPATION OCCUPATION RELATIONSHIP

COMPANY COMPANY ADDRESS ADDRESS

COMPANY ADDRESS COMPANY ADDRESS CONTACT NUMBER TELEPHONE NUMBER

HOME ADDRESS HOME ADDRESS EMAIL ADDRESS

CONTACT NUMBER CONTACT NUMBER OCCUPATION MOBILE PHONE NUMBER

COMPANY

EDUCATIONAL BACKGROUND
JUNIOR HIGH SCHOOL NAME: (Do not Abbreviate) SENIOR HIGH SCHOOL TRACK: Member of Cultural Minority Group? __ No
__ Yes (Specify CMG & attach certification from NCIP)
SHS NAME:

Do you have any physical disability or condition

SCHOOL ADDRESS (Barangay, City/Town, Province) SCHOOL ADDRESS (Barangay, City/Town, Province) that requires special attention? __ No
__ Yes (Specify / attach certification of Disability)

INCLUSIVE DATES: INCLUSIVE DATES:

Have you attended Technical / Vocational Course? NO YES (Where)

AVERAGE FAMILY INCOME
(Monthly) please check one 100,001 - above 100,000 - 50,001 50,000 - 40,001 40,000 - 30,001 30,000 - 20,001 20,000 - 10,001 10,000 - below

UNIVERSITY REGISTRAR Date:

TSU, San Vicente, Tarlac City

Madam:
I have the honor to apply for enrollment in the College of ___________________________ with the course _____________________________
major in __________________________ at the Tarlac State University, Tarlac City.

FOR COLLEGE FRESHMEN

(Be advised to keep Photocopies of the following Documents)
Report Card Form 138 / Alternative Learning System (ALS) (Original Copy)
Authenticated PSA Birth Certificate (Photocopy)
Certificate of Good Moral Character (Original Copy)
2 pcs. 2x2 colored pictures with name tag (taken within the last six months)
1 pc. Self-Stamped Mailing Envelope (at the Post Office)
NOTE: Refusal to take this pledge or violation of stated terms and conditions shall be
Accomplished Application Form for College Enrollment
sufficient cause for denial of admissions or non-acceptance in the University.

In consideration of my admission to Tarlac State University and all the privileges of students in this institution I hereby pledge to abide and comply
with all the rules and regulations set by competent authorities in this University. Furthermore, I bind myself with all the present and future
requirements of the curriculum I am enrolled in as prescribed by the institution.

Verified true and correct:

Head, Admission Unit Signature Over Printed Name of Applicant

Form No.: TSU-REG-SF-41 Revision No.: 00 Effectivity Date: October 1, 2020 Page 1 of 1