Republic of the Philippines

Bicol University
OFFICE OF ADMISSIONS
Legazpi City

APPLICATION FORM
BICOL UNIVERSITY COLLEGE ENTRANCE TEST
(BUCET)
SY 2023-2024

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)
Reference Code: 31972
SUBJECT BEYOND SENIOR HIGH SCHOOL.
Date of Appointment: Sep 30, 2022
CAREFULLY READ THE GENERAL INFORMATION FOR BUCET applicants and the contents Time of Appointment: (8:00AM-12:00PM)
of this form before filling in the required information.
This application is valid only for entrants during the school year indicated above. Permit No.: ____________________________
PRINT ALL ANSWERS. Verified 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 final. Changing of course is strictly not allowed.
COURSE CODE COURSE NAME CAMPUS

1st Choice A-134 BACHELOR OF SCIENCE IN ENTREPRENEURSHIP GC

2nd Choice A-135 BSBA MAJOR IN MICROFINANCE GC

2. PRINT OR TYPE YOUR NAME IN THE FOLLOWING SEQUENCE: Last Name, First Name, Middle Name.
Last Name Check one box only
FLORANDA
3. Sex: Male ✓ Female
First Name 4. Citizenship: ✓ Filipino
FRANCINE
Non-Filipino
Middle Name
ERMINO 5. Religion: ROMAN CATHOLIC

6. PERMANENT HOME ADDRESS

Number and Street P-1, ESTILLER

Subd./Village, Brgy. TABI

City/Town & Province GUBAT, SORSOGON

Postal/Zip Code 4710 Email Address florandafrancine06@gmail.com

Tel./Cell. Phone No.

0970155048

7. Senior High School graduated or graduating from: GUBAT NATIONAL HIGH SCHOOL Expected/date of graduation: 2023
School Address GUBAT, SORSOGON Learner's reference No. 114218100025
8. Junior High School Completed from: GUBAT NATIONAL HIGH SCHOOL
School Address GUBAT, SORSOGON

9. Applicant's Date of Birth: 2005 MARCH 6 10. Civil Status (Check one box only)
Year Month Date ✓ Single Married Other(specify) __________________

11. Applicant's Place of Birth: PEñAFRANCIA

12. Occupation of Father/Guardian: N/A Occupation of Mother/Guardian: HOUSE WIFE

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

✓ Less than P 10,000.00 P 15,001.00 - P 20,000.00 P 30,001.00 - P 40,000.00

P 10,001.00 - P 15,000.00 P 20,001.00 - P 30,000.00 P 40,001.00 - P 50,000.00 above

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 50.00 worth of mailing 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: Effectivity date: July 17, 2018

Powered by TCPDF (www.tcpdf.org)