Republic of the Philippines

DR. EMILIO B. E SPINOSA SR. MEMORIAL

STATE COLLEGE OF AGRICULTURE AND TECHNOLOGY
Admission and Registration Office Attach recent 2x2 photo with
www.debesmscat.edu.ph | Cabitan, Mandaon, Masbate white background and
nametag

APPLICATION FOR ADMISSION FORM

(For New and Transferee Student Applicant)

GENERAL INSTRUCTIONS: This form is for New (Grade 12 (Senior High School) Graduate and Graduating) and
Transferee Student Applicant from both public and private secondary high schools and CHED recognized private
and public Higher Education Institutions. Fill - in all the required information accurately. Do not abbreviate. (This
application for admission Form is valid only for A.Y, 2023– 2024)

I. APPLICANT’S COURSE PREFERENCES (Please refer to the list of Programs Offered at the back of the form)
Name of College Name of Course
First Choice:
Second Choice:
Third Choice:

II. APPLICANT’S PERSONAL INFORMATION Name of Campus

Last Name Main Campus
First Name
Cawayan Campus
Middle Name
Extension Name if there’s any, i.e. Sr., Jr., III

Sex: ___Age: ___Date of Birth: ______________Place of Birth: ______________________Religion: _____________

Civil Status: _______ Nationality: _____________Cellphone No.: _____________ Email Address: _______________

Father’s Complete Name: ________________________ Mother’s Maiden Name (Kumpletong Pangalan at Apelyido
Occupation: ___________________________________ ng Ina sa Pagkadalaga): _____________________________
Occupation: __________________________________
Permanent Address: __________________________ __________________________ __________________________
(House No./ Street) (Sitio/Village/Zone) (Barangay)
__________________________ __________________________ __________________________
(Municipality/City) Province (Zip Code)

III. SCHOOL LAST ATTENDED

(FOR SENIOR HIGH SCHOOL GRADUATE AND GRADUATING STUDENT APPLICANT)

Name of Senior High School Enrolled in/Graduated from: __________________________________________
___________________________________________________________________________________________
School’s Complete Address:
Learners Reference Number (LRN): Senior High School Track/Strand:
Grade 12 General Weighted Average (1st Sem.) _____ Grade 12 General Weighted Average (2nd Sem.) _____
General Weighted Average (1st & 2nd Sem.) _______ Type of School: Private Public
(FOR TRANSFEREE STUDENT APPLICANT)
Name of Previous School/Higher Education Institution (HEI): __________________________________________
___________________________________________________________________________________________
School/HEI Complete Address:
Course Taken:
No. of Units Earned:
No. of Subjects Taken:
General Weighted Average:
Type of School: SUC LUC Private HEI
Reason to Transfer:

IV. OTHER INFORMATON

MONTHLY FAMILY INCOME
Less than 10,000 10,001-15,000 16,000-25,000 26,000-35,000 36,000-49,000 more than 50,000

1. Is your family a member of 4 P’s? Yes No If yes, please indicate your household # _____________
2. Are you a member of any indigenous group? Yes No If yes, please specify ___________________
3. Are you a person with disability? Yes No If yes, please specify your disability _________________
4. Are you a solo parent? Yes No
5. Are you fully vaccinated? Yes No If yes, please indicate your last vaccination date ____________
===================================================================================================
APPLICANT’S CERTIFICATION

I hereby certify that all information provided in this application form is true and correct to the best of my knowledge and
belief. I acknowledge that any inaccurate information included herein invalidates this application.

__________________________________ _______________________________
(Signature over Printed Name of Applicant) (Signature over Printed Name of Parent)
Date: _____________________________ Date: _____________________________

Confidentiality Note: All information provided by the applicant is strictly confidential. The information is intended for personal use of the individual or the entity to whom it is
addressed. Any disclosure, copying, or other use of the information contained herein is strictly prohibited.

FM-ADM-01-a 06 01-30-23
 UNDERGRADUATE PROGRAMS OFFERING

DEBESMSCAT MAIN CAMPUS

COLLEGE OF AGRICULTURE (BOARD PROGRAMS)
COURSE CODE NAME OF COURSE
CA – 01 – BSA Bachelor of Science in Agriculture (BSA)
CA – 02 – BSAB Bachelor of Science in Agribusiness (BSAB)
CA – 03 – BSAF Bachelor of Science in Agroforestry (BSAF)
CA – 04 – BSES Bachelor of Science in Environmental Science (BSES)
COLLEGE OF ARTS AND SCIENCES (NON – BOARD PROGRAMS)
COURSE CODE NAME OF COURSE
CAS – 01 – AB Econ Bachelor of Arts in Economics (AB Econ)
CAS – 02 – BSCS Bachelor of Science in Computer Science (BSCS)
CAS – 03 – BS Entrep. Bachelor of Science in Entrepreneurship (BS Entrep)
CAS – 04 – BSIS Bachelor of Science in Information Systems (BSIS)
CAS – 05 – BPA Bachelor of Public Administration (BPA)
COLLEGE OF ENGINEERING (BOARD PROGRAMS)
COURSE CODE NAME OF COURSE
CENG – 01 – BSABE Bachelor of Science in Agricultural and Bio - Systems Engineering (BSABE)
CENG – 03 – BSCE Bachelor of Science in Civil Engineering (BSCE)
COLLEGE OF EDUCATION (BOARD PROGRAMS)
COURSE CODE NAME OF COURSE
CE – 01 – BEED Bachelor of Elementary Education (BEED)
CE – 02 – BSED ENG Bachelor of Secondary Education, Major in English (BSED - Eng)
CE – 03 – BSED FIL Bachelor of Secondary Education, Major in Filipino (BSED Fil)
CE – 04 – BSED MATH Bachelor of Secondary Education, Major in Mathematics (BSED - Math)
CE – 05 – BSED SCI Bachelor of Secondary Education, Major in Science (BSED Sci)
CE – 06 – BSED SOC STUD Bachelor of Secondary Education, Major in Social Studies (BSED - SocStud)
CE – 07 – BECED Bachelor of Early Childhood Education (BECED)
CE – 08 – BPED Bachelor of Physical Education (BPED)
CE – 09 – BTLED Bachelor of Technology and Livelihood Education (BTLED)
COLLEGE OF INDUSTRIAL TECHNOLOGY (NON-BOARD PROGRAMS)
COURSE CODE NAME OF COURSE
CIT – 01 – BSIT AT Bachelor of Science in Industrial Technology, Major in Automotive Technology (BSIT - AT)
CIT – 02 – BSIT CT Bachelor of Science in Industrial Technology, Major in Civil Technology (BSIT- CT)
CIT – 03 – BSIT ET Bachelor of Science in Industrial Technology, Major in Electrical Technology (BSIT - ET)
CIT – 04 – BSIT ELT Bachelor of Science in Industrial Technology, Major in Electronics Technology (BSIT -ELT)
CIT – 05 – BSIT FT Bachelor of Science in Industrial Technology, Major in Food Technology (BSIT - FT)

DEBESMSCAT CAWAYAN CAMPUS

COURSE CODE NAME OF COURSE
CC – 01 – BSA Bachelor of Science in Agriculture (BSA)
CC – 02 – BEED Bachelor in Elementary Education (BEED)
CC – 03 – BSED ENG Bachelor in Secondary Education, Major in English (BSED Eng.)
CC – 04 – BSIT ELT Bachelor of Science in Industrial Technology, Major in Electronics Technology (BSIT -
ELT)
CC – 05 – BSIT ET Bachelor of Science in Industrial Technology, Major in Electrical Technology (BSIT-
ET)

MASBATE
APPLICATION FOR ADMISSION
REQUIREMENTS FOR GRADE 12
(SENIOR HIGH SCHOOL)
GRADUATING STUDENT APPLICANT
✓ Accomplished Application Form
for Admission
✓ Photocopy of S.F. 9/Form
138/High School Report Card
(Grade 12 -First Semester only)
✓ Accomplished Certification
Form by the Head/Principal as
graduating student
✓ Recent 2x2 I.D. Picture (white
background with nametag)
Note: These requirements are for application for admission purposes only,
and not for enrolment.
APPLICATION FOR ADMISSION
REQUIREMENTS FOR GRADE 12
SENIOR HIGH SCHOOL) GRADUATE
STUDENT APPLICANT
(BEFORE THE SY 2022 – 2023)
✓ Accomplished Application
Form for Admission
✓ Photocopy of S.F. 9/Form
138/High School Report Card
(Grade 12 -First and Second
Semesters)
✓ Recent 2x2 I.D. Picture (white
background with nametag)
APPLICATION FOR ADMISSION
REQUIREMENTS FOR TRANSFEREE
STUDENT APPLICANT
✓ Accomplished Application Form
for Admission
✓ Authenticated photocopy of
Official Transcript of Records
(TOR) or Certification of Grades
from the school last attended
signed by the Registrar
✓ Recent 2x2 I.D. Picture (white
background with nametag)
For more information, please
contact:
The ADMISSION & REGISTRATION
OFFICE
FB Page: Debesmscat - Admission
and Registration Office
CP#: 0981-727-2189
 Republic of the Philippines
DR. EMILIO B. ESPINOSA SR. MEMORIAL
STATE COLLEGE OF AGRICULTURE AND TECHNOLOGY
Admission and Registration Office
www.debesmscat.edu.ph | Cabitan, Mandaon, Masbate

CERTIFICATION AS GRADE 12 GRADUATING STUDENT

Graduating Grade 12 (Senior High School) Applicant only

Date: ___________________

TO WHOM IT MAY CONCERN:

This is to certify that Mr./Ms. ____________________________________________

(Complete Name of Student)
is a bonafide student of _____________________________________________________,
(Complete Name of School)
________________________________________________with LRN No. ________________.
(Complete School Address)

Certifying further that he/she is graduating from Grade 12 (Senior High School)
this Second Semester, AY 2022-2023.

Issued this _________ day of _________________________ 2023 upon request of

Mr./Ms. __________________________________ for his/her Application for College
Admission Purposes Only.

_____________________________________________________________
(Signature over Printed Name of Principal/School Head/Authorized Person)

(This certification form is valid only for A.Y 2023 – 2024).

School dry seal

here.

FM-ADM-38 00 01-30-23