Republic of the Philippines

CAMARINES SUR POLYTECHNIC COLLEGES

Nabua, Camarines Sur

STUDENT TESTING AND ADMISSION

CSPC-F-STA-10

INFORMED CONSENT
ON THE POTENTIAL RISK ASSOCIATED WITH TAKING THE
CAMARINES SUR POLYTECHNIC COLLEGES - COLLEGE ENTRANCE TEST

PLEASE READ THIS DOCUMENT CAREFULLY.

You are given this informed consent form because the Camarines Sur Polytechnic Colleges (CSPC) and the
Office of Student Testing and Admissions encourage your participation in the entrance examination. All known
precautions are taken to safeguard all examinees, but the CSPC cannot guarantee your absolute safety from
any potential source of infection. You are asked to sign this form to signify your consent to participate in the
said activity despite the potential risks.

INFORMATION SHEET

Introduction and Purpose of the Activity

The Student Testing and Admissions office annually conducts its admission process. The CSPC – College
Entrance Test is one of its highlights. The CSPC – CET is an annual entrance examination for the incoming
first year students and transferees who wished to enroll in this institution. The CSPC-CET is designed to
measure students’ skills and mental abilities.

Due to the increasing number of vaccinated communities as well as the resume of the limited Face-to-Face
classes in the campus, the office would like to resume the conduct of in-person CSPC-College Entrance
Test for school year 2023-2024 after two years of suspension due to COVID-19 pandemic.

Procedure

The CSPC are instituting health safety protocols to ensure the safety of all student-applicants, as well as the
CSPC personnel involved in the conduct of the examination. Listed below are the Standard Guidelines on
Strict Health Protocols during entrance examination.

Examinees shall bring and observe the following during the scheduled entrance examination:
1. Vaccination Cards (1st or 2nd dose)
2. If not vaccinated: Negative result of the Reverse Transcription Polymerase Chain Reaction
(RT-PCR) test taken from three (3) to five (5) days prior to the scheduled examination
3. Informed Consent Form (Form A) and Health Declaration Form (Form B) & Health
Surveillance Form (Form C) after examination
4. Face mask
5. 70% ethyl alcohol for regular hand disinfection.
6. Observe physical distancing by maintaining 1-meter distance from one another.
7. Body temperature will be checked using thermal scanner prior to entry at examination
premises. Those with fever, colds or cough are not allowed to take the exams.
8. Examinees are advised to bring their food as they will not be allowed to exit the examination
room during break time.
9. Examinees shall sanitize before entering the examination room, after using the rest room
and before distribution of test questionnaires.

Possible Risks

By participating in the entrance examination, it is possible that you will be exposed to COVID-19. There is, for
example, a chance that you might contract the virus while transporting to the venue. Although reduced in
number with the mandatory minimum distances between examinees, you will still be staying in an enclosed
room together with other examinees for several hours. Nonetheless, we assure you that the CSPC and Office
of Student Testing and Admissions will implement all known safety measures prescribed by the Omnibus

Effectivity Date: December 2022 Rev. 0 Page 1 of 3

 Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

STUDENT TESTING AND ADMISSION

CSPC-F-STA-10
Guidelines of the Inter-Agency Task Force (IATF) and the recommendations of the scientific community to
reduce the possibility of infection.

You still have the responsibility to weigh the risks against the benefits. Your judgment and discernment will
guide you in deciding whether to take the licensure examination or not.

Alternative to Participating in the entrance examination

In the event of failure to take the scheduled entrance examination, (name is already included in the list of
examinees for specific dates), examinees shall be allowed to take the entrance examination rescheduled by
the Admission Staff subject to the following:

1. For those with health-related reasons: The examinee must submit a letter addressed to the
Director of Student Testing and Admissions with a medical certificate;
2. For those applicants who could not take the entrance examination due to unannounced holidays:
The examinees will be rescheduled by the Admission Staff depends on the availability of the dates
of examination.
3. For those applicants who are unable to take the entrance examination due to some valid
reasons: The examinee must submit a letter addressed to the Director of Student Testing and
Admissions stating clearly the valid reason.

Examinees who cannot take the scheduled entrance examination for any reasons other than those stated
above, may submit a request letter addressed to the Director of Student Testing and Admissions to be
rescheduled stating clearly the reasons of their failure to take the entrance examination. The written request
shall be submitted through the official email address of the Student Testing and Admissions Office
(testingandadmission@cspc.edu.ph)

Post Examination Requirement

Fifteen (15) days, after the examination, we require the examinees to submit a post-exam health status
update (Form C) to help the examinees and future conduct of entrance examinations. The form can be
downloaded from the Google Drive link posted on our official Facebook Page (CSPC Student Testing and
Admission) and this can be sent through the official email address of the Student Testing and Admissions
(testingandadmissions@cspc.edu.ph). Please provide the information as accurately as possible.

Agreement to Participate: If you agree to participate in the entrance examination, please indicate so by
signing on the specified space below.

Thank you.

Effectivity Date: December 2022 Rev. 0 Page 2 of 3

 Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

STUDENT TESTING AND ADMISSION

CSPC-F-STA-10

CERTIFICATE OF CONSENT

I, ___________________________________, of legal age, residing at ___________

(Last Name, First Name Middle Name)
___________________________________________ have read and understood the
(Address)
information and the potential health risks explained in this form. Despite such risks, I agree to take
the CSPC – College Entrance Test on ___________________________
(Date of Examination)

to be administered by the CSPC Student Testing and Admissions Office. I do hereby confirm and
declare that I am participating in this event on my own free will and volition.

In relation thereto, I hold CSPC, entirely free from any liability or responsibility in the event that I
contract COVID-19 during the period of the Entrance Examination on
__________________________.
(Date of Examination)

________________________________ ____________________
Name of Examinee and Signature Date

________________________________ ____________________
Name of Witness and Signature Date

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