OSAS- QF- 01

Republic of the Philippines ENTRY:

CAVITE STATE UNIVERSITY ____New Student
____Transferee 1x1
GENERAL TRIAS CITY CAMPUS ____ 2nd courser
ID Picture
Town Proper, City of General Trias, Cavite ____ from Branch Campus:

www.cvsu.edu.ph (______________)

APPLICATION FORM FOR ADMISSION

EXAM CONTROL NO: ______________________
Please Indicate Preferred Courses:
BS Psychology BS Psychology BS Psychology
1st choice 2nd choice 3rd choice

Learner’s Reference Number:  STRAND (SHS Grad): _____________

ABM

Name:
____________________________________________________________________________________
Last Name First Name Middle Name
Permanent Address: __________________________________________________________________
_______________________________________________________________Zip Code: ____________
Contact number: _________________________ Email Address: ________________________________
Sex: M F Age: _______ Date of Birth:___________________ Religion: ___________________
Nationality: ____________________ Civil Status: Single Married Others, specify: ___________

FAMILY BACKGROUND
Father Mother Guardian____________________
(Specify relationship)
Full Name: _____________________ ______________________ ___________________________
Contact no: _____________________ ______________________ ___________________________
Occupation: _____________________ ______________________ ___________________________
Number of Sibling/s: ______ Birth Order: Eldest Second Middle Youngest Only Child
Estimated Monthly Family Income: (Please tick the appropriate box)
below -10,000 11,000 – 20,000 21,000 – 30,000 31,000 – 40,000 41,000– 50,000 above 50,000
EDUCATIONAL BACKGROUND
Name of School Address Year Graduated
Elementary ______________________ ______________________ ______________
Senior High School ______________________ ______________________ ______________
Vocational ______________________ ______________________ ______________
College - For Transferees: _________________ ______________________ Course: ____________
For Second Courser: _________________ ______________________ Course: ____________
MEDICAL HISTORY INFORMATION
List any medications you are taking: ________________
Do you have any of the following? Kindly put a check (✓) To be filled up by the OSAS/Guidance Staff
Allergy (specifically, allergic to: __________________)
Date of Exam and time: ______________________
Asthma SUBMITTED REQUIREMENTS
Hypertension
Diabetes □ 2 copies of 1x1 ID Picture
Insomnia □ Short ordinary white folder
Vertigo New Student (SHS, ALS, BEC graduate)
□ Photocopy HS or SHS Form138 / Certificate of ALS
Scoliosis or physical condition, specify: __________ Rating
Others, please specify: _______________________ □ Photocopy Certificate of Good Moral Character
None Transferee / Second Degree taker
□ Photocopy Transcript of Records / Certificate of Grades
□ Photocopy Transfer Credentials / Honorable Dismissal
I hereby certify that all information stated above are true and correct □ Photocopy Certificate of Good Moral Character
as to the best of my knowledge. I hereby give consent for my personal □ Photocopy NBI Clearance
data included in my offer to be processed for the purposes of admission □ Photocopy Interview slip
and enrollment in accordance with Republic Act 10173 – Data Privacy Act Second Degree taker
of 2012. □ Photocopy Transcript of Records
□ Interview slip
______________________________ Assessed by: ________________
Signature over printed name
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 PLEASE ATTACH THE FOLLOWING REQUIREMENTS ON THIS APPLICATION
FORM:
FILIPINO APPLICANTS
MUST: All requirements shall be placed in a short ordinary FOLDER.

Grade 12 Graduate:
1. Certified true copy of Grade 12 Report Card
2. Certified true copy of Certification of Good Moral Character
3. Two copies of 1x1 ID Picture with name tag
TRANSFEREES: Process Flow for
Transferees:
1. Certified true copy of TOR or Certification of grades signed by the Registrar
2. Certified true copy of Honorable Dismissal or Transfer Credentials 1. Submit all these
requirements to
3. Certified true copy of Certification of Good Moral Character Guidance Office and
4. Certified true copy of NBI Clearance(for students who are 18 years old & above) have it checked by
the guidance staff.
or Police Clearance (if the student is 17 years old and below) 2. After getting the
5. Two copies of 1x1 ID Picture with name tag Notice for interview
form from the
Guidance, proceed to
If the applicant* is from the other CvSU Branch Campuses:
College for
* No need to take entrance exam, unless special condition interview/evaluation.
Requirements - 3. If passed, photocopy
1. Certified true copy of TOR or Certification of grades signed by the Registrar the form. If failed, go
2. Certified true copy of Honorable Dismissal or Transfer Credentials back to Guidance
Office.
3. Certified true copy of Certification of Good Moral Character 4. After passing the
4. Two copies of 1x1 ID Picture with name tag College interview,
student may now take
SECOND COURSER: exam
1. Certified true copy of TOR or Certification of grades signed by the Registrar
2. Two copies of 1x1 ID Picture with name tag

Process Flow for Foreign

FOREIGN APPLICANTS- Applicants:
Certified true copy of the following (items 1-6):
1. Foreign applicants must
1. Approved permit to study from the concerned embassy proceed first to the
2. Report Card or Transcript of Records from High School last attended Registrar’s Office for initial
evaluation of requirements.
3. Police Clearance Certificate issued by the National Police Authorities 2. Registrar office shall issue a
from the applicant’s country of origin or/and NBI Clearance simple note that they have
4. Affidavit of financial support duly authenticated by checked their requirements
and allow the Guidance office
the Philippine Foreign Service Post to process the applicant’s
5. Certificate of English Proficiency (as necessary) examination
6. Certification of Good Moral Character
7. Two copies of 1x1 ID Picture with name tag

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