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

CSPC-F-GUID-03

Guidance Center APPLICATION FOR CAMARINES SUR POLYTECHNIC COLLEGES COLLEGE ENTRANCE TEST (CSPC-CET for Transferee and HS Graduate Only) To Students and Parents: This form is only for applicants to CAMARINES SUR POLYTECHNIC COLLEGES ENTRANCE TEST (CSPC-CET). For High School Graduates and Transferees only. Carefully read the general information for CSPC-CET and answer all the details being asked as honestly as possible.

1.5” x 1.5” Colored Picture (Your most recent Picture). Computer generated picture is not accepted

Examinee Number: Testing Fee: PHP. 50. 00 O.R. Number: Recorded by: GPA:

ONLY CORRECT AND COMPLETELY FILLED UP FORMS will be issued an Admit to CSPC-CET Permit. PRINT ALL ENTRIES. 1. Reason/s for leaving your school 2. What College or University do you plan to pursue your studies? 1st Choice 2nd 3rd 3. In case you do not qualify for admission, where do you plan to pursue your studies?(enumerate) 4. Course applied in CSPC: 1st Priority 2nd Priority Preferred Campus: 5. Reasons why you want to study in CSPC? 6. Who will spend for your College Education? 7. Are you applying for a Scholarship Grant? 8. NAME:

Specify

Last Name: First Name: Middle Name: 9. SEX:

Male Female

10. DATE OF BIRTH AGE

: :

CITIZENSHIP: Others:

Filipino

Religion:

PLACE OF BIRTH:

11. PERMANENT HOME ADDRESS: Number and Street: Subdivision/Brgy: City/Town and Province: Zip Code Contact number: 12. NAME OF PREVIOUS SCHOOL: ___________________________________________Course and Year: ADDRESS: _______________________________________________________ SY last attended: 13. HONORS / AWARDS RECEIVED: _________ 14. TALENTS AND SKILLS: _________ 15. COMMUNITY INVOLVEMENT/S: ________ 16. ORGANIZATION/S: ___________ 17. PARENTS' OCCUPATION: Father: __________ Mother: 18. MONTHLY FAMILY INCOME: PHP. Less than 5, 000.00 PHP. 20, 00.00 – 24,000.00 PHP. 10, 00.00 – 14,000.00 PHP. 25, 00.00 – 29,000.00 PHP. 15, 00.00 – 19,000.00 PHP. 30, 00.00 – and above

CERTIFICATION I HEREBY DECLARE THAT ALL THE FOREGOING INFORMATION PROVIDED BY ME ARE TRUE AND CORRECT AND THAT I SHALL ABIDE BY THE POLICY GUIDELINES GOVERNING ADMISSION IN CSPC. I FURTHER CERTIFY THAT IF ANY OF THE INFORMATION INDICATED HEREIN IS NOT TRUE AND CORRECT MY APPLICATION FOR ADMISSION CAMARINES SUR POLYTECHNIC COLLEGES WILL BE NULL AND VOID AND THAT CSPC IS NOT IN ANYWAY RESPONSIBLE FOR MY MISREPRESENTATIONS I HAVE DECLARED.

Signature of Applicant

Signature of Parent/Guardian over Printed Name

(This application form is not for sale! Effectivity Date: September 2016

This application form is not for sale!) Rev.2

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

CSPC-F-GUID-03

TO THE COLLEGE DEAN/REGISTRAR/ADVISER/GUIDANCE COUNSELOR: The bearer is presently applying for Admission in CSPC for School Year . In this regard, may we ask for your assistance to fill up the necessary information needed in assessing the student. Thank you very much and God Bless.

ACADEMIC PERFORMANCE GRADE POINT AVERAGE: This student belongs to the:

Upper 10%

Upper 20%

Upper 40%

CHARACTER ASSESSMENT EXCELLENT VERY GOOD

Lower 50% of the graduating class

GOOD

FAIR

POOR

Emotional Stability Conscientiousness Adherence to Rules & Regulations Manner & Conduct Industriousness and Perseverance Social Attributes

CERTIFICATION WE HEREBY CERTIFY AS TO THE COMPLETENESS AND CORRECTNESS OF THE FOREGOING RECORD AND THAT ANY ERASURE OR ALTERATION MADE IN THE ACADEMIC RECORDS ABOVE RENDERS THE WHOLE ACADEMIC RECORDS INVALID. APPEARING HERE IS THE SCHOOL DRY SEAL.

____ HS Principal/Dean/Registrar’s Signature over Printed Name Date: _______________________________

NOTE TO THE COLLEGE DEAN/REGISTRAR/ADVISER/GUIDANCE COUNSELOR: Please place this Admission Application on a sealed mailing envelope and affix your signature outside for confidentiality. Thank you. REQUIREMENTS FOR TRANSFEREES:  Duly accomplished Application Form;  One (1) copy of 1 1/2 by 1 1/2 inch picture w/ blue background;  Testing Fee PHP. 50.00; and  Testing Fee Receipt from the Cashier’s Office.

COURSES OFFERED: CSPC Nabua Campus   

    

BS in Nursing (BSN) BS in Information Technology (BSIT) BS in Electronics Engineering (BSECE) BS in Civil Engineering (BSCE) BS in Mechanical Engineering (BSME) BS in Electrical Engineering (BSEE) BS in Tourism Management (BSTM) AB English

       

CSPC Buhi Extension Campus

BS in Food Service Management (BSFSM) BS in Office Administration (BSOA) BS in Computer Science (BSCS) Computer Technician (CT) Electronics Communication & Service Technology (ECST) Bachelor in Technical Teacher Education (BTTE) BS in Entrepreneurial Management (BSEM) BS Math

  

Electronics Comm. & Service Tech. (ECST) BS in Information Technology (BSIT) BS in Office Administration (BSOA)

GRADUATE PROGRAMS   

Master of Arts in Nursing (MAN) Master in Engineering (ME) Master in Business Management (MBM)

(This application form is not for sale! Effectivity Date: September 2016

This application form is not for sale!) Rev.2

Page: 2 of 2