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

CSPC-F-GUID-08

Guidance Center APPLICATION FOR CAMARINES SUR POLYTECHNIC COLLEGES COLLEGE ENTRANCE TEST (CSPC-CET) SENIOR HIGH SCHOOL

To Students and Parents: This form is only for applicants to CAMARINES SUR POLYTECHNIC COLLEGES ENTRANCE TEST (CSPC-CET). For SHS Grade 12 students only. Carefully read the general information for CSPC-CET and answer all the details being asked as honestly as you 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: GWA:

________

ONLY CORRECT AND COMPLETELY FILLED UP FORMS will be issued an Admission Slip to CSPC-CET. PRINT ALL ENTRIES. 1. What College or University is your first choice? Second? 2. In case you do not qualify for admission, where do you plan to pursue college? (enumerate) 3. Course applied in CSPC: 1st Priority 2nd Priority 4. Reasons why you want to study in CSPC?

Third? Preferred Campus:

_______ 5. Who will spend for your College education? 6. Are you applying for a Scholarship Grant? Specify 7. Do you belong to a household that is or was a beneficiary of 4Ps? _____________________________________________________ 8. NAME:

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 HIGH SCHOOL: ______________________________________________ Expected Date of Graduation: ____________ ADDRESS: _______________________________________________________________________________________________ 13. HONORS/AWARDS RECEIVED: 14. TALENTS AND SKILLS: 15. COMMUNITY INVOLVEMENT/S: 16. ORGANIZATION/S: 17. PARENTS' OCCUPATION: Father: 18. MONTHLY FAMILY INCOME:

Mother:

PHP.Less than 5, 000.00 PHP.10, 00.00 – 14,000.00 PHP.15, 00.00 – 19,000.00

PHP. 20, 00.00 – 24,000.00 PHP. 25, 00.00 – 29,000.00 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. Noted:

Signature of Applicant

Effectivity Date: July 2017

Signature of Parent/Guardian over Printed Name

TO THE SCHOOL PRINCIPAL/REGISTRAR/ADVISER/GUIDANCE COUNSELOR Rev.4

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

CSPC-F-GUID-08

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. God Bless. CERT IFICATION ACADEMIC REPORT

SENIOR HIGH SCHOOL

PERIODICAL RATINGS

SUBJECTS

1ST Grading

GRADE 11 2ND 3RD Grading Grading

4TH Grading

GRADE 12 1ST Grading

GENERAL AVERAGE: This student belongs to the: Upper 10%

Upper 20%

Upper 40%

Lower 50% of the graduating class

CHARACTER ASSESSMENT EXCELLENT VERY GOOD

GOOD

FAIR

POOR

Emotional Stability Conscientiousness Adherence to Rules & Regulations Manner & Conduct Industriousness and Perseverance Social Attributes Comments, which may help the Admission Committee, decide on the application for admission:

I 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.

_______ HS Principal/Registrar’s Signature over Printed Name

School Dry Seal

Date: _____________________________

NOTE TO THE PRINCIPAL/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 Grade 12 graduating students:  Duly accomplished Application Form;  Two (2) copies of 1 ½’ by 1 ½’’ inch pictures w/ blue background;

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 Electrical Engineering (BSEE) BS in Computer Science (BSCS) AB English

  

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

Effectivity Date: July 2017

         

• •

Testing Fee PHP. 50.00; and Testing Fee Receipt from the Cashier’s Office. CSPC Buhi Extension Campus

 BS in Food Service Management (BSFSM)  BS in Office Administration (BSOA)  BS in Mechanical Engineering (BSME) Computer Technician (CT) Electronics Communication & Service Technology (ECST) Bachelor in Technical Teacher Education (BTTE) BS in Entrepreneurial Management (BSEM) BS in Tourism Management (BSTM) BS Math Bachelor of Library & Information System (BLIS)

Rev.4

Bachelor in Office Administration (BSOA) BS in Information Technology (BSIT) Electronics Communication & Service Technology (ECST)

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