UNIVERSITY OF SOUTHERN MINDANAO COLLEGE ENTRANCE EXAMINATION (USMCEE) APPLICATION FORM (for SY 2018-2019) Staple one 2”x2” ID picture with name and signature at the back.

NAME: Write your name in CAPITAL LETTERS, one letter per box. FAMILY NAME FIRST NAME MIDDLE NAME Official Receipt Number: (Receipt of your payment of the USMCEE Fee)

USMCEE PERMIT Date of Exam:

Signature: Date:

Time: Venue:

In-charge, Testing Area/Schedule

Priority Program: The following are the degree programs offered at the University of Southern Mindanao requiring USMCEE. Put an X in the box corresponding to the program you prefer most to enrol in. (Choose one ONLY.) USM Main Campus (Kabacan) 1. AB English 2. AB Political Science 3. AB Psychology 4. BA Islamic Studies 5. Bachelor of Elementary Education 6. Bachelor of Library and Infornation System 7. Bachelor of Physical Education 8. Bachelor of Practical Agriculture 9. Bachelor of Secondary Education 10. Bachelor of Technical-Vocational Teacher Education 11. BS Accountancy 12. BS Accounting Technology 13. BS Agricultural and Biosystems Engineering 14. BS Agricultural Business 15. BS Agricultural Economics 16. BS Agriculture 17. BS Biology 18. BS Business Administration USM-UTDC-F01

19. BS Chemistry 20. BS Civil Engineering 21. BS Computer Engineering 22. BS Computer Science 23. BS Criminology 24. BS Development Communication 25. BS Development Management 26. BS Electronics Engineering 27. BS Fisheries 28. BS Food Technology 29. BS Hospitality Management 30. BS Industrial Technology 31. BS Information Systems 32. BS International Relations 33. BS Nursing 34. BS Nutrition and Dietetics 35. BS Tourism Management 36. BS Travel Management 37. BS Veterinary Technology Please turn to next page.

38. Doctor of Veterinary Medicine USM Kidapawan City Campus 39. Bachelor of Technical Teacher Education 40. Bachelor of Technology 41. Bachelor of Industrial Technology 42. Bachelor of Secondary Education 43. BS Mechanical Engineering 44. BS Electrical Engineering 45. BS Industrial Engineering 46. Food Preparation Services Technology* 47. Diploma of Technology* USM Buluan Campus 48. Bachelor of Elementary Education 49. Bachelor of Secondary Education * 3-year program

CELLPHONE NUMBER (If Any) MAILING ADDRESS (Where you want your USMCEE result mailed) Name of Establishment (e.g. name of school, etc.)

Number and Street Subdivision/Village, Brgy. City/Town, Province Postal/ZIP Code SHS TRACK/STRAND. Check the box corresponding to the senior high school you finished or are about to finish. Academic Track Accountancy, Business and Management (ABM) Strand Humanities and Social Sciences (HUMSS) Strand Science, Technology, Engineering and Mathematics (STEM) Strand General Academic Strand Sports Track Arts and Design Track

Technical-Vocational-Livelihood (TVL) Track Home Economics Strand Information and Communications Technology Strand Agri-Fishery Arts Strand Industrial Arts Strand (Not applicable--I finished a non-K+12 high school curriculum)

I hereby affirm that all information supplied herein are complete and accurate. If admitted, I agree to abide by the policies, rules, and regulations of the University of Southern Mindanao. I understand that the university has the option to make use of the data herein given for research purposes as long as they will be treated with utmost confidentiality. Date

Printed name

Signature

REMINDER: Please bring ballpen, well-sharpened pencil, and eraser when you take the USMCEE. For more information regarding USMCEE and admission, please contact: University Guidance Center USM, Kabacan, Cotabato Tel. No. (064) 572-2873 Office of Student Affairs USM, Kabacan, Cotabato Tel. No. (064) 572-2623 avbr2018

For more information regarding USMCEE Results, please contact: University Test Development Center USM, Kabacan, Cotabato Tel. No. (064) 572-2778 Facebook Community Page: https://www.facebook.com/usmcee2012 University Test Development Center