OSA- CQE Form A This form may be reproduced, but not for sale

Benguet State University College Qualifying Examination

Office of Student Affairs (BSU-CQE)
La Trinidad, Benguet
(074) 422 2043
Application Form

To the Student: Read and understand the instructions on this form. Carefully fill-out the information needed.
Please type or print in CAPITAL LETTERS. Avoid making erasures on the page.
This form is for students who have not taken the BSU- College Qualifying Examination before.

Instructions in Filling-out this Application Form

1. This Application Form is for:
a. Students who are currently enrolled in their Senior Year (4th Year) in any DepEd recognized secondary school;
b. Students who have graduated from high school but have not enrolled in any tertiary level school;
c. Students who enrolled in any tertiary level school, but wish to transfer to Benguet State University.
If you have already taken the College Qualifying Examination at Benguet State University, the results of your examination are valid for 2
years, thus you are not required to apply for examination. Please visit the BSU-Office of Student Affairs for further instructions.
2. Fill-out Part A, Personal Information and Part B, Course Preference. Print or type your entries in CAPITAL LETTERS. Avoid making
erasures and do not superimpose entries. Staple 1 pc. 2x2 ID picture with white background and no obstructing facial features.
3. Submit this Application Form with the following requirements:
a. For currently enrolled high school students
i. Certificate of enrollment from the high school principal and Testing fee receipt of Php 100.00 from the BSU-Cashiers’ Office.
b. For high school graduates who have not enrolled in any tertiary level school.
i. Photocopy of HS Form 138 (High School Report Card) &Testing fee receipt of Php 100.00 from the BSU-Cashiers’ Office.
c. For students who wish to transfer to Benguet State University
i. Photocopy of the Official Transcript of Records and Testing fee receipt of Php 100.00 from the BSU-Cashiers’ Office.
4. Requirements become the property of the University once submitted. Applicants can not retrieve requirements once submitted
IMPORTANT: Pay the Testing Fee first at the BSU-Cashiers Office, Administration Building before proceeding to the Office of Student
Affairs. Only applications with complete requirements will be issued a Test Permit
5. Submit your application in either of the following procedures:
Group Filing Individual Filing
(recommended for currently enrolled high school students) (recommended for high school graduates & transferees)
• Students submit all requirements to their school guidance counselor, • Attach the required certificate or copy of Form 138 or OTR
class adviser or any appointed representative of the school. • Pay the Php. 100 Testing Fee at the BSU-Cashier’s Office
• Pay the total Testing Fee Amount at the BSU- Cashier’s Office • Submit all the requirements in the following order:
• Submit requirements for processing. If application is submitted in the o Accomplished Application Form
morning, Test Permits will be released in the afternoon of the same o Certificate Form 138 or OTR for transferees
day. If application is submitted in the afternoon, Test Permits will be o Testing Fee Receipt
issued in the morning of the following business day. • Wait for the Test Permit to be issued to you.
Application period is from August 3, 2009 to October 30, 2009. Processing of application is done at the BSU- Office of Student
Affairs- Testing and Materials Development Unit (OSA-TMDU), 2nd floor Student Center Building. Telefax no; (074) 422 2043, Monday
to Friday 8:00am-5:00pm (No Lunch Break). Due to the volume of applications being processed toward the deadline, it is strongly
encouraged that high school applicants submit their application to their school guidance counselor, class adviser, or any appointed
representative of the high school and to file as a group three weeks before the deadline. Transferees are requested to apply in person at the
onset of the application period to accommodate processing of other documents that may be required by the concerned Colleges.

Part A. Personal Information

STAPLE 1pc. 2x2
Family Name M M M M M M M M M M M M M M m m ID Picture here.

First Name ai M M M M M M M M M M M M M M m m

Middle Name M M M M M M M M M M M M M M m m Do not paste your picture here.

Gender: ____ Birth Date: ____-____-______ Birth Place: ________________________

M/F Month Day Year City/Town & Province

Home Address: ___________________________________________________________

Complete address for mailing the results of your examination.

Name of High School: _______________________________________________________________________________

Complete Name of High School, specify if Main or Annex/ For Transferees: Write the complete name of the last school you have attended

Address of High School: _____________________________________________________________________________

For Transferees: Write the address of the last school you have attended

I will be graduating on: Month _________________Year________ I graduated from High School Last:_________________________
OSA- CQE Form A This form may be reproduced, but not for sale

Part B. Course Preference

The University has three campuses. Courses are listed under the campus where it is offered. Some courses are offered in two or more
campuses, however please take note of the code found beside each course. Assess your course choice wisely, take into account your
interests and abilities. Your examination results will be evaluated according to the course you have indicated in this form. Each course offered has
a cut-off score you need to obtain in order to qualify. If your examination result does not qualify you to the course you want, you may choose other
courses. However, your examination result will be re-evaluated according to the cut-off score of your next choice of course and the availability of the
slot in that course.

Undergraduate courses offered in Benguet State University

Course Course Name

Complete Name of Course Campus
Code Abbreviation
101 BSA Bachelor of Science in Agriculture Main Campus
102 BSAB Bachelor of Science in Agri-business Main Campus
103 BSDC Bachelor of Science in Development Communication Main Campus
104 BSAS Bachelor of Science in Applied Statistics Main Campus
105 BSES Bachelor of Science in Environmental Science Main Campus
106 BSIT Bachelor of Science in Information Technology Main Campus
107 BSAEng’g Bachelor of Science in Agricultural Engineering Main Campus
108 BSF Bachelor of Science in Forestry Main Campus
109 BSET Bachelor of Science in Entrepreneurial Technology Main Campus
110 BSHE Bachelor of Science in Home Economics Main Campus
111 BSND Bachelor of Science in Nutrition and Dietetics Main Campus
112 BSN Bachelor of Science in Nursing Main Campus
113 BEE Bachelor of Elementary Education Main Campus
114 BSE Bachelor of Secondary Education Main Campus
115 BLIS Bachelor of Library and Information Science Main Campus
116 DVM Doctor of Veterinary Medicine Main Campus
201 BEE (Bokod) Bachelor of Elementary Education Bokod Campus
202 BSIE (Bokod) Bachelor of Science in Industrial Education Bokod Campus
203 BSInT (Bokod) Bachelor of Science in Industrial Technology Bokod Campus
301 BEE (Buguias) Bachelor of Elementary Education Buguias Campus
302 BSE (Buguias) Bachelor of Secondary Education Buguias Campus
303 BSIE (Buguias) Bachelor of Science in Industrial Education Buguias Campus

Testing Schedule for the BSU-College Qualifying Examination

Date of Examination Province/Municipality/City Venue of Examination

November 7, 2009 La Trinidad High Schools Main Campus
November 8, 2009 Baguio City High Schools Main Campus
November 14, 2009 Atok and Tublay High Schools Main Campus
November 15, 2009 Bakun, Kapangan, Kibungan, Itogon, & Sablan High Schools Main Campus
November 21, 2009 Buguias and Mankayan High Schools BSU-Buguias Campus
November 22, 2009 Mt. Province High Schools Mt. Prov. Gen. Comprehensive HS
November 28, 2009 Bokod and Kabayan High Schools BSU- Bokod Campus
November 29, 2009 Tuba and other High Schools Main Campus
December 5, 2009 Late applicants/ re-scheduled examinees Main Campus

FIRST CHOICE
Course Code Abbrev. Complete Name of Course Campus

(Example: 101 BSA Bachelor of Science in Agriculture Main )

SECOND CHOICE
Write your second choice of course. This will help us evaluate your test result if you do not make it in your primary choice of course. Your score will be re-evaluated
and subject to the availability of slots.
Course Code Abbrev. Complete Name of Course Campus

(Example: 114 BSE Bachelor of Secondary Education Buguias )

______________________ __________ _________________________ _________

Student Date or Parent or Legal Guardian Date
(sign over printed name) (sign over printed name)