OSAS- QF- 01

Republic of the Philippines ENTRY:

CAVITE STATE UNIVERSITY ____New Student
____Transferee
Don Severino delas Alas Campus ____ 2nd courser 1x1
Indang, Cavite
____ from Branch
Campus:
ID Picture
(______________)
APPLICATION FORM FOR ADMISSION
CODE NO: ______________________
Please Indicate Preferred Courses:

st nd rd
1 choice 2 choice 3 choice

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

Name:______________________________________________________________________________________
Last Name First Name Middle Name
Permanent Address: __________________________________________________________________________
______________________________________________________________________Zip Code: ____________
Contact number: _______________________________ Email Address: ________________________________
Sex: Male Female 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 _____________________________ ___________________________ ______________
Secondary _____________________________ ___________________________ ______________
Vocational _____________________________ ___________________________ ______________
College - For Transferees: ______________________ ___________________________ Course: ________
For Second Courser: ____________________ ___________________________Course: ____________

MEDICAL HISTORY INFORMATION To be filled up by the OSAS/Guidance Staff

List any medications you are taking: ________________ Date of Exam and time: _______________________________
*****SUBMITTED REQUIREMENTS*****
Do you have any of the following? Kindly put a check ()
New Student Transferee
Allergy (specifically, allergic to: __________________) □ OR# _____________ □ HS Form138 □ TOR/COG
Asthma □ ID Picture □ Transfer Credentials
□ CGM □ NBI/Police Clearance
Hypertension □ Drug test result (if BS CRIM)
Diabetes Assessed by: ________________
Insomnia
nd
Vertigo Processing of Admission for: □ New student □ 2 Courser □Transferee
□ from Branch
Scoliosis or physical condition, specify: _____________ 1. Submission of requirements
Others, please specify: ___________________ □ completed □ with pending
nd
2. Interview with College (BSHM/TM, transferees and 2 coursers)
None □ passed □ redirected to ______________
nd
□ passed the 2 interview
I hereby attest that all information stated above is true 3. Entrance Exam
and correct. □ Qualified □ CWOBE
□ Final course: _____________________________
4. Release of NOA
______________________________ □ Date released: ____________________________
Signature over printed name
V01-2018-05-28
 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 /HIGH SCHOOL GRADUATE:

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

SECOND COURSER:
1. Photocopy of TOR or Certification of grades signed by the Registrar
2. Two copies of 1x1 ID Picture

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

V01-2018-05-28