APPLICATION FORM 1X1

Or
Central Mindanao University COLLEGE ADMISSION & SCHOLARSHIP TEST (CMUCAT) 2X2
(Revised 2012)
Application No:_________ Recent Photo
Instruction: PRINT ALL ENTRIES IN THIS APPLICATION FORM
Testing Fee – Php 125.00 (BOR Res. No. 23 s. 2004)

A. APPLICANT
NAME: SEX: ( ) Male
, , . ( ) Female
(Family Name) (First Name) (M.I.)
BIRTH PLACE: BIRTH DATE: AGE: RELIGION: .
HOME ADDRESS: , ,
(Street No.) (Municipality) (Province/City)
SCHOOL ADDRESS:__________________________________________________________________

B. FAMILY
FATHER MOTHER
NAME
EDUCATIONAL ATTAINMENT
OCCUPATION
FAMILY ANNUAL GROSS INCOME
(In pesos)

C. EDUCATION
LEVEL NAME OF SCHOOL YEAR HONORS/ AWARDS
GRADUATED
ELEMENTARY
HIGHSCHOOL
OTHERS (If Transferee)

D. COURSE/S YOU INTEND TO TAKE AT CMU E. HIGH SCHOOL GRADE

CHOSEN COURSE/S ENGLISH
FIRST CHOICE SCIENCE
SECOND CHOICE MATH

`G. APPLICANT’S SIGNATURE H. ACTION TAKEN (To be filled up by the CMUCAT Board)

I hereby certify that the foregoing ( ) APPROVED ( ) DISAPPROVED ( ) PENDING

Information are true and correct.

___________________________________
___________________________________ CMUCAT BOARD
Signature of Student Date:_______________________________
Date:_________________________

NOTE: Subject to revocation if the records upon which the approval is based are found incorrect/invalid

CUT ALONG THIS LINE - - - - - - - - CUT ALONG THIS LINE - - - - - - - - - CUT ALONG THIS LINE - - - - - - - - -

CMUCAT PERMIT
1x1 Present this to the PROCTOR during the exam
Or
2x2
Recent Photo NAME OF EXAMINEE: ___________________________________________
DATE OF TEST : ________________________ TIME ______________
PLACE OF TEST:_________________________________________________

_______________________________
CMUCAT BOARD
Date filed ____________________
Signature: ________________________
Printed Name:_____________________

Note: 1. NO CMUCAT PERMIT: NO EXAM.

2. Wear your high school ID during the exam
3. Testing fee is non-refundable.

(REPRODUCTION OF THIS FORM IS ALLOWED BUT NOT FOR SALE)