BSU-OU Form 1

Benguet State University

Open University
La Trinidad, Benguet 2601 www.bsu.edu.ph

2x2 ID Picture

APPLICATION FORM FOR ADMISSION

Your application shall be acted upon only after you submitted all the required documents. The deadline of application is: Last Saturday of May for first semester admission and Last Saturday of September for second semester admission. The requirements are as follows: 1. ". ). /. 0. 7. 8. 9. Certified Photocopy of fficial Transcript of !ecords and Certificate of Transfer Credential from the school that you last attended. Two letters of recommendation from your former professors#employers $for de%ree pro%ram& 'orm "(. 'our copies of your latest identical *+ picture $", - ",( with plain white bac.%round. Permit to Study from the head of your a%ency if employed. Payment of 1pplication 'ee of PhP122 for 'ilipinos and 3S4"0 for forei%n nationals $5on6refundable(. 1n essay of about 022 words indicatin% your purpose for applyin% to the distance education pro%ram and your plan after completin% the de%ree. ri%inal 5S $birth certificate if sin%le& marria%e certificate if married( :alid ;isa for forei%n nationals.

ADMISSION REQUEST: 1. +e%ree Sou%ht $ ( Master in Community +e;elopment $ ( Master in Community <ealth +e;elopment $ ( Master in Cooperati;e Mana%ement $ ( Master in +e;elopment Communication $ ( Master in <uman !esource Mana%ement $ ( Master in 5on6'ormal =ducation $1lternati;e Learnin% Systems( $ ( Master in 3rban Mana%ement $ ( +iploma in Trainin% Mana%ement $ ( +iploma in 3rban Mana%ement $ ( Second Semester $ ( Summer

". Semester for which admission is sou%ht: $ ( 'irst Semester ). State how your studies will be financed: PERSONAL DATA: 1. 5ame: 'amily 5ame ". Mailin% 1ddress: 5umber Street 'irst 5ame

Middle 5ame >ip Code Tel.#CP 5o. /. +ate of ?irth: 7. Aender : $ ( 'emale $ ( Male Country

City#Town Pro;ince

=6mail 1ddress ). Place of ?irth: 0. Citi@enship: 8. Ci;il Status: $ ( Sin%le $ ( Married

$ ( Bidow $ ( +i;orced ( M1#MS in CCCCCCCCCCCCCCCCCCC

9. <i%hest +e%ree Completed: $ ( 1?#?S in CCCCCCCCCCCCCCCCC $ D. Currently enrolled in other school for M1#MS: $ 12. Present ccupation: ( yes $

( noE if yes de%ree course: CCCCCCCCCCCCC 5o. of Years =mployed:

11. 5ame of Present =mployer $*nstitution#Company(: 1". 1ddress of Present =mployer:

ACADEMIC BACKGROUND (Please use additional s eets i! ne"essa#$% T ose a&&l$in' !o# Ce#ti!i"ate and S o#t Cou#ses need not !ill u& ite(s ) to *+ 1. List of schools you attended startin% with the most recent 5ame and 1ddress of School Colle%e: <i%h School: =lementary: 1re you currently enrolled in another colle%e#uni;ersityG CCCC Yes CCC 5o 5ame of School CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC +e%ree CCCCCCCCCCCCCCCCCCCCCCCCC ". List of researches you conducted and published apart from your thesis Title of 1rticle Title of Publication Year Published +e%ree# MaFor 'ield Year Completed

).

List of seminars#conferences that you attended in the last fi;e years. Title of Seminars#Conferences Place Year

/.

List your membership in honor& professional and#or ci;ic or%ani@ations. 5ame of r%ani@ation !ole Year

0.

List of scholarship& honors& pri@es and awards you recei;ed. Title of Seminars#Conferences Place Year

7.

List three persons whom you ha;e requested to recommend you. 5ame and Position 1ddress Contact 5umber

CERTI,ICATION * hereby affirm that all the information supplied herein is complete and accurate& and if admitted& * a%ree to abide by the rules and re%ulations of the pen 3ni;ersity. Si%nature of Student +ate Ad(itted: ( + P#o-ationa#$ ( + Re'ula# CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC +irector +ate $ $ $ $ $ $ !easons why admission is probationary: ( AB1 less than ".22 ( AB1 in =n%lish courses less than ".22 ( 1;era%e ratin% from former professors less than 02H ( Pre;ious de%ree not related to de%ree applied for. ( Bor. e-perience not related to de%ree applied for. ( Poor essay.