Bicol Univeristy

OFFICE OF ADMISSIONS
Legazpi City

APPLICATION FORM Staple/Paste

BICOL UNIVERSITY COLLEGE ENTRANCE TEST 2pcs.
(BUCET) 2x2 photo
SY 2020 - 2021 (recent)

Instructions to Students and Parents: Application Form No. ____________

THIS FORM IS ONLY FOR APPLICANTS WHO HAVE NOT ENROLLED IN ANY COURSE/ Application & Testing Fee: P 250.00 (free)
SUBJECT BEYOND SENIOR HIGH SCHOOL. Reference Code: 01188
CAREFULLY READ THE GENERAL INFORMATION FOR BUCET applicants and the contents Queue Date: Aug 22, 2019
of this form before lling in the information asked. Queue Time: (1:00PM-5:00PM)
ONLY CORRECTLY AND COMPLETELY FILLED OUT FORMS will be issued a TEST PERMIT.
This application is valid only for entrants during the school year indicated above. Permit No. ___________________________
PRINT ALL ANSWERS. Veri ed by: ___________________________

1. Intended Course. Print your Course Choice and CODE number on the box provided below. Please refer to the BUCET GENERAL INFORMATION on
College Freshmen Admission. Course indicated in this form are nal. Changing of course is strictly not allowed.
COURSE CODE COURSE NAME CAMPUS

1st Choice A-23 B Secondary Education CE

2nd Choice A-32 AB Communication CAL

2. PRINT OR TYPE YOUR NAME IN THE FOLLOWING SEQUENCE: Last Name, First Name, Middle Name. Place one letter in each box.
Check one box only:
Last Name BACARON
3. SEX Male
✓ Female
First Name ANGELA 4. CITIZENSHIP: ✓ Filipino

Non-Filipino
Middle Name URNA
5. RELIGION: ROMAN CATHOLIC
6. PERMANENT HOME ADDRESS

Number and Street PUROK 2

Subd./Village, Brgy. NUSERY

City/Town & Province MASBATE CITY, MASBATE

Postal/Zip Code 5400 Email Address gelaybacaron2002@yahoo.com

Tel./Cell. Phone No. 09103738081

MASBATE NATIONAL COMPREHENSIVE HIGH

Expected/date of graduation 2020
7. Senior High School graduated or graduating from: SCHOOL
School Address MASBATE CITY, MASBATE Learner's Reference No. 113682070012
8. Junior High School Completed from MASBATE NATIONAL COMPREHENSIVE HIGH SCHOOL
School Address MASBATE CITY, MASBATE
9. Applicant's Date of Birth: 2002 JULY 6 10. Civil Status (Check one box only)
Year Month Date ✓ Single    Married    Other (specify)
11. Applicant's Place of Birth: MASBATE CITY, MASBATE
12. Occupation of Father/Guardian: NONE Occupation of Mother/Guardian: HOUSEWIFE

13. Do you have any PHYSICAL DISABILITY or CONDITION that would make it di cult for you to take a regular test? ✓   No   Yes
(Please attach Certi cation of Disability and Submit to the BUAO).
14. Monthly Family Income:
✓   Less than P 10,999.00 (attach Certi cate of Indigency)   P 15,000.00 - P 20,000.00   P 31,000.00 - P 49,000.00

  P 11,000.00 - P 14,000.00   P 21,000.00 - P 30,000.00   Exceeding P 50,000.00

15. Is your family a member of:

15.1 4 P's   Yes ✓   No 15.2 Indigenous People   Yes ✓   No

APPLICANT'S CERTIFICATION

I HEREBY CERTIFY ON MY HONOR THAT I HAVE UNDERSTOOD THE HEREIN INSTRUCTIONS AND THAT ALL THE INFORMATION HEREIN
CONTAINED IS TRUE AND CORRECT. FURTHER, I ATTEST THAT I HAVE NOT ENROLLED IN ANY COLLEGE COURSE/SUBJECT BEYOND SENIOR
HIGH SCHOOL, OTHERWISE MY APPLICATION FOR ENTRANCE IN BICOL UNIVERSITY WILL BE RENDERED INVALID.

Signature of Applicant Signature of Parent/Guardian over Printed Name

NOTE: Please submit P 45.00 worth of stamps and (1) long window envelope, for mailing your BUCET Result.

BU-F-ADMISSION-29 Not for Sale. Reproduction is allowed. Rev. 1

Effectivity date: July 17, 2018 Page 1 of 2