VALID PAMANTASAN NG LUNGSOD NG VALENZUELA 

FOR PLV CAT 2019 ONLY 

Application No. 

COLLEGE ADMISSION TEST APPLICATION FORM 

I  declare  under  oath  that  I  personally  accomplished  this  application  form,  and  I  hereby  certify  that  the  information 
given  are  true,  correct,  and  complete statements. Further, I understand that the acceptance and approval of my application for the 
examination is based on the aforestated information. 
I  therefore  agree  that,  in  case  of  post-verication  yields  information  contrary  to what is declared, my application shall 
be disapproved, and my payment will be forfeited. I further agree that any misinterpretation made in this document may cause the 
invalidation of the result of this examination. 
Further,  I  hereby  give  my  consent  to  the  Pamantasan  ng  Lungsod  ng  Valenzuela  that  the  abovementioned  data  may 
form  part  of  its  database that can be used for relevant purposes but may not be limited to proling and research, and especially as 
basis of data-driven decisions of the University. 
Examination Room Assignment / Time: 
INSTRUCTIONS: READ APPLICATION REQUIREMENTS BELOW. DO NOT APPLY IF NOT QUALIFIED. Fill in 
all the required information legibly. DO NOT leave an item blank. 
If item is not applicable, indicate “N/A”. Place “X” mark in appropriate boxes. Only fully accomplished forms will be 
accepted. Credentials led in support of this application will become the property of this institution and will not be 
returned to the applicant. 
A. NAME OF APPLICANT as it appears on the Birth Certicate 
(Place one letter in each box and leave one box blank between names) 
Last Name 
First Name 
Middle Name 
School Address 
E. INTENDED COURSE 
FIRST CHOICE (Course/Major): 

Name Extension 
B. FACTS OF BIRTH 
Citizenship Gender Date of Birth (MM / DD / YYYY) Place of Birth (City, Municipality / Province) 
Male Female 
Father’s Name (Last Name, First Name, Name Extension, Middle Name) Mother’s Maiden Name (Last Name, First 
Name, Name Extension, Middle Name) 
C. CURRENT DEMOGRAPHIC DATA 
Address House / Room / Floor / Block / Lot / Phase No. Street Name Subdivision 
Barangay City / Municipality District 
Zip Code Height (Meters) Weight (Kilos) 1 2 N/A 
E-mail Address 
 Mobile Number Telephone Number D. EDUCATIONAL BACKGROUND 
Name of Last School Attended (Do Not Abbreviate) 
School Classication 
Public Private Other/s: __________ 
UNDERGRADUATE DEGREE PROGRAMS OFFERED 
• COLLEGE OF BUSINESS, ACCOUNTANCY AND PUBLIC ADMINISTRATION 
1. Bachelor of Science in Accountancy (BSA) 2. Bachelor of Science in Business Administration major in Financial 
Management (BSBA-FM) 3. Bachelor of Science in Business Administration 
major in Human Resource Development Management (BSBA-HRDM) 4. Bachelor of Science in Business 
Administration major in Marketing Management (BSBA-MM) 5. Bachelor of Science in Public Administration (BSPA) 
• COLLEGE OF EDUCATION 
1. Bachelor of Elementary Education major in Pre-School Education (BEED) 2. Bachelor of Secondary Education major 
in English (BSED-ENG) 3. Bachelor of Secondary Education major in Filipino (BSED-FIL) 4. Bachelor of Secondary 
Education major in Mathematics (BSED-MATH) 5. Bachelor of Secondary Education major in Biological Science 
(BSED-BIOSCI) 6. Bachelor of Secondary Education major in Physical Science (BSED-PHYSCI) 
• COLLEGE OF ARTS & SCIENCES 
1. Bachelor of Arts in Communication Studies major in Theater Arts (BACS) 2. Bachelor of Science in Psychology (BSP) 
3. Bachelor of Science in Social Work (BSSW) 
• COLLEGE OF ENGINEERING AND INFORMATION TECHNOLOGY 
1. Bachelor of Science in Civil Engineering (BSCE) 2. Bachelor of Science in Electrical Engineering (BSEE) 3. Bachelor of 
Science in Information Technology (BSIT) 
Section Year Graduated (If Applicable) 
Region 
G. REQUIREMENTS EVALUATION (To be accomplished by the PLV Ofce for Admissions) 
APPLICATION REQUIREMENTS 
SECOND CHOICE (Course/Major): 
1. Certied True Copy of Grade 11 (1st and 2nd Semester 
School Year 2017-2018 report card with GWA of 83% and above. 
2.  Certied  True  Copy  of  Grade  12  report  card  for  the  recent  Grading  Period  (School  Year  2018-2019)  with  no  grade 
lower than 80% per subject during the time of application. 
3. Certied True Copy of School ID (Front and Back) 
4. Photocopy of PSA/NSO Birth Certicate 
(Must be a Filipino Citizen) 
5. Proof of Residency (2018 Voter’s Registration Certicate from the 
COMELEC that parent or the applicant is a Registered Voter of Valenzuela). 
6. Sketch of Residence (with Valenzuela City Hall as starting point). 
7. Two (2) recent Passport Size ID Pictures with the following specications: 
• Colored with white background and computerized name (First Name, Middle Initial, Last Name and Extension Name). 
8. Non-Refundable amount of Php 250.00 application and examination fee. 
 Note: Spaces for Printed Name/Signature and Right Thumb Mark of applicant F. DECLARATION 
should be left blank. These shall only be accomplished in the presence of the Requirements Evaluator/Processor. 
Signature over Printed Name of Applicant 
Passport Size ID Picture (3.5 x 4.5 cm) 
Right Thumbmark 
Signature over Printed Name of Requirement’s Evaluator 
THIS FORM IS NOT FOR SALE (Print Only in 8.5 x 13 Bond Paper)