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Benguet State University-Admission Test Code:


QF-ADM-01 Number
03

Application Form Effectivity September 27, 2019 Ctrl No.

TO THE STUDENT
Read carefully the BSU-AT Guidelines and Requirements on page 2 before accomplishing this form . STAPLE 3 copies of recent 2” x 2”
ID picture (clear/standard photo)
TYPE OR PRINT LEGIBLY all information needed and then place a check ()mark in the appropriate box.
with white background and name
Only application form accomplished correctly and completely will be processed. tag (Signature over printed name)

ACADEMIC STATUS OF APPLICANT


[ ] Currently enrolled as Grade 12 Student [ ] Transferee
[ ] Senior High School Graduate [ ] Second (2nd) Degree sample
[ ] ALS /PEPT Passer [ ] Others (please specify): ______________

BACKGROUND INFORMATION
Last Name

First Name

Middle Name

Sex: [ ] Male [ ] Female Birth Date (MM/DD/YYYY) : ___/___/______ Age: ______ Civil Status: [ ] Single
Citizenship: [ ] Filipino [ ] Foreign (Specify) _______________ [ ] Dual (Specify) _______________ [ ] Married
Nationality: [ ] Filipino [ ] Foreign (Specify) _______________ [ ] Separated
[ ] Widow/Widower
CONTACT INFORMATION
Permanent Home Address
________________________________________________________________________________________________________________
House No. & Name of Street District/Barangay/Subdivision Municipality (Town)/ City
_____________________________________________________________________________________ Zip code: ____________
Province Country/State
Telephone/ Mobile No. (required): _____________________ Email Address (required): ___________________________________

Last school attended or where you are currently completing Secondary Level Education
Name of School (Please specify if Main or Annex Campus.) : _____________________________________________________________________
Complete Address: ________________________________________________________________________________
Type of School: [ ] Public [ ] Private Learner’s Reference Number (LRN): ___________________
Do you have any PHYSICAL DISABILITY OR CONDITION that requires special attention or would make it difficult for you to
take a regular test? [ ] No [ ] Yes (specify) ______________________________________________________________________

DEGREE PREFERENCE (considering the list of degree programs on page 2, write your preferences below )
Degree Program applying for:
Code Complete Name of Degree Program Campus
Example: BSA Bachelor of Science in Agriculture [ ] La Trinidad [ ] Buguias [ ] Bokod

First Choice

_____________ ____________________________________________________ [ ] La Trinidad [ ] Buguias [ ] Bokod

Second Choice

_____________ ____________________________________________________ [ ] La Trinidad [ ] Buguias [ ] Bokod

ATTESTATION
I affirm that I have read and understood all the instructions contained in this application form and that the information
supplied are true, complete and accurate. I promise to abide by the rules and regulations of Benguet State University regard-
ing the BSU-Admission Test and my possible admission to the University. I am aware that any information I have concealed,
falsely given and/or withheld is enough basis for the disqualification of my application .
Attested by:

____________________________________ ___________ _______________________________________ ____________


Applicant Date Parent or Legal Guardian Date
(signature over printed name) (signature over printed name)

ACKNOWLEDGEMENT SLIP OF TEST PERMIT


To be filled out by the Applicant/ Authorized Representative To be filled out by OSS-SWS-TMDU Personnel

Name of Claimant: ___________________________________________________________


Released on: _________________________
Contact No/s.: _______________________________________________________________
Processed by: _________________________
Claimant’s Signature: ________________________ Date: ______________________

This form may be reproduced but not for sale. 1 of 2


Benguet State University-Admission Test
Application Form

GENERAL GUIDELINES
 The BSU– Admission Test is for applicants who have not taken it for the past two years. If you have taken the examination already but
did not enroll and intend to enroll in the university, please visit the Office of Student Services-Student Wellness Services-Testing and
Materials Development Unit (OSS-SWS-TMDU) for further instructions.
 Submit the accomplished application form and complete requirements to the OSS-SWS-TMDU (Rm. 205, 2nd floor , Student Center
Bldg) for processing.
 Walk-in applicants will not be entertained on the day of the examination.
 Submitted documents in compliance with the admission test requirements shall become the property of BSU and are not to be
returned to the applicant.
 Schedule of the Admission Test will be identified upon filing of the application form.
 Admission of applicants will depend on the admission policy of each College/ Academic Institute especially in terms of grades and

BSU-AT Requirements
Academic Status of Applicant Required Documents
☞ Certificate of Enrollment from the School Registrar/Principal
Currently enrolled Grade 12 ☞ Two (2) certified true copies of Form 138 in Grade 11 and Grade 12 (if applicable) with computed
student expected to graduate General Weighted Average duly signed by the Principal or other authorized school personnel

☞ Two (2) certified true copies of Form 138 in Grade 11 and Grade 12 with computed General
Senior High School graduate Weighted Average duly signed by the Principal or other authorized school personnel

☞ Endorsement Slip duly signed by the Dean/ Director of the College/Academic Institute you intend to
Transferee enroll in BSU (blank forms are available at the OSS-SWS-TMDU)
☞ Two (2) certified copies of True Copy of Grades
☞ Accomplished BSU-AT Application form; Forms may be obtained from BSU-La Trinidad OSS-SWS-TMDU
(Rm. 205, 2nd floor , Student Center Bldg), BSU-Buguias Campus, BSU-Bokod Campus or can be down-
loaded from www.bsu.edu.ph
All Applicants
☞ Three (3) copies of recent 2x2 ID picture (clear/standard photo) with white background and
(other requirements to be
name tag (signature over printed name)
submitted)
☞ Marriage Certificate (for married applicants only whose maiden name is indicated in her Senior High
School Form 137/ True Copy of Grades)
*** No Testing Fee will be collected

The following are the Undergraduate Degree Programs of Benguet State University
REMINDERS: The University has three (3) campuses (La Trinidad, Buguias, Bokod). Degree programs are listed under the campus where it is offered .
Some of the courses are offered in two or more campuses; hence, take note of the campus where you are applying. Assess your degree choice wise-
ly. Your examination result will be evaluated according to your choices of degree programs you have indicated in this form. Each degree program
offered has a cut-off score you need to obtain in order to qualify. If your result does not qualify you on your first preference, you will be evaluated on
your second choice, subject to the availability of slot and the admission policy set by the College/ Academic Institute of your next choice.

LA TRINIDAD Campus
LA TRINIDAD Campus
Code Degree Programs
Code Degree Programs
College of Agriculture (CA)
BSA Bachelor of Science in Agriculture College of Teacher Education (CTE)
BSAB Bachelor of Science in Agribusiness BEEd Bachelor of Elementary Education
BSDC Bachelor of Science in Development Communication BECEd Bachelor of Early Childhood Education
BLIS Bachelor of Library and Information Science
College of Arts and Sciences (CAS)
BPEd Bachelor of Physical Education
BA FL Bachelor of Arts in Filipino
BTLEd - HE Bachelor of Technology and Livelihood Education-
BA EL Bachelor of Arts in English Language Studies
Home Economics
BA Com Bachelor of Arts in Communication
BTLEd - AA Bachelor of Technology and Livelihood Education-
BSES Bachelor of Science in Environmental Science
Agri-fishery Arts
BSS Bachelor of Science in Statistics
BSEd– Eng Bachelor of Secondary Education-English
College of Engineering and Applied technology (CEAT) BSEd– Sci Bachelor of Secondary Education-Science
BSABE Bachelor of Science in Agricultural and Biosystems Eng’g BSEd– Fil Bachelor of Secondary Education-Filipino
BSEd– SS Bachelor of Secondary Education-Social Studies
College of Home Economics and Technology (CHET)
BSEd– Math Bachelor of Secondary Education-Mathematics
BS Entrep Bachelor of Science in Entrepreneurship
BSEd– Val Ed Bachelor of Secondary Education-Values Education
BSHM Bachelor of Science in Hospitality Management
BSND Bachelor of Science in Nutrition and Dietetics
College of Forestry (CF) BUGUIAS Campus
BSF Bachelor of Science in Forestry
College of Nursing (CN) Code Degree Programs
BSN Bachelor of Science in Nursing BEEd– Bug Bachelor of Elementary Education
BSEd– Bug Bachelor of Secondary Education
College of Veterinary Medicine (CVM) BPEd– Bug Bachelor of Physical Education
DVM Doctor of Veterinary Medicine BTVTEd– Bug Bachelor of Technical-Vocational Teacher Education
Institute of Information Technology (IIT)
BSIT Bachelor of Science in Information Technology BOKOD Campus
Institute of Human Kinetics (IHK)
Code Degree Programs
BSESS Bachelor of Science in Exercise and Sports Sciences
BEE– Bok Bachelor of Elementary Education
Institute of Public Administration (IPA) BTLEd– Bok Bachelor of Technology and Livelihood Education
BPA Bachelor in Public Administration BSInT Bachelor of Science in Industrial Technology
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