Bicol Univeristy

OFFICE OF ADMISSIONS
Legazpi City
Staple/Paste
1pc.
PERSONAL INFORMATION SYSTEM
2x2 photo
BICOL UNIVERSITY COLLEGE ENTRANCE with nametag
SCORING SYSTEM (BUCESS)
SY 2021 - 2022
Application Form No. ____________
Instructions to Students and Parents:
Application & Testing Fee: P 250.00 (free)
THIS FORM IS ONLY FOR APPLICANTS WHO HAVE NOT ENROLLED IN ANY COURSE/
Reference Code:
SUBJECT BEYOND SENIOR HIGH SCHOOL.
Date of Appointment:
CAREFULLY READ THE GENERAL INFORMATION FOR BUCET applicants and the contents
Time of Appointment:
of this form before lling in the information asked.
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

Course Choice

SHS Track

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

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

Number and Street

Subd./Village, Brgy.

City/Town & Province ,

Postal/Zip Code
Email Address

Tel./Cell. Phone No.

7. Senior High School graduated or graduating from: Expected/date of graduation

School Address
8. Junior High School Completed from
School Address
9. Applicant's Date of Birth:
Year
11. Applicant's Place of Birth:
12. Occupation of Father/Guardian:
, Learner's Reference No.
,
10. Civil Status (Check one box only)
Month Date Single    Married    Other (specify)
Occupation of Mother/Guardian:

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 20,999.00   P 31,000.00 - P 49,999.00

  P 11,000.00 - P 14,999.00   P 21,000.00 - P 30,999.00   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- Not for Sale. Reproduction is allowed. Rev. 1

Effectivity date: January 11, 2021 Page 1 of 2
 SECONDARY SCHOOL RECORD
TO THE PRINCIPAL:
This form is an official document to be used by the BU Admissions Office for selective admission and research purposes.
1. Please type or print legibly all information called for. Do not abbreviate
2. For the student's name, print last name, first name and middle name in full.
3. Be sure that all grades (i.e., including failing marks) are indicated and that all entries are complete and specific such as number of units or credits
earned for such subject on this page.
4. TAMPERING WILL INVALIDATE THIS APPLICATION FORM.

NAME OF STUDENT APPLICANT: _______________________________________________________________________________________________

Last Name First Name Middle Name
Name of High School: __________________________________________________________________________________________________________
Nationalized High School Vocational - Tech Private Sectarian Private Non-Sectarian NGU Sponsored
Address of High School: _________________________________________________________________________________________________________
District/Town City/Province
Track in Senior High School: ACADEMIC TECH-VOCATIONAL ARTS & DESIGN
( ) ABM ( ) HUMSS ( ) GAS Area of Specialization: SPORTS
( ) STEM ( ) PRE-Baccalaureate Maritime __________________________
Year of Graduation: __________________________________________________ No. of Graduates/Expected Graduates: __________________________

GRADE 9 GRADE 10 GRADE 11

Basic/Core Subjects 1st sem., 2nd sem.,
SY 20___ to 20___ SY 20___ to 20___ SY 20___ to SY 20___ SY 20___ to SY 20___
Final Final
Final Grades Final Final
Final Grades Remarks Remarks Final Grades Remarks Final Grades Remarks
Grades Grades Grades Grades
○ FILIPINO
● Komunikasy on at Pananaliksik sa Wika at Kulturang Pilipino
● Pagbasa at Pagsusuri ng Iba't Ibang Teksto Tungo sa
○ ENGLISH
● Oral Communication in Context
● Reading & Writing Skills
● 21st Century Lit. from the Phil. & the World
○ MATHEMATICS
● General Mathematics
● Statistics & Probability
○ SCIENCE
● Earth / Life Science
● Physical Science
○ ARALING PANLIPUNAN
● Understanding Culture, Society & Politics
● Contemporary Phil. Arts from the Regions
● Introduction to the Philosophy of the Human Person
○ EDUKASYON SA PAGPAPAHALAGA
● Personal Development/Pansariling Kaunlaran
○ TECHNOLOGY & LIVELIHOOD EDUCATION
○ MAPEH
● Physical Education and Health
● Disaster Readiness & Risk Reduction
○ ICT / ● Media and Information Literacy
Other Basic/Core Subjects in JHS/SHS

● APPLIED & / SPECIALIZED SUBJECTS

● ADDITIONAL SUBJECTS

GENERAL WEIGHTED AVERAGE

(P lease fill in the 4 bo xes fo r year 9 to 11)
○ Subjects offered in Gr. 9 to 10
○ Subjects offered in Gr. 9 to 10
●● Subjects
Subjects offered
offered in Gr. 11 This studentThis
in Gr. 11 studenttobelongs
belongs the: to the: Upper 10% Upper Upper
Upper 10% 20% 20% UpperUpper
40%40% Lower
Lower
50%50%of of
thethe graduating class.
graduating class.

PRINCIPAL'S CERTIFICATION
I HEREBY CERTIFY AS TO THE COMPLETENESS AND CORRECTNESS OF THE FOREGOING RECORD AND FURTHER
ATTEST THAT ________________________________________________________________.
(Fill-in applicant's name)
will be graduating in senior high has graduated in senior high school
school this school y ear 20___ - 20___ during the school y ear __________.
Form 137-A requested by :
(check () appropriate box )
____________________________________
Name of School
Affix school dry seal here, if school has one. Principal's Signature (in ink) ___________________
(Facsimile not allowed)

Date _______________________________ Principal's Name (Print) _______________________