Catanduanes State University College Entrance Examination Application Form
CATANDUANES STATE UNIVERSITY
CEE APPLICATION FORM
Staple a recent 2”X 2”
photograph (taken within
the last six months) in this
Be sure to print your name
at the back of the photo.
TO THE STUDENT AND PARENTS/GUARDIAN:
Print legibly all information required. Use BLACK BALLPEN. Place X marks in appropriate boxes only. Only accomplished application
forms will be processed.
1. NAME OF STUDENT: Print or type your full name in the following sequence: LAST NAME, FIRST NAME, MIDDLE NAME.
2. SEX: Male
3. DATE OF BIRTH: (Month, Day, Year) __ __ - __ __ - __ __ __ __
4. PLACE OF BIRTH:
_______________________________________ 5. AGE: ________________________________
6. COMPLETE HOME ADDRESS: _______________________________________________________________________
7. CIVIL STATUS:
__________________________ 8. RELIGION: ______________________________________
9. CITIZENSHIP :
________________________ 10. CONTACT NUMBER: _______________________________
11. EMAIL ADDRESS: ______________________________________________
12. COURSES TO TAKE: (List down your first three (3) choices)
1. 1st choice:
2. 2 choice:
3. 3 choice:
13. HIGH SCHOOL (where you completed/are completing secondary level education):
HIGH SCHOOL NAME: (Do not abbreviate) ________________________________________________________________________
ADDRESS: (City/Town, Province) ________________________________________________________________________________
14. 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) ___________________________________________________________
15. SOCIO-ECONOMIC DATA (Furnish all the required information on each family member listed. Write DECEASED after name of
deceased family members. Under the column “Highest Educational Attainment”, indicate the educational level which the household
member actually completed (e.g. Grade II, Third Year High School, High School Graduate, Second Year College, B.S.E., or Ph.D.)
(Do not leave blank)
(In Phil. Peso)
BROTHERS AND SISTERS:
GRADE OR YEAR LEVEL
16. Have you applied/are you planning to apply to other schools?
___ No ___ Yes
What are these schools? _____________________________________________________________________________
17. Does anyone from your family an employee of Catanduanes State University?
___ No ___ Yes
Is YES, who and his/her position: ______________________________________________________________________
18. Does anyone from your family an alumnus/alumna of Catanduanes State University?
___ No ___ Yes
If YES, who and kindly indicate what level? (Grade School, High School, College, or Graduate School)
19. Honors/Awards/Distinctions Received: __________________________________________________________________
20. Reasons for applying at Catanduanes State University: _____________________________________________________
I affirm that:
1. All the information supplied in this application form are
true, complete and accurate;
2. I will abide by the Institution’s rules and policies on test
administration and on student fees including tuition,
scholarships, and financial assistance programs.
I am aware that any or all the information in this application may
be checked against the original documents and that withholding
information or giving false information will disqualify me from
admission/will be basis for dismissal, if admitted. I also
understand that no results for my application may be released
until all requirements are satisfied.
SIGNATURE OF STUDENT
I certify that:
The information which my son/daughter/ dependent
has furnished in this application form is true,
complete and accurate.
I recognize that in signing this application form, I share with
my son/daughter/dependent the responsibility for the
veracity and completeness of the information supplied herein.
SIGNATURE OF PARENT/GUARDIAN