CATANDUANES STATE UNIVERSITY
CEE APPLICATION FORM

Staple a recent 2”X 2”
photograph (taken within
the last six months) in...
BROTHERS AND SISTERS:
NAME

GENDER

MARITAL
STATUS

PRESENT OCCUPATION/
GRADE OR YEAR LEVEL

EMPLOYER/ SCHOOL
ATTENDING

1...
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Catanduanes State University College Entrance Examination Application Form

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Catanduanes State University College Entrance Examination Application Form

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Catanduanes State University College Entrance Examination Application Form

  1. 1. CATANDUANES STATE UNIVERSITY CEE APPLICATION FORM Staple a recent 2”X 2” photograph (taken within the last six months) in this box. 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. _________________________ (Last Name) _______________________ (First Name) _________________________ (Middle Name) 2. SEX: Male Female 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: _________________________________________ nd 2. 2 choice: _________________________________________ rd 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.) NAME Father Mother (Maiden Name) Legal Guardian MARITAL STATUS HIGHEST EDUCATIONAL ATTAINMENT PRESENT OCCUPATION EMPLOYER (Do not leave blank) GROSS INCOME (In Phil. Peso)
  2. 2. BROTHERS AND SISTERS: NAME GENDER MARITAL STATUS PRESENT OCCUPATION/ GRADE OR YEAR LEVEL EMPLOYER/ SCHOOL ATTENDING 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 ____________ Date I certify that: 1. 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 ____________ Date

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