Bicol Univeristy

OFFICE OF ADMISSIONS
Legazpi City

APPLICATION FORM Staple/Paste

BICOL UNIVERSITY COLLEGE ENTRANCE TEST 2pcs.
(BUCET) 2x2 photo
SY 2020 - 2021 (recent)

Instructions to Students and Parents: Application Form No. ____________

THIS FORM IS ONLY FOR APPLICANTS WHO HAVE NOT ENROLLED IN ANY COURSE/ Application & Testing Fee: P 250.00 (free)
SUBJECT BEYOND SENIOR HIGH SCHOOL. Reference Code: 20843
CAREFULLY READ THE GENERAL INFORMATION FOR BUCET applicants and the contents Queue Date: Sep 25, 2019
of this form before lling in the information asked. Queue Time: (1:00PM-5:00PM)
ONLY CORRECTLY AND COMPLETELY FILLED OUT FORMS will be issued a TEST PERMIT.
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

1st Choice A-41 BS Nursing CN

2nd Choice A-72 BS Civil Engineering CENG

2. PRINT OR TYPE YOUR NAME IN THE FOLLOWING SEQUENCE: Last Name, First Name, Middle Name. Place one letter in each box.
Check one box only:
Last Name LUMANOG
3. SEX Male ✓ Female
First Name SHELLA LOVE
4. CITIZENSHIP:
✓ Filipino

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

Number and Street ZONE 7 LUPA

Subd./Village, Brgy. BARANGAY

City/Town & Province LIBMANAN, CAMARINES SUR

Postal/Zip Code 4407 Email Address shellalovelumanog6477@gmail.com

Tel./Cell. Phone No. 09507893741

7. Senior High School graduated or graduating from: BICOL CENTRAL ACADEMY Expected/date of graduation 2020
School Address LIBMANAN, CAMARINES SUR Learner's Reference No. 112672070035
8. Junior High School Completed from HOMOBONO H. GONZALEZ NATIONAL HIGH SCHOOL
School Address LIBMANAN, CAMARINES SUR
9. Applicant's Date of Birth: 2001 SEPTEMBER 2 10. Civil Status (Check one box only)
Year Month Date ✓ Single    Married    Other (specify)
11. Applicant's Place of Birth: STA. CRUZ MANILA

12. Occupation of Father/Guardian: TAXI DRIVER Occupation of Mother/Guardian: HOUSEWIFE

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

  P 11,000.00 - P 14,000.00   P 21,000.00 - P 30,000.00   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-29 Not for Sale. Reproduction is allowed. Rev. 1

Effectivity date: July 17, 2018 Page 1 of 2