ADMISSION’S COPY

Mindanao State University – General Santos City

MSU Senior High School Admission Test (MSU SHSAT) Staple or paste a recent
APPLICATION FORM 2” x 2” photo with white
background and write
Examinee No.: School Year 2020 - 2021

Instruction: Please PRINT all entries neatly and legibly and put a check (✓) mark on boxes indicating
your full name at the back
the desired strand, age, sex, civil status, and cultural community. After paying the Examination Fee at
the Cashier’s Office, bring this form to the Office of the Senior High School for your examination
schedule and room assignment.
1. NAME OF STUDENT
Last Name 2. Desired Strand
STEM HUMSS ABM
First Name 3. DepEd LRN

Middle Name 4. CITIZENSHIP

5. DATE OF BIRTH (MM-DD-YYYY) 6. AGE 7. SEX 8.CIVIL STATUS 9. RELIGION

- - M F Single Married
10. PLACE OF BIRTH

11. CONTACT NUMBER (09…..) 12. ARE YOU A MEMBER OF A CULTURAL MINORITY?
YES NO IF YES, please specify:
13. PERMANENT ADDRESS

14. NAME OF JUNIOR HIGH SCHOOL (please write the complete name of the school)

15. COMPLETE ADDRESS OF JUNIOR HIGH SCHOOL (Include street, city, state or province, postal zone and country)

16. Parent / Guardian Information

Father’s Name Mother’s Maiden Name Guardian’s Name (if Applicable)
Name (Last Name, First Name)
Occupation
Tribe
Contact Number
I hereby certify that all entries on this form are true and correct.

_________________________________
Signature of Applicant
Date of Application: Official Receipt No.: Date and Time of Examination:

___________________________________ ___________________________________ _________________________________

Mindanao State University – General Santos City

MSU Senior High School Admission Test (MSU SHSAT)
EXAMINATION PERMIT Staple or paste a recent
2” x 2” photo with white
Examinee No.: Official Receipt No.:
background and write
Last Name, First Name, Middle Name
your full name at the back
Name of Junior High School Address of Junior High School

Date and Time of Examination PROCESSED AND APPROVED BY REQUIREMENTS SUBMITTED:

DEC 15, 2019 | to be checked by the processor
Place of Examination Processed by:____________________________ ___ Application Form
___ ID Picture
MSU FATIMA CAMPUS ___ Principal’s Certification
Date: _________________________________
Room No. ___ Report Card (photocopy)
MSU-GSC SHSAT REQUIREMENTS:

____ 1. Certification from the School Principal that the applicant is enrolled in Grade 10

____ 2. Photocopy of Grade 10 Report Card (1st and 2nd Quarters S.Y. 2019-2020)

____ 3. Duly Accomplished Application Form

____ 4. Php 250 non-refundable Examination Fee to be paid at the MSU Fatima Campus Cashier’s Office.

REMINDERS TO THE EXAMINEE

1. Be at your testing center one (1) hour before your scheduled examination
2. Present the Examination Permit and your school I.D. to the Proctor / Room Examiner
3. Bring at least two blue/black ball pen and snacks
4. Test results will be posted on the MSU-GSC SHS Facebook page (fb.com/MSUGSCSHS)