Republic of the Philippines

Bicol University
OFFICE OF ADMISSIONS
Legazpi City

APPLICATION FORM
BICOL UNIVERSITY COLLEGE ENTRANCE TEST
(BUCET)
SY 2023-2024

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)
Reference Code: 26117
SUBJECT BEYOND SENIOR HIGH SCHOOL.
Date of Appointment: Sep 14, 2022
CAREFULLY READ THE GENERAL INFORMATION FOR BUCET applicants and the contents Time of Appointment: (1:00PM-5:00PM)
of this form before filling in the required information.
This application is valid only for entrants during the school year indicated above. Permit No.: ____________________________
PRINT ALL ANSWERS. Verified 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 final. Changing of course is strictly not allowed.
COURSE CODE COURSE NAME CAMPUS

1st Choice A-23 BACHELOR OF SECONDARY EDUCATION CE

2nd Choice A-19 BSBA MAJOR IN OPERATIONS MANAGEMENT CBEM

2. PRINT OR TYPE YOUR NAME IN THE FOLLOWING SEQUENCE: Last Name, First Name, Middle Name.
Last Name Check one box only
DELA PASION
3. Sex: ✓ Male Female
First Name 4. Citizenship: ✓ Filipino
RAZEAL
Non-Filipino
Middle Name
VARDE 5. Religion: ROMAN CATHOLIC

6. PERMANENT HOME ADDRESS

Number and Street #082, P-5, SAN ROQUE STREET VINZONS CAMARINES NORTE

Subd./Village, Brgy. BARANGAY III (POB.)

City/Town & Province VINZONS, CAMARINES NORTE

Postal/Zip Code 4603 Email Address razealdelapasion28@gmail.com

Tel./Cell. Phone No.

09072127586

7. Senior High School graduated or graduating from: VINZONS PILOT HIGH SCHOOL Expected/date of graduation: 2023
School Address VINZONS, CAMARINES NORTE Learner's reference No. 112316100125
8. Junior High School Completed from: VINZONS PILOT HIGH SCHOOL
School Address VINZONS, CAMARINES NORTE

9. Applicant's Date of Birth: 2004 DECEMBER 28 10. Civil Status (Check one box only)
Year Month Date ✓ Single Married Other(specify) __________________

11. Applicant's Place of Birth: VINZONS CAMARINES NORTE

12. Occupation of Father/Guardian: TRICYCLE DRIVER Occupation of Mother/Guardian: HOUSE WIFE

13. Do you have any PHYSICAL DISABILITY or CONDITION that would make it difficult for you to take a regular test? ✓ No Yes
(Please attach Certification of Disability and Submit to the BUAO).
14. Monthly Family Income:

✓ Less than P 10,000.00 P 15,001.00 - P 20,000.00 P 30,001.00 - P 40,000.00

P 10,001.00 - P 15,000.00 P 20,001.00 - P 30,000.00 P 40,001.00 - P 50,000.00 above

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 50.00 worth of mailing 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: Effectivity date: July 17, 2018

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