Reference No.: BatStateU-FO-REG-12 Effectivity Date: May 18, 2022 Revision No.

: 03

APPLICATION FORM FOR SHIFTER/TRANSFEREE

Request to: Shift: ___ From another College of the same Constituent Campus ___ From the same College
Transfer: ___ From another Constituent Campus ___ From other university
PERSONAL INFORMATION
Name of
Student: Last Name First Name Middle Name Suffix
SR Code: Date of Birth: Age:
Permanent
Address:
Nationality: Contact Number:
Program Preferred Constituent
Applied for: Campus:
Previous Previous Constituent
Program: Campus/University:
Reason for Shifting/
Transferring:

Requested by:

__________________________ __________________________
Signature over Printed Name of Student Signature over Printed Name of Parent/Guardian
Date Signed: Date Signed:
---------- to be filled-out by the Evaluator of the Admitting College ----------
Course/s taken from Previous Program/University Final Credit Equivalent Course/s in the
Course Code Course Title Grade/s Unit/s Preferred Program

(Use extra sheets if necessary)

Evaluated and Interviewed by: Reviewed and Approved by:
Qualified to Shift/ Transfer:
Yes, Program: _______________________________
No, Reason/s: _______________________________

____________________________ ____________________________
Signature over Printed Name of Dean/Head, Academic Affairs
Department/Program Chairperson Date Signed:
Date Signed:

Page 1 of 3
 ---------- to be filled-out by Testing and Admission Office ----------
This part is applicable ONLY for applicants from other universities
Examination Rating Verified by: Remarks:

The student is eligible to shift program/

_______________________________ transfer:
Signature over Printed Name of
Authorized Official YES NO
Designation:
Date Signed:
To the Campus Registrar:

The applicant is allowed to shift/transfer to: under

the College of

effective Semester, Academic Year .

Sincerely yours,

_____________________________
Signature over Printed Name of
Dean/ Head, Academic Affairs
Date Signed:
Received by:

______________________________
Signature over Printed Name of Registrar’s Staff
Date Signed:

Page 2 of 3
 Annex A
Republic of the Philippines
BATANGAS STATE UNIVERSITY
The National Engineering University
Name of Campus
Campus Address
Telephone Number
E-mail Address

PROPOSED COURSES FOR ENROLLMENT

Name: Program:
Campus: Academic Year:
YEAR 1
First Semester
Unit/s Pre-
Course
Course Title requisite/ Remarks
Code Lec Lab Co-requisite

Total Units
Second Semester
Unit/s Pre-
Course
Course Title requisite/ Remarks
Code Lec Lab Co-requisite

Total Units
Midterm
Unit/s Pre-
Course
Course Title requisite/ Remarks
Code Lec Lab Co-requisite

Total Units
(Use additional sheets if necessary)
Evaluated by: Approved by:

___________________________________
Signature over Printed Name of
Department/Program Chairperson
Date Signed:
Required Attachment: Program Curriculum
___________________________________
Signature over Printed Name of
Dean/ Head, Academic Affairs
Date Signed:
Page 3 of 3