ONLINE PROGRAMS OFFICE

Visca, Baybay City, Leyte, PHILIPPINES

Telefax: (053)565 0600 local 1103
Email: ou@vsu.edu.ph
Website: www.vsu.edu.ph

APPLICATION FOR ADMISSION

1x1 ID
Picture

To the Applicant: This form shall not be acted upon unless the following documents and
fees are received by the Online Programs Office:
1. Official Transcript of Record, in the English language from each college previously
attended. (Original TOR with dry seal).
2. Candid appraisal from former professor and present supervisor (Please use FM-
OPO-02).
3. Certification of English proficiency by your professor in English (Please use GS Form
No. 3) or TOEFL score. This is required only of applicants from countries where
English is not the medium of instruction and/or not the native language.
4. Application fee of P100 for Filipino citizens or $10 for foreign nationals. (Please
deposit to VSU Land Bank Account (Acct. name: VSU Fund 164-3572100013),
PALAWAN Express, Cebuana Lhuillier or any mode of payments applicable).

Name _____________________________ Seeking Admission for_______ 1st Sem. 20___

_______ 2nd Sem. 20___

Degree Sought: [ ] M.Ag.Dev. .

Major Field _______________ Minor Field_________________

A. Sex: [ ] Male [ ] Female Civil Status: [ ] Single [ ] Married [ ] Widower

B. Date of Birth: Place of Birth:
C. Citizenship: E-mail Address: Contact No.
D. Present Position/Occupation:
E. Agency/Office:
F. Mailing Address:
G. Religion: _____________________________________________________________

H. Educational Background
Degree(s)
GPA* College/University Year Obtained Major Field
Earned

Page 1 of 3
Vision:  A globally competitive university for science, technology, and environmental conservation.
Mission:  Development of a highly competitive human resource, cutting-edge scientific knowledge FM-OPO-01
V1 01-09-2023
and innovative technologies for sustainable communities and environment.
No.
 * Grade Point Average/Letter Grade Average
Why are you interested in graduate study?

H. What do you plan to do after getting your graduate degree?

I. What are the possible sources of financial support for your graduate study?

SOURCE PERCENT
Self
Scholarship (specify source)
Assistantship (specify source)
Others: (specify)

J. Personal references: (List 3 names and addresses of people who may have
adequate knowledge about your scholastic competence, personality, and
potential for graduate work and whom you have requested to recommend you.
1. ______________________________________________________________
2. ______________________________________________________________
3. ______________________________________________________________

K. Work Experience (attach additional sheet, if necessary)

Position/Job Agency/Office Inclusive Dates

1. Membership in honor and professional organizations

(Please use additional sheet if necessary)

2. Scholarship, honors, prizes and awards.

(Please use additional sheet if necessary)

3. Publication: Give the complete bibliographical information.

(Please use additional sheet if necessary)

4. Unpublished research papers and/or thesis

(Please use additional sheet if necessary)

_____________________________
Signature of Applicant

_____________________________
Date

Page 2 of 3
Vision:  A globally competitive university for science, technology, and environmental conservation.
Mission:  Development of a highly competitive human resource, cutting-edge scientific knowledge FM-OPO-01
V1 01-09-2023
and innovative technologies for sustainable communities and environment.
No.
 *Indicate N/A or NONE for fields not applicable

Page 3 of 3
Vision:  A globally competitive university for science, technology, and environmental conservation.
Mission:  Development of a highly competitive human resource, cutting-edge scientific knowledge FM-OPO-01
V1 01-09-2023
and innovative technologies for sustainable communities and environment.
No.