ISO 9001:2015 CERTIFIED TEST PERMIT NUMBER

BULACAN STATE UNIVERSITY

OSAS STUDENT SERVICES DIVISION
OFFICE OF ADMISSIONS AND ORIENTATION SERVICES
B20-00371
ATBulSU APPLICATION FORM

APPLICATION GUIDELINES
1. A candidate for graduation of any DepEd-recognized Senior High School;
2. Must have a General Point Average of 85% or better for the First and Second Semesters of their Grade 11, for courses with Board
Examinations;
3. General Point Average of 83% or better for the First and Second Semesters of their Grade 11, for non-board program;
4. For College of Industrial Technology, there is no particular GWA requirement, preferably coming from the TVL Track, with relevant
National Certificate (NCI, NC2);
5. Possesses good moral character and in good health.
6. The Medical/Admission Permit shall be distributed on a specified date to be posted at the Office of Admissions on the date of release
of qualifiers.

APPLICATION DETAILS

Application Type: Academic Year: Campus:

COLLEGE FRESHMAN A.Y. 2020-2021 - 1ST SEMESTER BUSTOS CAMPUS

APPLICANT INFORMATION

CRUZ FEMALE
Last Name Name Suffix (e.g. Jr., I.) Gender

RONA MAE +63-936-2469-395

First Name Landline Number Mobile Number

REYES [email protected]
Middle Name Email Address

11/12/2001 FILIPINO SINGLE ROMAN CATHOLIC

Date of Birth (MM/DD/YYYY) Citizenship Civil Status Religion

552 PUROK 6 TALACSAN SAN RAFAEL, BULACAN 3008

Permanent Mailing Address Zip Code

PROGRAM PREFERENCES

First Choice:
BACHELOR OF SCIENCE IN BUSINESS ADMINISTRATION MAJOR IN FINANCIAL MANAGEMENT
Second Choice:
BACHELOR IN SECONDARY EDUCATION MAJOR IN MATHEMATICS

PARENT'S DETAILS

FATHER MOTHER

Name RONALD S. CRUZ CAROLYN P. REYES

Highest Educational Attainment ELEMENTARY ELEMENTARY

Occupation CONSTRUCTION WORKER NONE

Employment Status UNEMPLOYED UNEMPLOYED

Monthly Income NONE NONE

OTHER INFORMATION

Disability:
NONE
What language/s and/or dialect/s do you use at home?
TAGALOG
Is your family belonging to Indigenous People (IP) e.g. ethnic group / native people or aborigines? If yes, inidicate the group.
NO
Is your family included in the DWSD Listahan (4Ps):
NO

I hereby affirm that I have read and understood all the instructions in connection with my application for the ATBulSU. I likewise affirm that all information supplied herein are
complete and accurate. I am aware that any or all of the information furnished in this application form may be checked against documents. Withholding or giving false information
will make me ineligible for admissions or subject to dismissal. If admitted, I agree to abide by the policies, rules and regulations of the Bulacan State University

________________________________________________________ ________________________
Signature over Printed Name of Applicant Date

I hereby certify the veracity and completeness of the above information in this application.

________________________________________________________ ________________________
Signature over Printed Name of Authorized Contact Person Date
 ISO 9001:2015 CERTIFIED TEST PERMIT NUMBER
BULACAN STATE UNIVERSITY
OSAS STUDENT SERVICES DIVISION
OFFICE OF ADMISSIONS AND ORIENTATION SERVICES
B20-00371
GRADES FORM

GRADES DETAILS GUIDELINES

1. Only the School Registrar or Principal may certify the Grades Form.
2. Compute for the average of all interrelated subjects taken within the same school year.
3. State the grades in standard quantitative equivalent (e.g. 85.00, 89.50).
4. General Weighted Average (GWA) for Grade 11 will include ALL subjects taken by the student in Grade 11.
5. For schools with a basic education program that does not follow the Department of Education's K-12 Program but is recognized by DepEd to be its equivalent, indicate the
GWA of the student during the most recent completed Grade Level instead of that of Grade 11.
6. Affix the school seal for validation. In the absence if a school seal, please attach a certified true copy of of Form 137A (Transcript of Records).
7. Countersign all corrections or alterations, if any.

Applicant Name:
RONA MAE REYES CRUZ

GWA 1st Sem GWA 2nd Sem Total GWA

Grade 11

Track / Strand GENERAL ACADEMIC STRAND

Affix School Seal Here

School Name BULACAN POLYTECHNIC COLLEGE-SAN RAFAEL CAMPUS

School Address POBLACION SAN RAFAEL BULACAN

Certified By:
Classification PUBLIC SCHOOL

Principal / Registrar

Name of School: Bulacan Polytechnic College-San Rafael Campus

Address: Poblacion San Rafael Bulacan

CERTIFICATE OF MORAL CHARACTER

Date:
TO WHOM IT MAY CONCERN:

This is to certify that RONA MAE REYES CRUZ has NO DEROGATORY RECORDS
extant in this Office while studying in this school, for he/she is known to be a person of unquestionable moral character.

Signature of Principal / Guidance Counselor

Name in Print

FOR COLLEGE OF EDUCATION APPLICANT ONLY

Name of School: Bulacan Polytechnic College-San Rafael Campus

Address: Poblacion San Rafael Bulacan

PRINCIPAL'S CERTIFICATION

Date:
TO WHOM IT MAY CONCERN:

This is to certify that RONA MAE REYES CRUZ is a candidate for graduation for
the school year _______________________ and belongs to the top 10% of the graduating students.

Signature of Principal

Name in Print

To be accomplished by the BulSU Office of Admissions and Orientation Services

Checker: _____________________________________________ ____________________________

OAOS Representative Date