THIS FORM IS NOT FOR SALE.

REPRODUCTION IS ALLOWED

DALUBHASAAN NG LUNSOD
NG SAN PABLO COLLEGE ADMISSION TEST APPLICATION FORM
COUNSELLING, TESTING, 1st SEMESTER AY 2022 - 2023
ADMISSION & GUIDANCE TO THE APPLICANT:
OFFICE Read the DLSP-CAT GENERAL INFORMATION (at the back) carefully before filling out this form. PRINT
legibly all information required. Place √ marks in appropriate boxes. Only correctly and completely filled-out
form will be accepted for processing. Areas with are REQUIRED to be accomplished

1. PROGRAM/COURSE APPLIED FOR: BS IN HOSPITALITY MANAGEMENT

___________________________________ Application no.: AN-2216881
(for testing use only)
2. PROGRAM/COURSE ENROLLED: BS IN HOSPITALITY MANAGEMENT
_____________________________________
(indicate major if any; see Program Offerings) 109758090026
LRN No.:_______________________________
3. NAME OF APPLICANT: Print or type your full name in the following sequence: LAST NAME, FIRST NAME, MIDDLE NAME.
Place one letter in each box. Leave one box blank between names.
Last C O M B O C A R
First C E D R I C K
Middle O P A N A
4. Date of Birth 0 8 - 1 8 - 2 0 0 3 5. Place of Birth: SAN PABLO CITY

6. Sex: Female Male ✓ 7. Civil status: Single ✓ Married Widower 8. Religion: CATHOLIC 9. Citizenship: FILIPINO

10. Mobile no. 0 9 9 5 5 4 2 4 9 7 6 11. Email Address: [email protected]

✓
12. Permanent Address: 540 SITIO TALANG SANTISIMO ROSARIO SAN PABLO CITY LAGUNA Postal Code: 4 0 0 0
s
1}
13. Father: Roderick Basig Combocar 14. Mother: Glenda Opana Combocar 15. Guardian: Glenda Opana Combocar

Occupation: Farmer Occupation: Farmer Relationship: Mother

Company & Address: N/A Company & Address: N/A Address: Santisimo Rosario San Pablo City

Contact no./s: 09094362836

Contact no./s: 09094362836 Contact no./s: 09094362836 Occupation: Farmer

16. Average Family Income

(Monthly) Please check one 100,001-above 100,000-50,001 50,000-40,001 40,000-30,001 30,000-20,001 ✓ 10,000 below

17. Senior High School Track: TVL 18. College (if any): 19. Member of Cultural Minority Group?
SHS Name School Name ✓ no ___yes
__
Santisimo Rosario Integrated High School ____________________________
Address (Brgy. City Town, Province) Address (Brgy. City Town, Province) Do you have any physical disability or
Santisimo Rosario San Pablo City condition that requires special attention?
Inclusive Dates: 07/04/2022 Inclusive Dates: __ no ___yes
Program : (Specify attached certification of Disability

CONSENT DLSP ENTRANCE/ ASSESSMENT REMARK/S:

I am fully aware that Dalubhasaan ng Lunsod ng San Pablo or its designated representative
is duty bound and obligated under the Data Privacy Act of 2012 and its Implementing Rules
and Regulations (IRR) effective since September 8, 2016, to protect all my personal and __________________________________________
sensitive information that it collects, processes, and retains upon my application for
admission, enrolment, and during my stay in the College. Likewise, I am fully aware that
__________________________________________
DLSP may share such information to affiliated or partner organizations as part of its
contractual obligations, or with government agencies pursuant to law or legal processes. In
this regard, I hereby allow DLSP to collect, process, use and share my personal data in the _________________________________________
pursuit of its legitimate academic, research, and employment purposes and/or interests as
an educational institution.
OATH Evaluated by:
I hereby certify that all information supplied in this application form for DLSP-CAT is
complete and accurate. I also understand that any false information will disqualify me from
being admitted to the College.
MRS. EILEEN A. OPENA, RPm ______________
________________________________ ______________ Guidance Counselor III Date
Signature of Applicant Date (Admission Officer)

________________________________ ______________
Signature of Parent/Guardian Date

Form No.: DLSP-AO/GO-SF-01 Revised No.: 00 Effectivity Date: March 13, 2019 Page 1 of 2

Please cut here -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

TO BE FILLED OUT ONLY BY TESTING PERSONNEL AUTHORIZED TO RECEIVE AND/OR PROCESS APPLICATIONS.
NOTE: 1. LATE EXAMINEES will not be allowed to take the TEST. Please come 30 minutes before your scheduled time.
2. Failure to come on the scheduled date and time will mean forfeiture of slot.
DLSP-CAT PERMIT / CLAIM STUB Bring the following:
Name : ______________________________________ 1. Test Permit
Program Applied: ______________________________________ 2. Ball pen (not gel pen)
School Last Attended : __________________________________ 3. Identification card with picture
Date of Test : _______________ Time: _________________

Present this TEST PERMIT/CLAIM STUB to claim your TEST RESULT.

 GENERAL INFORMATION
QUALIFICATIONS FOR DLSP-CAT: PROGRAM/COURSE OFFERINGS:
You are qualified to take the DLSP-CAT, if;
1. You completed/ are completing senior high school.
2. You are high school graduate on or before March 2018. Department of Teacher Education
3. You are ALS certified eligible for admission to College. • Bachelor in Elementary Education
• Bachelor in Secondary Education
ADDITIONAL QUALIFICATIONS: Department of Arts and Sciences
1. Must not have taken any college subject/s previously; • Bachelor of Science in Psychology
2. Must not be taking any college subject/s at present; and • Bachelor of Science in Public Administration
3. Students enrolled in vocational courses or those not • Bachelor of Science in Economics
leading to a degree program can apply for the DLSP-CAT. • Bachelor of Arts in Political Science
Department of Accountancy and Entrepreneurship
DOCUMENTARY REQUIREMENTS:
• Bachelor of Science in Accountancy
Present Original and submit photocopy only.
1. Form 138 (Report Card) • Bachelor of Science in Accounting Technology
2. Certificate of Good Moral Character. • Bachelor of Science in Entrepreneurship
3. Authenticated (PSA) Birth Certificate. Department of Business and Hospitality Management
4. 2 pcs. identical 1”x1” and 1 pc. 2”x2” current photo with white background • Bachelor of Science in Business Administration
5. Accomplished DLSP-CAT Form (Form No.: DLSP-AO/GO-SF-01). • Bachelor of Science in Hospitality Management
• Bachelor of Science in Office Administration
For transferees: Department of Technology and Engineering
1. Transcript of Records • Bachelor of Science in Computer Engineering
2. Honorable Dismissal • Bachelor of Science in Information Systems
3. Good Moral Certificate
• Bachelor of Science in Information Technology
4. 2 pcs. identical 1”x1” and 1 pc. 2”x2” current photo with white background
Non-degree Programs (1-year Certificate of Training)
For alternative Learning System (ALS) • Automotive and Electronics Technology
1. A & E Results • Electronics and Computer Technology
2. Certificate of Passing A & E Examination
(Division Office)
3. Good Moral (Division Office)
4. Birth Certificate (PSA Certified)
5. 2 pcs. identical 1”x1” and 1 pc. 2”x2” current photo with white background

HOW TO QUALIFY FOR AN UNDERGRADUATE DEGREE PROGRAM:

To qualify in a particular undergraduate degree program, the applicant
needs to choose from among the list of programs offered in the College.
The applicant needs to indicate the choice of programs in the College
Admission Test Application Form. (E.g. Bachelor of Science in Accountancy).

THE DLSP-CAT APPLICATION:

1. Obtain application forms from Counselling, Testing, Guidance & Admission
Office located at Brgy. San Jose, City of San Pablo, Laguna
2. Fill out the DLSP-CAT Form (Form No.: DLSP-AO/GO-SF-01). in print and bold letters.
3. Requirements should be clipped to the application form.
4. Submit the completed and accomplished application form and requirements to the CTAG Office.
5. Wait for the TEST PERMIT once your application form is submitted
*Take note of your scheduled date, time, venue and room number.

OFFICE HOURS: 8:00am-5:00pm Monday-Friday

Form No.: DLSP-AO/GO-SF-01 Revised No.: 00 Effectivity Date: March 13, 2019 Page 2 of 2

TAKING THE DLSP-COLLEGE ADMISSION TEST

You are required to come at least 30 minutes before your scheduled time. Remember to bring the following:

1. Your TEST PERMIT (No Test Permit, No Test)

2. Ball pen (not gel pen)
3. 1 valid ID for verification
4. Pencil Sharpener *NOTE: The use of any electronic gadget during the test is STRICTLY PROHIBITED. This is a ground for
DISQUALIFICATION from taking the test.

WHEN TO CLAIM YOUR TEST RESULT

1. Please refer to your TEST PERMIT for the schedule of releasing of Test Results.
2. Proceed to the Counselling, Testing, Guidance & Admission Office and present your TEST to claim your test result.
3. The submission of complete requirements for enrolment is indicated on the Test Result.

WHAT IF I DO NOT QUALIFY FOR THE COURSE I APPLIED FOR?

You did not qualify for the program you applied; you have several options. You can try other programs if: * your rating is within
their posted cut-off, and * they still have available slots. However, there is no guarantee of acceptance because each
Department has its own criteria.

LATE EXAMINEES WILL NOT BE ALLOWED TO TAKE THE TEST.