College Entrance Assessment Application Form: Catanduanes State University
College Entrance Assessment Application Form: Catanduanes State University
College Entrance Assessment Application Form: Catanduanes State University
Print legibly all information required. Use BLACK BALLPEN. Place X marks in appropriate boxes only. If not applicable, kindly put N/A. Only
accomplished application forms will be processed.
BASIC INFORMATION:
1. NAME OF STUDENT: Print or type your full name in the following sequence: LAST NAME, FIRST NAME, MIDDLE NAME
Widow/Widower Separated
10. CONTACT INFORMATION:
11. Do you have DISABILITY or CONDITION that requires special attention or would make it difficult for you to take a regular test?
No
SCHOLASTIC INFORMATION:
CERTIFICATION:
This certifies that he/she is possess good moral character and integrity. Records show that his strengths are:
1. ____________________________________________________________________________________
2. ____________________________________________________________________________________
3. ____________________________________________________________________________________
Furthermore, he/she [ ] has been subjected to any disciplinary action (please specify)
__________________________________________________
[ ] has not been subjected to any disciplinary action.
Issued this ______ day of __________________, 20_____ for CatSU College Entrance Assessment purposes.
___________________________________________________________________
School Head/Guidance Counselor/Designate
Contact Number: _____________________________
I certify to the completeness and correctness of the foregoing record. [ ] Affixed here is the school dry seal
[ ] This school has no dry seal
______________________________________ Contact Number: ____________
Email Address: _____________
Signature over printed Name
I affirm that:
1. All information supplied in this application form is true, complete and accurate;
2. I have not taken CatSU Entrance Assessment previously;
3. I will abide by the institution’s rules and policies on test administration, and screening process.
I am aware that any or all the information in this application may be checked against the original documents and I understand that I will be
allowed to take the examination upon the submission of complete requirements.
Furthermore, I understand that all information I provide in this form as well as during the College Entrance Assessment may be used by the
University for research and I believe that my personal details will be treated with utmost confidentiality.
___________________________________ I certify that all information here are true and correct.
Signature of Student
Date: ______________________ ____________________________________________________________
Parent/Guardian’s Signature over Printed Name
Date: ____________