ISO 9001:2015 CERTIFIED TEST PERMIT NUMBER
BULACAN STATE UNIVERSITY
OSAS STUDENT SERVICES DIVISION
OFFICE OF ADMISSIONS AND ORIENTATION SERVICES
20-20386
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 MALOLOS CAMPUS
APPLICANT INFORMATION
DISQUITADO FEMALE
Last Name Name Suffix (e.g. Jr., I.) Gender
LAMBETT JOY +63-915-8029-116
First Name Landline Number Mobile Number
SAN FELIPE ljdsqtd@gmail.com
Middle Name Email Address
09/27/2001 FILIPINO SINGLE ROMAN CATHOLIC
Date of Birth (MM/DD/YYYY) Citizenship Civil Status Religion
024 ZONE 1 MUZON SAN JOSE DEL MONTE, BULACAN 3023
Permanent Mailing Address Zip Code
PROGRAM PREFERENCES
First Choice:
BACHELOR OF SCIENCE IN CIVIL ENGINEERING
Second Choice:
BACHELOR OF SCIENCE IN MECHANICAL ENGINEERING
PARENT'S DETAILS
FATHER MOTHER
Name LAMBERTO R. DISQUITADO MA. LIZA SF. DISQUITADO
Highest Educational Attainment COLLEGE COLLEGE
Occupation NONE FOOD SELLER
Employment Status UNEMPLOYED SELF-EMPLOYED
Monthly Income NONE LESS THAN PHP 10,000
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
20-20386
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:
LAMBETT JOY SAN FELIPE DISQUITADO
GWA 1st Sem GWA 2nd Sem Total GWA
Grade 11
Track / Strand SCIENCE, TECHNOLOGY, ENGINEERING AND MATHEMATICS STRAND
Affix School Seal Here
School Name CITY OF SAN JOSE DEL MONTE NATIONAL SCIENCE HIGHSCHOOL
School Address ECOPARK, MUZON, CITY OF SAN JOSE DEL MONTE, BULACAN
Certified By:
Classification PUBLIC SCHOOL
Principal / Registrar
Name of School: City Of San Jose Del Monte National Science Highschool
Address: Ecopark, Muzon, City Of San Jose Del Monte, Bulacan
CERTIFICATE OF MORAL CHARACTER
Date:
TO WHOM IT MAY CONCERN:
This is to certify that LAMBETT JOY SAN FELIPE DISQUITADO 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: City Of San Jose Del Monte National Science Highschool
Address: Ecopark, Muzon, City Of San Jose Del Monte, Bulacan
PRINCIPAL'S CERTIFICATION
Date:
TO WHOM IT MAY CONCERN:
This is to certify that LAMBETT JOY SAN FELIPE DISQUITADO 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
