Reference No. BatStateU-FO-TAO-02 Effectivity Date: October 30, 2024 Revision No.

:09
BATANGAS STATE UNIVERSITY Application Number: 2025121991
The National Engineering University (tel:2025121991)
Testing and Admission Office
APPLICATION FORM
FOR COLLEGE ADMISSION

To the Applicant
Please read the BatStateU College Admission Guidelines and Requirements before accomplishing
the form.
This form is applicable for Senior High School graduates, currently enrolled in Grade 12 or for
applicants who is ap-plying for a college program for the first time without any previous college
credits attained
Fill out this application form properly and completely. Write N/A on fields that are not applicable and
do not leave any black spaces.

Pursuant to Republic Act No. 10173, also known as the Data Privacy Act of 2012, the Batangas State University, the ACADEMIC STATUS OF APPLICANT
National Engineering University recognizes its commitment to protect and respect the privacy of its customers and/or  Currently enrolled as Grade 12 student
stakeholders and ensure that all information collected from them are all processed in accordance with the principles of Senior High School Graduate
transparency, legitimate purpose and proportionality mandated under the Data Privacy Act of 2012.
AFFIRMATIVE ACTION PROGRAM (AAP)
APPLICANT’S INFORMATION Alternative Learning System Graduate
CASTILLO Indigenous Applicant
 Indigent Applicant
Surname
Person with Disability (PWD)
JEWEL ANNE
Iskolar ng Bayan
First Name Children of Solo Parents
CARINAN Integrated School / Laboratory School
Middle Name None
BARANGAY IV (POB.), SANTO TOMAS 4234
Address Zip Code
09/05/2007 FEMALE 17 CONTACT PERSON IN CASE OF EMERGENCY
Date of Birth Sex Age
Roman Catholic FILIPINO Contact Person:ANNABELLE CASTILLO
Religion Nationality
Address:POBLACION 4 STO TOMAS BATANGAS
09665242404 (tel:09665242404)
Contact Number: 09458016142 (tel:09458016142)
Mobile Number Landline Number
jewelannecastillo012@gmail.com Relationship:Parent
Email Address
EDUCATIONAL INFORMATION
THE TANAUAN CITY ACADEMY INC
Senior High School
Technical-Vocational-Livelihood /Home Economics N/A
Track/Strand Specialization, if any
2022-2023 2024-2025
JHS Completion Year SHS Completion Year
Have you ever transferred during your Senior Your High School? Type of School
Yes,previously from Public SUC
 No  Private LCU

GRADES

 Regular Admission (non-AAP/ Indigent/ Indigenous/ PWD) Filipino Abroad (non-DepEd Curriculum)
Alternative Learning System Filipino Abroad (with DepEd Curriculum)

Percentage of Correct
Grade 8 Grade 9 Grade 10 Grade 11, 1st Semester Grade 11, 2nd Semester
Responses
English 0 N/A N/A 80 84 91
Mathematics 0 N/A N/A 85 85 89
Science 0 N/A N/A 79 86 90
RECOMMENDATION PROGRAM CHOICES / CHOSEN CAMPUSES

To be filled out only for CTE applicants.

:
 College/ Department Remarks:
To be filled out only for BS Criminology applicants.
1. First Choice BS Hospitality Management MALVAR
College/ Department Remarks: 2. Second Choice BS Tourism Management MALVAR
To be filled out only for BS Nursing applicants. 3. Third Choice Bachelor of Food Engineering Technology MALVAR
College/ Department Remarks:
To be filled out only for BS Tourism applicants.

College/ Department Remarks:

:
 Reference No. BatStateU-FO-TAO-02 Effectivity Date: October 02, 2023 Revision No.:08
BATANGAS STATE UNIVERSITY
The National Engineering University

Testing and Admission Office

APPLICATION FORM FOR COLLEGE ADMISSION

OTHER INFORMATION

Are you the first member in the family to apply for College/ Tertiary Education?
Yes  No
Is your family a recipient of the 4Ps Program of the government?
 Yes No
Are you a member of any indigenous group?
Yes  No If yes, please identify: N/A
Are you a member of LGBTQIA+?
Yes  No Prefer not to say
Are you an internally displaced person?
Yes  No If yes, please provide some details: N/A
Are you a person with disability?
Yes  No If yes, please identify:
Are you a child of a solo parent?
Yes  No
Estimated Monthly Family Income:
 Less than PhP 10,957
PhP 10,957 to less than PhP 21,914
PhP 21,914 to less than PhP 43,828
PhP 43,828 to less than PhP 76,699
PhP 76,699 to less than PhP 131,484
PhP 131,484 to less than PhP 219,140
PhP 219,140 and above

PARENTAL INFORMATION

CASTILLO,ANNABELLE C. 45 HOUSE WIFE 0 09458016142 (tel:09458016142)

Mother’s name Age Occupation Monthly Income Contact Number
CASTILLO,JOEL T. 43 TRYCICLE DRIVER 0 09263405499 (tel:09263405499)
Father’s name Age Occupation Monthly Income Contact Number

SIBLING/S INFORMATION
FULL NAME(Last Name, First Name, Middle Initial) AGE HIGHEST EDUCATIONAL ATTAINMENT (eg. Elementary, High School, College) SCHOOL YEAR GRADUATE

CERTIFICATION
I hereby certify that all information provided herein is complete and accurate. Misrepresentation, falsification and any form of
dishonesty committed in relation to my application shall be sufficient grounds for my disqualification from admission to BatStateU.
Signature of applicant:_______________________ To be filled out by TAO Personnel only:
Date Signed: 01/07/2025 Official Receipt No. :
Scheduled Date of test:
Scheduled Time:
Campus Applied for MALVAR
Examination Venue
Room Assignment
Date of Filing of Application : 01/07/2025
Name of Evaluator:
Name and Signature of Examiner :
: