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1. Application Form Rev.9 Updated

The document is an application form for the Camarines Sur Polytechnic Colleges College Admission Test (CSPC-CAT), which includes data subject acknowledgment and informed consent for data processing. It outlines the requirements for different applicant categories, such as SHS applicants, transferees, and college graduates, along with a list of programs offered at both the Nabua and Buhi campuses. Additionally, it emphasizes the importance of accurate information and the consequences of misrepresentation in the admission process.

Uploaded by

Eunard Balbuena
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© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
7 views

1. Application Form Rev.9 Updated

The document is an application form for the Camarines Sur Polytechnic Colleges College Admission Test (CSPC-CAT), which includes data subject acknowledgment and informed consent for data processing. It outlines the requirements for different applicant categories, such as SHS applicants, transferees, and college graduates, along with a list of programs offered at both the Nabua and Buhi campuses. Additionally, it emphasizes the importance of accurate information and the consequences of misrepresentation in the admission process.

Uploaded by

Eunard Balbuena
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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Republic of the Philippines

CAMARINES SUR POLYTECHNIC COLLEGES


Nabua, Camarines Sur
CSPC-F-STA-01

STUDENT TESTING AND ADMISSION OFFICE


APPLICATION FORM
CAMARINES SUR POLYTECHNIC COLLEGES COLLEGE ADMISSION TEST
(CSPC-CAT)

DATA SUBJECT ACKNOWLEDGEMENT AND INFORMED CONSENT:

“I hereby allow CSPC and its authorized personnel to collect and process the relevant data provided by me and consent
to the confidentiality bound performance of legitimate guidance functions such as counseling, admission of the students,
reporting, referrals, data security and compliance to legal requirements. I also have been aware of my data privacy rights to be
informed, to object, to access, to rectification, to erasure/blocking, and the damage and impact of such rights towards
psychological care. Further, I hereby declare that all the foregoing information provided by me is true and correct and that I
shall abide by the policy guidelines governing admission in CSPC. I further certify that if any of the information indicated herein
is not true and incorrect, my application for admission in Camarines Sur Polytechnic Colleges will be null and void and that
CSPC is not in any way responsible for the misrepresentations I have declared.”

✓___________________________________________
SIGNATURE OVER PRINTED NAME

----------------------------------------------------------------------------------------------------------------------------- ----------------------

 SHS (Track/Strand: ________)


 Transferee  2-year course Graduate Passport-
 HS Graduate (Year: _______ )
 ALS Graduate  Re-ad  TESDA/Vocational Course sized photo,
 ETEEAP Graduate unedited or
__________________________________________________________________________________ unfiltered in
blue
PREFFERED CAMPUS:  Nabua/Main Campus  Buhi Campus
background
Control Number: ________________________ GENERAL WEIGHTED AVERAGE: _______________
__________________________________________________________________________________________

NAME: (fill out your name in the box provided) DATE OF FILING: - -
LAST NAME:✓

FIRST NAME:✓

MIDDLE NAME:✓

SEX: ✓  MALE  FEMALE  INTERSEX NOT LISTED (PLS. SPECIFY) ______________  PREFER NOT TO STATE
CITIZENSHIP: ✓______________________RELIGION: ✓____________CONTACT NUMBER:✓ _____________________________
DATE OF BIRTH: ✓___________________ AGE: ✓________________ PLACE OF BIRTH:✓ _______________________________
(mm/dd/yyyy)
E-MAIL ADDRESS: ✓ _________________________________________________________________________________________
NAME OF MOTHER: ✓_____________________________OCCUPATION:✓ ________________CONTACT NUMBER: ✓_________
NAME OF FATHER: ✓_____________________________ OCCUPATION:✓________________CONTACT NUMBER:✓ _________
PERMANENT ADDRESS:✓ ____________________________________________________________________________________
LAST SCHOOL ATTENDED:✓ __________________________________________________________________________________
ADDRESS: ✓________________________________________________________________________________________________

1. Program applied in CSPC: 1st Priority ✓ _______________ 2nd Priority ✓ ________________


2. Reasons why you want to study in CSPC?✓
________________
3. Do you have any other financial assistance?✓ Specify ✓ ________
4. Is your family a member of:
4.1 Listahanan/4 P’s program?✓  Yes  No 4.2 Indigenous People? ✓  Yes  No
5. Are you a First-Generation College Student? (first in their families to pursue College Degree) ✓  Yes  No
6. Do you have any physical disabilities that could make taking a regular test difficult? ✓  Yes  No
7. Are you a child of a CSPC employee? ✓  Yes  No
8. Are you a child of a solo parent? ✓  Yes  No
9. Are you residing in a Geographically Isolated and Disadvantaged Area (GIDA)? ✓  Yes  No
10. Monthly Family Income:  Less than P 9,520.00  Between P 9,520.00 to P 19,040  Between P 19,040.00 to P 38,080
 Between P 38,080 to P 66,460  Between P 66,460 to P 114,240  Between P 114,240 to 190,400  At least P190,400

Effectivity Date: December 2024 Rev.9 Page 1 of 2


Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur
CSPC-F-STA-01

REQUIREMENTS:

For SHS Applicants:


▪ Duly accomplished Application Form (CSPC-F-STA-01)
▪ One (1) pc. of original passport size picture in blue background
▪ Photocopy of SF9 (Grade 11) and Photocopy of SF10 Grade 9 and 10 Grades (JHS)
▪ Scanned softcopy of the Application Form (CSPC-F-STA-01) saved as PDF and apply to https://icloudph.com/cspc/sias/
✓ File name: (Last Name, First Name, Middle name)

For Transferees:
▪ Duly accomplished Application Form (CSPC-F-STA-01)
▪ One (1) pc. of original passport size picture in blue background
▪ Photocopy of Transcript of Records (TOR) with GWA or Certificate of Grades (COG) with GWA
▪ Scanned softcopy of the Application Form (CSPC-F-STA-01) saved as PDF and apply to https://icloudph.com/cspc/sias/
✓ File name: (Last Name, First Name, Middle name)

For TESDA/Vocational Course/ALS and ETEEAP:


▪ Duly accomplished Application Form (CSPC-F-STA-01)
▪ One (1) pc. of original passport size picture in blue background
▪ Photocopy of Report Card
▪ Scanned softcopy of the Application Form (CSPC-F-STA-01) saved as PDF and apply to https://icloudph.com/cspc/sias/
✓ File name: (Last Name, First Name, Middle name)

For College Graduate/2nd Courser students:


▪ Duly accomplished Application Form (CSPC-F-STA-01)
▪ One (1) pc. of original passport size picture in blue background
▪ Photocopy of Transcript of Records (TOR)
▪ Photocopy of Certificate of General Weighted Average
▪ Scanned softcopy of the Application Form (CSPC-F-STA-01) saved as PDF and apply to https://icloudph.com/cspc/sias/
✓ File name: (Last Name, First Name, Middle name)

PROGRAM OFFERED:
CSPC Nabua Campus CSPC Buhi Campus
✓ BS in Nursing (BSN) ✓ BS in Office Administration (BSOA)
✓ BS in Midwifery (BSM) ✓ Bachelor of Early Childhood Education (BECEd)
✓ BS in Information Technology (BSIT)
✓ BS in Information Systems (BSIS) SOON TO OFFER
✓ BS in Computer Science (BSCS) ✓ BS in Environmental Science (BSES)
✓ Bachelor of Library & Information Science (BLIS) ✓ Bachelor in Human Services (BHumServ)
✓ BS in Electronics Engineering (BSECE)
✓ BS in Civil Engineering (BSCE)
✓ BS in Electrical Engineering (BSEE)
✓ BS in Mechanical Engineering (BSME)
✓ BS in Architecture (BSARCH) GRADUATE SCHOOL PROGRAMS
✓ BS in Computer Engineering (BSCPE)
✓ BS in Hospitality Management (BSHM) Master’s Degree Programs
✓ BS in Office Administration (BSOA) ✓ Master of Arts in Nursing (MAN)
✓ BS in Entrepreneurship (BS Entrep) ✓ Master in Engineering (MEng)
✓ BS in Tourism Management (BSTM) ✓ Master in Business Management (MBM)
✓ BS in Business Administration Major in Financial Management (BSBA-FM) ✓ Master in Information Technology (MIT)
✓ BS in Mathematics (BS Math) ✓ Master of Arts in Nursing Major in Disaster
✓ BS in Applied Mathematics (BS Applied Math) Resilience (MANDR)
✓ BS in Development Communication (BSDevCom) ✓ Master in Hospitality Management (MHM)
✓ AB in English Language (AB ELS) ✓ Master in Nursing Education (MNE)
✓ Bachelor of Public Administration (BPublicAd)
✓ Bachelor in Human Services (BHumServ) Doctorate Degree Programs
✓ Bachelor of Special Needs (BSNEd) ✓ Doctor of Philosophy in Business
✓ Bachelor of Physical Education (BPEd) Management (DBM)
✓ Bachelor of Culture and Arts Education (BCAEd)
✓ Bachelor in Technical Vocational Teacher Education (BTVTEd) Soon to offer
o Major in:
▪ Food Service Management (FSM) ✓ Doctor of Philosophy in Nursing (PhD in
▪ Electronics Technology (ELX) Nursing)
▪ Fish Processing (FP) ✓ Doctor in Information Technology (DIT)

SOON TO OFFER

✓ BS in Entertainment and Multimedia Computing


✓ BS in Public Health
✓ BS in Emergency Medical Services
✓ BS in Nutrition and Dietetics
✓ BS in Social Work

Effectivity Date: December 2024 Rev.9 Page 2 of 2

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