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Republic of the Philippines
DR. EMILIO B. ESPINOSA, SR. MEMORIAL STATE COLLEGE
OF AGRICULTURE AND TECHNOLOGY
(Masbate State College)
GUIDANCE AND COUNSELING OFFICE

www.debesmscat.edu.ph
Cabitan, Mandaon, Masbate



STUDENT APPLICATION FORM FOR ADMISSION

GENERAL INSTRUCTIONS: This form is for all Transferee Applicants from public and private higher education institutions (HEI). Fill in all the required information accurately. Do not abbreviate. (This application form for admission is valid only for A.Y 2022 - 2023)

GENERAL INSTRUCTIONS: This form is for all Graduating Grade 12 Senior High School and Grade 12 Graduate Applicants from public and private secondary high schools. Fill in all the required information accurately. Do not abbreviate. (This application form for admission is valid only for A.Y 2022 - 2023)

A. APPLICANT COURSE PREFERENCES (Your course choice is final. Changing of course is not advisable).

What campus do you prefer to get in to?

Main Campus
Cawayan Campus
Masbate City Campus

Please enter your Grade 11th or 12th Math and Science grade.

College or Department can be selected once. So, select your top 3 choices.




B. APPLICANT PERSONAL INFORMATION



Male
Female

Permanent Address:








C. SCHOOL LAST ATTENDED

Name of Senior High School Enrolled in/Graduated from:

School Complete Address:

Learners Reference Number (LRN):

Senior High School Track/Strand:

Grade 9 General Weighted Average:

Grade 10 General Weighted Average:

Grade 11 General Weighted Average (1st Sem.)

Grade 11 General Weighted Average (2st Sem.)

Did you already graduate from senior high school?

Yes
No

Grade 12 General Weighted Average (1st Sem.)

Grade 12 General Weighted Average (2st Sem.)

Private
Public
SUC
LUC
Private HEI

D. OTHER INFORMATION

MONTHLY FAMILY INCOME

Less than P10,000
P10,001 - P15,000
P16,000 - P25,000
P26,000 - P35,000
P36,000 - P49,000
more than P50,000

Yes
No,

Yes
No,

Yes
No,

Yes
No

Yes
No


APPLICANT'S CERTIFICATION

I hereby certify that all information provided in this application form is true and correct to the best of my knowledge and belief. I acknowledge that any inaccurate information included herein invalidates this application.

(Signature over Printed Name of Applicant)

(Signature over Printed Name of Parent)

Confidentiality Note: The information on this form provided by the applicant is confidential. The information is intended for personal use of the individual or the entity to whom it is addressed. Any disclosure, copying, or other use of the information contained herein is strictly prohibited.