Bicol University
OFFICE OF ADMISSIONS
Legazpi City
Please staple
here 1 copy of
the most recent
2x2 ID photo
APPLICATION FORM
SENIOR HIGH ADMISSION TEST (SHAT)
SY 2023 - 2024
Application Form No. __03251_
Appl. & Testing Fee: P200.00_______
O.R./M.O. No.______________________
Date Paid:_________________________
Recorded by:______________________
PERMIT No.:_______________________
Queue Date________________________
To the applicant and Parents:
CAREFULLY READ THE INSTRUCTIONS contained in this form before filling in the
information asked for.
Only CORRECTLY and COMPELETELY FILLED-UP FORMS will be issued a TEST
PERMIT.
PRINT ALL ANSWERS.
SHS TRACK:
STEM
1. PRINT YOUR NAME IN THE FOLLOWING SEQUENCE: Last Name, First Name, Middle Name.
Last Name
First Name
Middle Name
ALMONTE
Check one box only:
2. SEX
ANDREA GALE
3. CITIZENSHIP
Male
✓ Female
✓ Filipino
FRANCISCO
NonFilipino
5. Permanent Home Address
4. RELIGION:
ROMAN CATHOLIC
Number and Street #627, P-5, BLOCK 3, LOT 8, NAPOVILLE
Subd/Village, Brgy. NAPO
City/Town & Province POLANGUI, ALBAY
Postal Zip Code
4506
Telephone No./Cell No. 09472815176
6. Name of High School: BICOL REGIONAL SCIENCE HIGH SCHOOL
School Address LIGAO CITY, ALBAY
7. Date of Birth:
2006
Year
MAY
3
Month
Date
9. Occupation of Father/Guardian: MARINE ENGINEER
10. Number of children in the family
2
8. Place of Birth:
AQUINAS HOSPITAL, LEGAZPI CITY
Town/City
Occupation of Mother/Guardian TEACHER
Email Address of Parents/Guardian zarah.almonte@deped.gov.ph
Contact Number of Parents/Guardian 09296152001
11.Aggregate MONTHLY FAMILY INCOME : (Check one box only.)
Less than P10,000.00
P15,000.00 - P20,999.00
P11,000.00 - P14,999.00
P21,000.00 - P30,999.00
P31,000.00 - P49,999.00
✓
Exceeding P50,000.00
I hereby certify that all information herein contained is true and correct.
Signature of Applicant
Signature of Parent/Guardian
Document No. BU-F-ADMISSION-26
Effectivity Date: March 17, 2021
Rev.1