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MINDANAO STATE UNIVERSITY

SYSTEM ADMISSION & SCHOLARSHIP EXAMINATION 2019 (MSU-SASE) Paste 2” x 2” ID photo


(This form is Not for Sale. No Fold/No Creases)
in white background,
Cover shaded box with APPLICATION with NAME TAG inside
the sticker provided
FORM this box.
Requirements: Important: DO NOT
1. Certification from High School Principal that the applicant is a Grade 12 student. If graduated previously in Senior High School,
diploma or Grade Card is required;
STAPLE.
2. Two (2) copies 2” x 2” ID pictures; with complete name tag and white background; (Use paste or glue or
3. Duly accomplished Application Form.
4. Submit not later than October 30, 2018. No onsite application during the examination day. No Application Form will be submitted
plastic tape.)
AFTER deadline. MSU- SASE is FREE. No Testing Fee.
Instruction: Accomplish this form carefully. Make sure you double check that every required information is complete, correct, and accurate. Any wrong information can be
ground for disqualification either in taking the exam or in admission to MSU. Please PRINT all entries neatly and legibly USING BALLPEN. DO NOT LEAVE any blank
unfilled, Else, your application will not be processed. OVPAA/MSU-SASE Unit cannot and will not make any changes for your SASE Report of Rating other than what is
submitted in the Application Form.
WARNING and IMPORTANT NOTE: Before answering campus preferred, consult with Parents/Guardians.
Students from other PREFERRED CAMPUS MAY NOT BE ACCEPTED IN ANOTHER CAMPUS DUE TO LIMITED SLOTS AND VARYING CUT OFF SCORES.

1. MSU CAMPUS PREFERRED: ____________________________________ Test Center Code: ________________

Choose one Campus where you intend to study.: (MSU-Marawi, MSU-Iligan Institute of Technology, MSU-General Santos, MSU-Tawi-Tawi, MSU-Sulu, MSU-Maguindanao,
MSU-Naawan, MSU-Buug, MSU-LNAC Sultan Naga Dimaporo, MSU-Maigo School of Arts & Trades, MSU-LNCAT)

YOUR BIOGRAPHICAL DATA (as it appears on your Senior High School record)
2. LAST NAME:
FIRST NAME:
MIDDLE NAME:
3. Age: ______ 4. Sex:  Male  Female 5. Civil Status:  Single  Married 6. Religion: ____________________ 7. Citizenship: _____________
8. Date of Birth: MM___ DD___ YY _____ 9. Place of Birth: 10. Cellphone Number:
11. Present Address: 12. Zip Code:
13. Permanent Home Address: 14. Zip Code:
YOUR EDUCATIONAL BACKGROUND
15. TRACK/STRAND: 16. LRN:
17. NAME OF SCHOOL CURRENTLY ENROLLED:
18. ADDRESS OF SCHOOL:
19. Type of School:  Private  Public
20. PREFERRED PROGRAM: Please refer to Program Flyer and make sure the program is available in your preferred campus. Write your preferred program and
its program code. (Important Note: MSU-Marawi and MSU-IIT have quota programs, certain colleges/departments have additional admission
requirements or you cannot be accommodated because of required minimum scores in certain programs.)
1st Choice: 2nd Choice:
YOUR PARENTS’ DATA
FATHER MOTHER (Maiden Name)
NAME: 21. 22.

CONTACT NUMBER: 23. 24.

OCCUPATION: 25. . 26.

MONTHLY FAMILY INCOME: 27. 28.

ETHNIC ORIGIN/TRIBE: 29. 30.


(Ethnic Origin/Tribe of parents must be indicated. Example: Meranao, Tausog, Cebuano, Ilonggo, Higaonon, Kalagan, Kamayo, Maguindanao, Manobo,
Mamanwa, Mansaka, Sama, Jama Mapun, Kalibugan, Boholano, Iranun, Ilocano, Subanen, B’laan, T’boli, others, or not applicable (N/A)).

(Processor cuts along dashed line!) M S U S AS E P E R M I T


NAME OF TAKER:
____________________________________________________________________________________________________
(Last Name) (First Name) (Middle Name) Paste 2” x 2” ID photo in white
NAME OF SCHOOL CURRENTLY ENROLLED: background, with NAME TAG
ADDRESS OF SCHOOL: inside this box.
BRING THE FOLLOWING PLACE OF EXAM: Important: DO NOT STAPLE.
ON EXAMINATION DAY: ___________________________________________________________________
Building Room No. (Use paste or glue or plastic
1. This Exam. Permit DATE: TIME: tape.)
2. School ID
PROCESSOR PRINTED NAME and SIGNATURE: STUDENT’S SIGNATURE:
3. Pencil (Lead No. 2)
4. Rubber Eraser
5. Blue or black Ballpen
Test Center Code:
Important Instruction: PRINT/SHADE the bubbles/circles using a dark lead pencil.
31. Test Center Code: 

32. Test Center Address:

_______________

33. LAST NAME: FIRST NAME: MIDDLE NAME:


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  
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  
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  
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34. Sex  35. Civil Status 
I hereby certify that all entries on this form are true and correct.

36. Applicant’s Signature over Printed Name: ________________________________________________________________ Date: _____________________________

37. Parent’s/Guardian’s Signature over Printed Name: _____________________________________________________ Date: _____________________________