Mindanao State University

ILIGAN INSTITUTE OF TECHNOLOGY

Andres Bonifacio Avenue, Tibanga, Iligan City 9200 Philippines
COLLEGE OF SCIENCE AND MATHEMATICS
Telefax: +63 63 221 4068 / +63 63 221 4054 local 145 http://csm.msuiit.edu.ph

page 1 of 2
CSM GP Form 1

APPLICATION FOR ADMISSION TO A GRADUATE PROGRAM

passport size
INSTRUCTION: Type or print clearly in ink and submit this application photo here
form together with all the requirements.
Degree Sought: ________________________ Major: _______________
st nd
[ ] 1 Semester [ ] 2 Semester [ ] Summer of Academic Year: ______
Name: _______________________, __________________ ________
Last First M.I.
_________________ _________________ _________________ ___________________
Date of Birth Place of Birth Citizenship Tel. No.: Home/Office

E-mail Address(es): __________________________ Mobile No.: ______________________

Address: ________________ _________________ _________________ ____________
No./Street City/Town Province Zip Code
Marital Status: Married _____ Single ______ Widow/Widower _____
Information on nearest relative (Father/Mother/Spouse/Guardian):
_________________________ _____________________________________ _____________
Full Name Address/Telephone Number Relationship

Education (from secondary to highest university education)

Institution Location Date Attended Degree and Major
________________________ _________________ ____________ ___________________
________________________ _________________ ____________ ___________________
________________________ _________________ ____________ ___________________

Scholastic honors or awards/special trainings: ________________________________________

_____________________________________________________________________________

Title of Examination Date Taken Rating

Civil Service Eligibility: ______________________________ __________________ ______
Professional Licensure: ______________________________ __________________ ______

Professional Experience (from latest employment; include teaching and research. Use additional
sheet or you may use the back of this sheet, if necessary.)

Position Employers Name/Address/Tel. No. Inclusive Dates Remarks

____________ _______________________________ __________________ _____________
____________ _______________________________ __________________ _____________
____________ _______________________________ __________________ _____________

References
Name and Title: ____________________________________ Address: __________________
Name and Title: ____________________________________ Address: __________________

I declare that the information supplied in this application and the documents supporting it are
true and complete. I acknowledge that the provision of incorrect information and/or documentation in
relation to my application may result in cancellation of admission or enrollment. If admitted, I agree to
abide by the policies, rules and regulations of the College of Science and Mathematics, MSU-IIT.

________________________ _____________
Signature Date
CSM GP Form 1 page 2 of 2
Name of Applicant: _______________________________________________________

Degree Sought: _________________________________________________________

Classification: (to be filled up by the Program Coordinator)

REGULAR CONDITIONAL PROBATIONAL

SPECIAL NOT QUALIFIED

Remarks: _____________________________________________________________________
_____________________________________________________________________________

RECOMMENDING APPROVAL: APPROVED:

__________________________ __________________________
Program Adviser Dean, CSM

Notes:

Admission Requirements:
(1) A bachelors degree, or masters degree, from a recognized institution is required for admission to
a masters program or doctoral program, respectively.
(2) For an applicant to a masters program, an undergraduate Grade Point Average (GPA) of 2.00 or
better, and for an applicant to a doctoral program, a GPA of 1.75 or better in the masters program;
or some evidences of potential ability to pursue a graduate degree, e.g., excellent performance in
teaching or research.
(3) Evidence of suitable background or its equivalent in the degree sought.

Classification of Graduate Students:

Regular - a full-fledged regular graduate student who satisfactorily complies with all the requirements
for admission, including those prescribed by the department/college offering the degree.
Conditional - an applicant with deficiencies, e.g., prerequisite courses, but satisfies all the basic
requirements for admission. The said deficiencies should be satisfied on or before the
end of the second semester of the first year of attendance. A student on conditional
status is dismissed from CSM if he/she fails to earn a GPA of 2.00 or better in the first
semester of residence for the masters degree, or a GPA of 1.75 or better for the
doctoral degree.
Probational - an applicant who fails to earn an undergraduate GPA of 2.00 or better but has proven
to be capable to pursue a masters degree, or an applicant who fails to earn a GPA of
1.75 or better in the masters degree but has proven to be capable to pursue doctoral
studies. A student on probation is dismissed from CSM if he/she fails to earn a GPA of
2.00 or better in the first semester of residence for the masters degree, or a GPA of
1.75 or better for the doctoral degree.
Special - an applicant who, in writing, does not intend to pursue a graduate degree but seeks
admission to the Graduate Program to register in some courses. Credits earned during the
period as a special student are not credited for any degree unless the basic requirements for
admission to the degree have been satisfied, approved and recommended by the
department/college. Such credits shall not exceed nine (9) units.
Not Qualified - an applicant who does not have the necessary preparation to pursue the degree
sought.
Other Requirements: Submit two sets of documents to the program coordinator, each containing the following items: (1)
accomplished admission form, (2) Photocopy of Transcript of Records, (3) Photocopy of Transfer Credentials/Honorable
Dismissal (for non-MSU alumnus), (4) passport size photo attached to the Application for Admission form, (5) official receipt of
the admission fee, and (6) if possible, two letters of recommendation from former professors or experts in your field (in sealed
envelop).

Note: To claim the Certificate of Admission, the student must submit the approved Program of Study to the Deans Office.
 Mindanao State University
ILIGAN INSTITUTE OF TECHNOLOGY
Andres Bonifacio Avenue, Tibanga, Iligan City 9200 Philippines
COLLEGE OF SCIENCE AND MATHEMATICS
Telefax: +63 63 221 4068 / +63 63 221 4054 local 145 http://csm.msuiit.edu.ph

CSM GP Form 2

RECOMMENDATION FORM FOR ADMISSION TO A GRADUATE PROGRAM

Name: Mr./Ms. ________________________ ________________________ _____________

Last Name First Name Middle Name
Degree Sought: _____________________________________ Major: ____________________
st nd
[ ] 1 Sem [ ] 2 Sem [ ] Summer Academic Year: _________________________________
How long have you known the applicant? _______________________________________ years
In what capacity have you known the applicant? _______________________________________
He/She ranked ________________________in my class of ______________________students.
Please rate the applicant by checking the appropriate box of corresponding characteristics in
comparison with other students in his/her class or other persons you have known. You may use the
back of this sheet for additional comments. Your evaluation will be kept confidential.

Excellent Good Satisfactory Average No Basis for

Upper 5% 6-20% 21-50% Below 50% Judgment
Intellectual ability
Academic preparation for
proposed field of study
Motivation
Analytical and problem
solving ability
Initiative and
Independence
Diligence in study and work
habits; Honesty and integrity
Oral communication
Skills
Written communication
Skills
Emotional
Maturity
Potential as
a teacher
Potential as
a researcher

Check the level of your recommendation of the applicant for admission to graduate studies:
__ Recommend with
__ Strongly Recommended __ Recommended __ Not Recommended
Reservations

Printed Name: _____________________________________ Signature: ________________

Position: _____________________________________ Date: ____________________
E-mail Address: ________________________________________________________________
Name and Address of Organization: ________________________________________________
Note: Please enclose the completed form in an envelope, seal the envelope, and sign across the seal. Return
the sealed envelope to the applicant or mail directly to the Dean, College of Science and Mathematics, MSU-
Iligan Institute of Technology, Tibanga, Iligan City 9200.