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LOURDES SCHOOL OF MANDALUYONG

Shaw Blvd., Greenhills, Mandaluyong City 1552


Webpage Address: www.lsm.edu.ph
P.O. Box 12959 Ortigas Center Pasig City 1605
6311921;6329547;6316307;6316356;6339443;6316310

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APPLICATION FORM
Applying for _______________________________________
(Grade/Year Level)

PERSONAL DATA
Name: __________________________________________________________________ Tel. No.: ___________________
(Last Name)

(Given Name)

(Middle Name)

Address: _____________________________________________________________________________________________
Date of Birth: ________________________________ Place of Birth: _________________________________________
Nationality: __________________________________ Religion: ______________________________________________
Date of Baptism: _____________________________ Church where Baptism was held: ______________________
Name of All Schools Previously Attended
School

Grade/Year

Brothers presently studying in Lourdes School of Mandaluyong


Name

School Year

Grade/Year Level

If not living with parents, state with whom:


Name of Guardian: ___________________________________________________________________________________
Address: _____________________________________________________________________________________________
Occupation of Guardian: _____________________________________________________________________________
FAMILY DATA
FATHER

MOTHER (Maiden Name)

Name:______________________________________________
Date of Birth:_______________________________________
Nationality:_________________________________________
Religion:____________________________________________
Occupation:_________________________________________
Office Address:______________________________________
Tel. No.:_____________________________________________

____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________

Educational Background
Grade School: _______________________________________
High School: ________________________________________
College: _____________________________________________
Post Graduate: ______________________________________

____________________________________________
____________________________________________
____________________________________________
____________________________________________

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Signature of Parent/Guardian
______________________________
Date

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