To the School Administrator or Teacher: Kindly accomplish this form.

Type or print legibly all

information needed. Return to the parent/s of the student with your signature. Thank you.

CERTIFICATION

This is to certify that _____________________________________ is a

bona fide student of ___________________________________________________
Name of School and Address

for School Year 2013-2014. He is 5 years old and is presently enrolled in a level
that is preparatory to Grade 1.

This certification is issued upon the request of :

Mr./Mrs./Ms._______________________________________________
Name of Parent/Guardian

for application purposes.

____________________________
School Head
Signature over printed name
Pls. affix school’s dry seal.
________________
___ The school has no dry Date
seal.