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2019 Application Form For Admission PDF
2019 Application Form For Admission PDF
FAMILY BACKGROUND
Father Mother Guardian____________________
(Specify relationship)
Full Name: _____________________ ______________________ ___________________________
Contact no: _____________________ ______________________ ___________________________
Occupation: _____________________ ______________________ ___________________________
Number of Sibling/s: ______ Birth Order: Eldest Second Middle Youngest Only Child
Estimated Monthly Family Income: (Please tick the appropriate box)
below -10,000 11,000 – 20,000 21,000 – 30,000 31,000 – 40,000 41,000– 50,000 above 50,000
EDUCATIONAL BACKGROUND
Name of School Address Year Graduated
Elementary ______________________ ______________________ ______________
Senior High School ______________________ ______________________ ______________
Vocational ______________________ ______________________ ______________
College - For Transferees: _________________ ______________________ Course: ____________
For Second Courser: _________________ ______________________ Course: ____________
MEDICAL HISTORY INFORMATION
List any medications you are taking: ________________
Do you have any of the following? Kindly put a check (✓) To be filled up by the OSAS/Guidance Staff
Allergy (specifically, allergic to: __________________) Date of Exam and time: ______________________
Asthma SUBMITTED REQUIREMENTS
Hypertension
Diabetes □ 2 copies of 1x1 ID Picture
Insomnia □ Short ordinary white folder
New Student (SHS, ALS, BEC graduate)
Vertigo □ Photocopy HS or SHS Form138 / Certificate of ALS
Scoliosis or physical condition, specify: __________ Rating
Others, please specify: _______________________ □ Photocopy Certificate of Good Moral Character
None Transferee / Second Degree taker
□ Photocopy Transcript of Records / Certificate of Grades
□ Photocopy Transfer Credentials / Honorable Dismissal
I hereby attest that all information stated above is true and correct. □ Photocopy Certificate of Good Moral Character
□ Photocopy NBI Clearance
______________________________ □ Photocopy Interview slip
Second Degree taker
Signature over printed name □ Photocopy Transcript of Records
□ Interview slip
Assessed by: ________________
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PLEASE ATTACH THE FOLLOWING REQUIREMENTS ON THIS APPLICATION
FORM:
FILIPINO APPLICANTS
MUST: All requirements shall be placed in a short ordinary FOLDER.
SECOND COURSER:
1. Photocopy of TOR or Certification of grades signed by the Registrar
2. Two copies of 1x1 ID Picture
FOREIGN APPLICANTS
Process Flow for Foreign
1. Approved permit to study from the concerned embassy Applicants:
2. Report Card or Transcript of Records from High School last attended
1. Foreign applicants must
3. Police Clearance Certificate issued by the National Police Authorities
proceed first to the
from the applicant’s country of origin or/and NBI Clearance Registrar’s Office for initial
4. Affidavit of financial support duly authenticated by evaluation of requirements.
2. Registrar office shall issue a
the Philippine Foreign Service Post
simple note that they have
5. Certificate of English Proficiency (as necessary) checked their requirements
6. Photocopy of Certification of Good Moral Character and allow the Guidance office
to process the applicant’s
7. Two pieces 1x1 ID Picture examination
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