NEW OLD

SCHOOL YEAR_______________ 1X1 PICTURE

LRN # ______________________
ADMISSSION FORM
LAST NAME FIRST NAME MIDDLE NAME

GRADE LEVEL APPLIED FOR: ___________________________

GENERAL AVERAGE: ________________________ HONORS RECEIVED: ________________________

DATE OF BIRTH PLACE OF BIRTH DO NOT FILL OUT

 Original and Photocopy F138
 2 Photocopies (PSA) Birth
Month day year Certificate
 Photocopy Baptismal Certificate
AGE GENDER NATIONALITY RELIGION  Certificate of Good Moral
 ESC Certificate
 Long Brown Envelope
SUBMISSION DATE: _______________
COMPLETE HOME ADRESS
vv

No. Street Village / Subdivision Barangay City Province Zip Code

FOR NEW PUPIL(S)/STUDENT(S) ONLY

LAST SCHOOL ATTENDED GRADE LEVEL

SCHOOL ADDRESS GENERAL AVERAGE Honors Received:

FAMILY INFORMATION

FATHER MOTHER
NAME
(Last Name, First Name, Middle Name)
HIGHEST EDUCATIONAL ATTAINMENT
OCCUPATION
BUSINESS ADDRESS
CONTACT NUMBERS
Name of Brother(s)/Sister(s) Enrolled in LRAI:
Name Level
______________________________________________________ _______________________
______________________________________________________ _______________________
______________________________________________________ _______________________

IN CASE OF AN EMERGENCY, IF UNABLE TO CONTACT PARENT, CONTACT:

LEGAL GUARDIAN RELATIONSHIP TO APPLICANT

ADDRESS CONTACT NO.

I DECLARE THAT THE INFORMATION PROVIDED HEREIN ARE TRUE AND CORRECT.
___________________________________
SIGNATURE OVER PRINTED NAME

SCHEDULE OF FEES
Check the level where you belong DO NOT FILL OUT
PRE-ELEMENTARY ELEMENTARY HIGH SCHOOL ASSESSMENT
PLAN A: 18,596.50 PLAN A: 19,466.00 PLAN A: 20,361.00
Amount Paid : ________________
PLAN B: 10,687.75 PLAN B: 11,140.50 PLAN B: 11,606.50 Date : ________________
PLAN C: 10,854.50 PLAN C: 11,346.00 PLAN C: 11,855.00 O.R. # : ________________

PLAN D: 5,463.10 PLAN D: 5,644.200 PLAN D: 5,830.60

Assessed By: ___________________

DISCOUNT ON TUITION FEE ONLY: SPECIAL DISCOUNT ON BROTHERS & SISTERS (Given only to the youngest child)
100% - Rank 1 50% - Rank 2 40% - 4th Child 30% - 3rd Child
10% - PLAN A 20% - 2nd Child