QVA No.

: 21-AAF6EB0A

Senior High School Voucher Program

Qualified Voucher Applicant Certificate

This is to certify that CIRILO, ETHAN MARIUS URBANO is a Qualified Voucher Applicant (QVA) of the
Senior High School Voucher Program of the Department of Education.

Declared Learner Reference Number: 400846150077

Junior High School: San Lorenzo Ruiz School
City/Municipality: Meycauayan City
Validity: Grade 11, School Year 2021 - 2022; up to Grade 12, School Year 2022 - 2023 only

By applying to the SHS Voucher Program, the student above declared that he/she is eligible to apply to the
Senior High Voucher Program and belongs in one of the following categories:

Category D - Filipino Grade 10 completers in private schools in SY 2020 - 2021 who are not ESC
grantees
Category E - Filipino Grade 10 completers who completed Grade 10 prior to SY 2020 - 2021 but not
earlier than 2016 and had not previously enrolled in Grade 11
Category F - Filipino Learners who had passed the ALS A&E Test for Grade 10 not earlier than 2016 and
had not previously enrolled for Grade 11 or will take the ALS A&E Test in SY 2021 - 2022
Category G - Filipino Learners who passed the PEPT for Grade 10 not earlier than 2016 and had not
previously enrolled for Grade 11 or will take the PEPT in SY 2021 - 2022

The student-applicants and their parent and/or guardian may be held liable for any misdeclaration or
falsification of data that could have led to the acceptance of his/her application.

Notes to the Senior High School:

1. The QVA Certificate is only for those who applied to the SHS Voucher Program and does not include
those who are automatically eligible (Grade 10 completers in public schools and Grade 10
completers in private schools who are ESC Grantees)
2. The SHS Voucher may be used only when the student enrolls in a private Senior High School or in
State/Local Universities and Colleges.
3. Qualified Voucher Applicants are expected to comply with the admission requirements of the Senior
High School provider.
4. Students under Category F and Category G must still present proof to the school that
they had passed the ALS Equivalency Test and PEPT and are eligible to enroll in Grade
11.