Republic of the Philippines

Department of Education
NATIONAL CAPITAL REGION
SCHOOLS DIVISION OF LAS PIÑAS CITY

LAS PIÑAS CITY NATIONAL SCIENCE HIGH SCHOOL CONTROL NO.: ________
Application Form for S.Y. 2023 – 2024

Instructions:
Please accomplish this form. Fill out all the information needed. 1” x 1”
DO NOT ABBREVIATE AND DO NOT LEAVE ANY ITEM BLANK. ID Photo

PERSONAL DATA
1) NAME OF APPLICANT (Last Name, Given Name, Middle Name): 2) BIRTHDATE (mm/dd/yyyy):

3) AGE (as of June 1, 2023): 4) SEX: 5) CONTACT NUMBER:

___ Male
___ Female
6) COMPLETE PERMANENT ADDRESS (please include your zip code):

7) HEALTH/MEDICAL CONDITION OF THE APPLICANT:

EDUCATIONAL BACKGROUND
1) NAME OF SCHOOL (write the name of the school in full): 2) COMPLETE SCHOOL ADDRESS

3) SCHOOL TYPE (Elementary): 4) SCHOOL CONTACT NUMBER:

___ Public
___ Private
5) APPLICANT’S GENERAL AVERAGE (S.Y. 2022 – 2023):
Quarter 1: Quarter 2: Quarter 3:

1” x 1” EXAMINATION PERMIT CONTROL NO.: ________

ID Photo

This is to certify that the bearer of this permit is _______________________________________, an elementary school
pupil of __________________________________________ located at ____________________________, for school
year 2022 – 2023. The applicant is eligible to take the entrance examination on May 31, 2023, at Las Piñas City National
Science High School, Carnival Park St., BF Resort Village, Talon Dos, Las Piñas City.

REMINDERS TO THE EXAMINEE:

1. Be at the testing center one hour before the scheduled examination.
2. Present the Examination Permit and school ID to the Proctor/Room Examiner.
3. Bring at least two (2) sharpened #2 pencil, a good eraser, and snacks.