Application Form 1

ENTRANCE FOR ADMISSION APPLICATION FORM

REGIONAL SCIENCE HIGH SCHOOL S.Y. 2013-2014

NOT FOR SALE REPRODUCTION IS ALLOWED

Staple Only
Instructions: Please accomplish this form. Type or print legibly all information needed. DO NOT ABBREVIATE. DO NOT LEAVE ANY ITEM BLANK. Countersign all erasures and corrections made.

1X1 Photo

PERSONAL DATA: 1) NAME OF APPLICANT: (Last Name , First Name , Middle Name ) 2) BIRTHDAY: M M D D Y Y Y Y 6) COMPLETE HOME/PERMANENT ADDRESS: 3) AGE as of June 30, 2012: 4) SEX: MALE 5) CONTACT FEMALE NUMBERS:
(Include all possible numbers)

Zip Code 7) Congressional District Province

SCHOOL AND SCHOLASTIC INFORMATION: (To be filled out by the Class Adviser/ Principal) 1) NAME OF SCHOOL: _______________________________________________ 2) COMPLETE SCHOOL ADDRESS:________________________________________________________ 3) SCHOOL TYPE

PUBLIC
PRIVATE with license Y N

4) SCHOOL CONTACT NO.:________________________________________________

SY 2011-2012 Gen. Weighted Average Batch Rank Honors Received (if available) Special Awards:________________________________

SY 2012-2013 (This portion is a MUST for pupil-applicant to supply the needed data)

Performance Rating 1st Quarter 2 Quarter 3rd Quarter

nd

English

Math

Science

I hereby certify that the pupil applicant is of good moral character and officially enrolled in this school for S.Y. 2012-2013. This certifies further to the accuracy and correctness of the foregoing data/ information.

Printed Name and Signature of Class Adviser/Principal Dates to remember: November 5, 2012 January 4, 2013 - Filing and Deadline of PQF1 January 5-11, 2013 - Posting of Qualified Pupil Applicants to take the Admission Test January 15, 2013 January 16, 2013 - 1st Screening Exam for Congressional Districts I & II - 1st Screening Exam for Congressional Districts III & IV, Cauayan City, Santiago City, Tuguegarao City, Cagayan, Quirino, and Nueva Vizcaya - Posting of 2nd Screening Qualifiers March 1, 2013 - Second Screening Examination March 5 - April 5, 2013 - Posting of Qualifiers for oral interview April 8, 2013 - Oral Interview and Enrolment January 21, 2013

QUALIFIED
IMPORTANT:

NOT QUALIFIED

1. Entrance for Admission Application Form (AF1) is available at school registrars office and can be downloaded at school website. 2. Latest photocopy of F138 (report of rating). 3. Bring pencil #2 and blank sheets of bond paper for problem solving in mathematics on examination day. 4. Qualifiers will receive a report of rating individually. 5. Walk-in /on-site registration of pupil examinees will be allowed provided the following requirements are met: 1. 1x1 ID picture 2. Accomplished entrance for admission application form 3. Latest photocopy of F138 (report of rating)

School website:

regionalsciencehigh02.blogspot.com/ http://bropitkarldict.wix.com/rshs02