Professional Documents
Culture Documents
Birth Date:
Age:
Birth Place:
Sex
1 x 1 ID
Picture
Citizenship:
Religion:
Average Grade:
Family Data
Name
Age
Occupation
Income
Father
Mother
Guardian
Brothers/Sisters
Applicant's Statement
I hereby apply for admission into the First Curriculum Year at the above named private high school
that participates in the Educational Service Contracting Program of the Department of Education. If
selected, I will abide by the policy guidelines of the ESC Program and the rules of the school where
I will be enrolled. All the information supplied above is correct to the best of my knowledge. Any
willful misrepresentation made by me shall be sufficient reason for my disqualification.
Applicant's Signature
ESCF02-02
Student
Parent/Guardian
School Head
Note: Signature over printed name.
2010-ESCF01-01
This Billing Statement also serves as the contract between DepED and the private school
with regard to the latter's participation in the ESC program of the GASTPE in accordance with
the program guidelines issued for the school year stated above.
Instructions: Please prepare 4 copies of this form and no erasures.
Billed to:
Department of Education
Address:
Pasig City
Date:
School Id:
School Name:
School Address:
On account of: ESC Grants for School Year 2011-2012
Total Grantees & Amount Due for ESC School Year 2011-2012(ESC-Returnees)
Year Level
No. of
Grantees
Amount of
Grant
5,500.00
First Year
Second Year
5,500.00
Third Year
5,500.00
Fourth Year
Total Grantees
5,500.00
otal Amount Due
We certify, under the penalties of perjury, that the data entered above are consistent with the list of
qualified ESC-Returnees listed in ESC Form 2.
School Head
Note: Signature over printed name.
Special Instructions:
Please deposit payments to school's account with Land Bank of the Philippines (LBP). The account
details of which are as follows:
Branch:
School Account Name:
Account number:
Requirement: Please attach an IMI1 or STI1 printout from signed by the bank's branch manager.
Recommending approval for payment amounting to Php_______________________________
School ID
Name of School
Region
Province
Municipality
Street/Barangay
of
Page
No. of grantees for this page
Instructions: Please prepare 4 copies. Type the data needed. The students' names shall be alphabetically arranged (Last Name first and then First Name) regardless of gender, year level, or class section. No erasures allowed.
No.
Last Name
First Name
MI
Gender
Current Year LevelLast School Year Attended
Reason for Dropping/Leaving School
No.
We certify, under the penalties of perjury, that the list of students entered above are the qualified ESC-Returneesfor School Year 2011-2012in accordance with the ESC Implementing
Guidelines and have attended classes until July 15, 2010.
Parents' Association President/Representative
Note: Signature over printed name.
School Head
2010-ESCF03-01
School Id:
School Name:
School Address:
First Year
I.
Tuition Fee
II.
Second Year
Third Year
Fourth Year
Miscellaneous Fees
(Please indicate breakdown)
IV.
Total School Fees (Sum of Part I, Part II, and Part III)
P
V.
Please indicate any special concessions given to ESC grantees (e.g. tuition waiver, discounts, any forms of assistance, etc.)
P
We certify, under the penalties of perjury, that the above information contained herein is true and correct and is in accordance
with the ESC Implementing Guidelines.
School Head
Note:Signature over printed name.
Please attach a true copy of the current school year's schedule of tuition and other school fees submitted and marked
received by the DepEd Regional/Division Office.
School ID
Name of School
Region
Province
Street/Barangay
Instructions: Please prepare 4 copies. Type the data needed. Teachers' names shall be alphabetically arranged (Last Name first and then First Name) regardless of their gender. No erasures allowed.
No.
Last Name
First Name
MI
Gender License Number Date of Birth
Total Subsidy
Taxes Witheld Amount Received
Signature
We certify, under the penalties of perjury, that the list above are teachers who are qualified to participate in the Teacher Salary Subsidy Program.
School Head
Date Received
Date Received
School Head
No.