SAN PABLO CITY SCIENCE HIGH SCHOOL

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SENIOR HIGH SCHOOL APPLICATION FORM

Instructions: 1” X 1”
Please type or print legibly all information needed. DO NOT ABBREVIATE. DO NOT PICTURE
LEAVE ANY ITEM BLANK
DEADLINE OF SUBMISSION: MARCH 8, 2019

Track Applied for :  STEM Learners Reference Number (LRN)

I. PERSONAL INFORMATION:
1. Last Name: First name: Middle Name:

2. Permanent Mailing Address:

( House Number, Street (Cmpd, Block, Lot, Sitio, Purok), Barangay, Town / City, Province, Postal Code)
3. Date of Birth: Place of Birth: Nationality: SEX:
(MM/DD/YYYY))
4. Landline: Mobile Number: Email Address:

II. FAMILY BACKGROUND:

FATHER’S NAME: MOTHER’S NAME:

OCCUPATION

NAME OF COMPANY

MONTHLY SALARY

CONTACT NUMBER/S
GUARDIAN: Relationship to applicant NUMBER OF
SIBLINGS:

III. EDUCATIONAL INFORMATION:

ELEMENTARY SCHOOL (Where you completed Elementary Level Education / Grade 6)
School Name (Do not Abbreviate) Type of School
Public Private
Address (Street, Barangay, City / Town, Province) Month /Year of Completion

JUNIOR HIGH SCHOOL (where you completed /completing JHS / Grade 10)
School Name (Do not Abbreviate) Type of School
Public Private
Address (Street, Barangay, City / Town, Province) School Contact Number: Month /Year of Completion

TO BE FILLED OUT BY SCHOOL AUTHORITY CONCERNED:

1. I hereby certify that the applicant is currently enrolled as Junior High School
student for school year 2018-2019. I hereby certify that the student-
2. I further certify that the student-applicant does not have a grade lower that 83 applicant is of good moral
in English, Mathematics and Science (for STEM) and does not have a grade character.
below 80 in other subjects in any quarter.

School Head/ Registrar’s Signature over Printed Name Adviser/ Guidance Counselor’s
Signature over Printed Name

TO BE FILLED OUT BY THE SCREENING:

Documents submitted:
______ NCAE (photocopy) Received by: _______________________
______ Photocopy of Form 138 (Report card)
______ Photocopy of Birth Certificate Date: ______________________
______ 1x1 picture with name tag

Additional Requirement: REMINDERS:

Php 30.00 for Miscellaneous fee 1. Be on your testing area at least 30 minutes before your
schedule examination,
2. Bring your examination permit and school ID,
3. Bring at least 2 (two) sharpened pencils with eraser and
sharpener,
4. Examinees should wear school uniform or decent attire (do not
wear shorts, mini skirt or sleeveless, ripped jeans, etc).