DepEd-National Capital Region

DIVISION OF CITY SCHOOLS VALENZUELA

Valenzuela City

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1 X 1

VALENZUELA CITY SCIENCE HIGH SCHOOL

VCSHS Form 1

APPLICATION FORM

APPLICANTS PERSONAL DATA:

Name: _______________________________________________ Sex: ___________ Age: _________
Last
First
Middle
Date of Birth: _______________________________ Place of Birth: ___________________________
Complete Address: _______________________________________________ Tel. No: _____________
School: _____________________________________________________
Public
Private
Location: _______________________________________________ Schools Tel. No: ______________
Father: __________________________________________ Occupation: _________________________
Mother: _________________________________________ Occupation: _________________________
_______________________
Date

_______________________________
Applicant
(Signature over printed name)

CERTIFICATION

_____________________
Date

TO WHOM IT MAY CONCERN:

This is to certify that _________________________________ belongs to the upper 10% of the entire
Grade VI graduating class this school year _______________ and does not have any grade below 83 % in all
his/her subjects for the first and second grading periods.
_______________________________
School Head
(Signature over printed name)

PARENTS CONSENT
I hereby give my consent to my son/daughter ____________________________________ of
_______________________ Elementary School to take the Selection Test for Admission to the Valenzuela City
Science High School on
. If my child qualifies through the examination and interview,
he/she will promptly enroll in said school, will abide with the policies, and rules and regulations of the school.
________________________________
(Signature of Father/Guardian)

__________________________________
(Signature of Mother/Guardian)

EXAMINATION PERMIT
Date of Examination:
Place of Examination: VCSHS-A. Marcelo St., Dal., Val. City

O.R. No. _________________

Date ____________________

VALENZUELA CITY SCIENCE HIGH SCHOOL

Examination Permit

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1 x 1

Name: _______________________________________ School: _______________________________________

Address: _________________________________________________________ Tel. No: ___________________
Date of Examination: ______________________ Place of Examination: VCSHS-A. Marcelo St., Dalandanan, Val. City
.
This form may be photocopied / reproduced

APPLICATION PROCEDURE
As an applicant to the Valenzuela City Science High
School, you must submit the following:
1. Accomplished
photographs;

VCSHS Form I with two (2) 1 X 1

2. A Certified True Copy of the F138 with grades for the first
and second grading periods duly signed by the principal /
school head should be submitted during the filing of the
application form; and
3. An examination fee of P ______ to defray the expenses in
the processing, administration, and scoring of the test.

Please forward this application to the VCSHS c/o Office of the Principal
MR. ARNEIL D. ARO, A. Marcelo St., Dalandanan,
Valenzuela City.
DEADLINE FOR SUBMISSION OF THIS FORM WILL BE ON OR
BEFORE _________________, 2009
For inquiries please contact VCSHS Tel. No. 291-55-91

REMINDERS TO THE EXAMINEE

1. Be at your testing center at least 30 minutes before the schedule of
examination.
2. Present this examination permit and your school ID to the Examiner.
3. Bring at least two (2) sharpened soft lead pencils (Mongol #2) and a
good eraser.