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HIGH SCHOOL 2OT2PHILIPPINESCIENCE (NCE) EXAMTNATTON NATTONAL COMPETTTTVE APPLICATIONFORM

TIIC'CMRTCRIRT' RRCNOT fOR 'OTC. TilCY MNY BCPIIOTOOOPICD.

Instructions: Please accomplish this form in two copies, Type or print legibly all information needed. ABBREVIATE. DO NOT LEAVEANY ITEM BLANK. Countersign all erasures and corrections made. DEADLINEOF SUBMISSION: PERSONAL DATA: 1) NAME OF APPLICANT: (Last Name, Firct Name, Middle Name) July 15, 2011

DO NOT

MM 3) AGE as of June 1, 2012:

DD

4) SEX:

MALE FEMALE

s) coNTAcT
NUMBERSI

6)

EMAILADDRESS:

7) COMPLETE HOME/ PERMANENTADDRESS: rl

_
I
I

TOBEFILLEDUPBYTHEPARENTS: citizen? 1. Isyour a Filipino child

2. Doesyour child have pendingapplication immigrantin any foreign country? as l___l Ll Examination 3. Hasyour child taken the PSHS NationalCompetitive before? LJ LJ you like your child to study? 4. In which of the followingPSHS would Campuses Indicate your top 2 choicesof campus by writing "1" as firct choice and "2" as second choice in the box provided,

YES NO tr t]

CONSIDER THE FOLLOWING WHEN CHOOSING A CAIAPUS: 1. 2. The score in the NCEis the major basisfor quatifying the PSHS. to At[ examinees are ranked from highest to towest. The top 240 or so quatifiers irrespectiveof region of origin witt be invited to enroll at the Main Campus but acceptance to the invitationis not computsory. Quatifiers for a regional campus who are residents of that region are given priority to enrotlin that campus. Non-residents of the region may be considered as alternate quatifiers if their scores are within the cut off score for that region,and if stotsare avaitab(e. Requests changein choiceof campuswitl for be entertainedONLY the deadtine fiting on for of apptication, the latest. at

[-lIr.ocos l-lclcavaN

REGIoN sanlldefonso, Ilocos sur vALtEy - Bayombong, Nueva Vizcaya

l-l
l-l

elsrrnN wsAYAs Paro, Leyte

* cenrnnl MINDANAo Bato-i. Lanao Norte det Davao city sournrRN MINDANAo Tugbok, ADMIN.REGTONBaguio conolr-LERA Ciby
3.

Freeportzone, Pampanga I cenruL LuzoN - Clark Camarines Sur [_-lsrcol REGToN Goa, I urun - Diliman, city Quezon vrsAYAs- Jaro, Iloilo cty Iwtsr:nN vrsAYAs- Argao, cebu l-lc;nrml [-l

4.

Parent's Signature over Printed Name

TO BE FILLED UP BY THE SCHOOL AUTHORITY CONCERIVED: 1) (Write name of school in full): NAME OF SCHOOL 2) COMPLETE SCHOOLADDRESS:

4) GRADE LEVEL AT PRESENT:

Pupil's GENERALAVERAGE GRADE(SY 2010-2011):

| |

| Grade 6 | Grade 7

s) scHool
CONTACTNO.:
g) ' Number of Pupils in the Batch (sY 2010-2011):

71 Pupil's RANK in the Batch '' (sY 2o1o-2011)r

1) I herebycerrify that the pupil-applicant is officialiy enrolledin the schoolibr SY 20ll-2012. chech appropriatebox) the 2-) I also certify rhar rhe pupil- applic anr (Please ! ! belongsto the upper l0o/o the batch (SY 2010-2011) doesnot havea gradebeiow 80. of and of but doesnot belong to the upper l0o/o the batch (SY 2010-2011), has a gradeof 85 or higher in Science and Math, and a minimum gradeof 80 in all other subjects.

I hereby ceffify that the pupil-applicant is of good conduct and behavior.

Principal/School Head'sSignature over PrintedName

Guidance nselor/Adviser's Cou Signatureover PrintedName

rhiss,vliil; p;ff;;ippri-tflll;?3R#"-tt:ttRt3i'tt
Submitthe followingupon filing of application: Futtyaccomptished Apptication Form in two ( 2 )c o p i e s . Two (2) identicatrecent1 x 1 lD pictures . test Non-refundable fee - P 100 for private school students/Free for public school students lf the applicant does not belong to upper 10% o f t h e b a t c h( S Y2 0 1 0 - 2 0 1 ) : . C o p yo f r e p o r tc a r d( 5 Y2 0 1 0 - 2 0 1 1 ) . Minimum final grade of 85 in Science & Math; 80 in all other subjects "

no*r',i,,i" th;;estil;m;it. al
For use of the PSHSCashier's Office Mode of Payment: [ [ ] Cash ] Money Order

For use of the PSHS Registrar/DoST PSTO or Coordinatcr RECOMMENDATIO}.I As per data above: Approved: I Disapproved:t Reason/s DisapprovaL: for

No, of Applicants: AmountPaid: No. of stampsissued: Number: Series PaymentReceived by: Date:

Processed by: H LI Date:

DOST PSHS

TO REMINDERS THE EXAMINEE: yourscheduled (eithera.m, or p.m. as indicated the exampermit). in 1. Beat yourtesting centeron September 10, 2O11one (1) hourbefore examination RoomExaminer. 2. Present ExaminationPermit and your school LD. to the Proctor/ the #2), a good eraser andsnacks. 3. Bringat least two sharpenedsoft lead pencils (Mongol 4. If you do not receive your examination permit two (2) weeks before the exam, you may visit or call the nearest PSHSCampus or call PSHSSAdmissionsOffice at telephone no. (02) 926-5701or check at www.pshs.edu.ph. eitherby mailor you may alsocheckresults www.pshs.edu.ph. You may alsoinquirefrom the nearest at if 5. Youwill be notified you qualifyto enrollat PSHS Office, PSHS Regional Campus callPSHSS-Admissions Tel. No.:(02) 926-5701. or Office Admissions OED,PSHSS