Professional Documents
Culture Documents
TO THE STUDENT AND PARENT/GUARDIAN: Print legibly all information required. Place X marks in appropriate boxes.
1. NAME OF STUDENT: Print your full name in the following sequence: LAST, FIRST, MIDDLE. 2. GENDER Male Female
Place one letter in each box. Leave one box blank between names.
FIRST
MIDDLE
5. JUNIOR HIGH SCHOOL (JHS) (Where you completed/are completing JHS / Grade 10)
Junior High School Name (Do not Abbreviate) Month/Year of Completion
6. SENIOR HIGH SCHOOL (SHS) PROGRAM APPLIED FOR: Put an X mark in the box of the track (Academics, TVL, Sports, Arts and Design) you intend to enroll.
Please write also your specific stand/specialization.
Track:
Strand:___________________________________________________Specialization:_____________________________________________________
THIS REGISTRATION FORM IS NOT FOR SALE AND MAY BE REPRODUCED Page 1/2
Subdivision/Barangay
Town/City
9. CONTACT INFORMATION
Email Address
Application Requirement:
(1) Pre-registration Form (Downloadable) LEARNER REFERENCE NUMBER (LRN)
(2) 2 pieces of 2” x 2” photo
(3) 1 Long Brown Envelope
(4) Photocopy of School ID
I understand that all information I provide in this form may be used by the UPHSL or Department of Education and I consent to such with the assurance
that my personal details will be kept confidential.
Signature over Printed Name of the Student Signature over Printed Name of the Parent/Guardian
__________________ __________________
Date Date