FINAL INSTRUCTION

1. Prior to submission, please check that the completed application form has the following:
• Validation Code
• Attached passport size ID picture
• Dry seal of the school
• Principal/Guidance Counselor's signature
2. Submit the printed application form to Counter 17-Student Admissions Office with the
following:
• Passport size ID picture (identical with the one attached in the admission form)
• Application fee of PHP350.00 (Filipino students) or USD50.00 (International
students)
 APPLICATION FOR ADMISSION

APPLICANT'S INFORMATION
Validation Code D201323B6E
DateApplied 03/29/2014
Entrance Category FRESHMAN
Course Preference
First Choice Bachelor of Secondary Education
Second Choice Bachelor of Elementary Education
Third Preference NON

BASIC INFORMATION
Name LEGASPI, REGINE LEPON
Gender FEMALE
Birth Date 03/06/1998
Birth Place DASMARINAS
Religion BAPTIST
Civil Status SINGLE
Citizenship FILIPINO
Address 201 ANABU 2-D IMUS,CITY CAVITE PH 4103
Email regine_legaspi03@yahoo.com
Contact No. 424-32-15
Fathers Name POLICARPIO Z LEGASPI
Occupation COMPANY DRIVER
Mother's Name REBECCA L LEGASPI
Occupation MIDWIFE
Guardian's Name REBECCA LEGASPI [MOTHER]
Contact No. 09297297233
Guardian Address 201 ANABU 2-D IMUS,CITY, CAVITE PH 4103

EDUCATION INFORMATION
Grade School Pasong Santol Elementary School [YG:2010]
Address Anabu IID, Imus, Cavite
High School Fiat Lux Academe [YG:2014]
Address Phase III, Golden City, Imus, Cavite
.......................................................................................................................................................

This is to certify the veracity and completeness of all information written on this form. We fully
understand that any misinterpretation shall be a ground for the applicant's right for admission or
revocation of course credit, grades, or degree.

______________________ _____________________________________
Applicant's Signature Signature over printed name of Guardian

.......................................................................................................................................................

CERTIFICATION OF ENROLLMENT

_______________________
(Date)

This is to certify that REGINE L. LEGASPI is a bonafide FOURTH YEAR student of FIAT LUX ACADEME for
school year 2013-2014.

This further certifies that the aforementioned student has no pending case and has not been given any
disciplinary sanction due to violation of any school policy.

_____________________________
Signature over printed name of the
School Principal/Guidance Counselor

Note: This admissions form is not

valid without the school seal