Control No.

____________

Learners Reference Number (LRN)

Student Admission Enrollment Form - Senior High School
Please fill-out this form completely ____________
APPLICATION FOR ADMISSION

Date of Application: ___________________ for SY: Temporary ID number:

Choose one track, then put a check mark in the box of your chosen strand.

ACADEMIC TRACK TECHNICAL VOCATIONAL LIVELIHOOD (TVL) TRACK

Accountancy, Business and
Management (ABM) Strand
Humanities and Social Sciences
(HUMSS) Strand
Science, Technology, Engineering
and Mathematics (STEM) Strand
General Academic Strand (GAS)
Home Economics (HE)
Tour Guiding Services
(Bread and Pastry Production, Tourism Promotion Services,
Food and Beverage Services)
Housekeeping
(Tour Guiding Services, Tourism Services, Bread and Pastry Production)
Information and Communication Technology (ICT)
Animation - Computer Programming
Contact Center Services - Computer Programming

PERSONAL DATA
Last Name First Name Middle Name

Name in Native Language Character (Native Name or Nickname):

Date of Birth (mm/dd/yyyy): Sex: Place of Birth:
Nationality: Religion: Civil Status: Birth Order:
Email Address: Contact Number:
How will you be supported in your studies?
Self supporting (Working) Parent’s full support Relatives / family friends
Scholarship/subsidy (name of grant):
• Are you an ESC Grantee? Yes No
ESC ID Number (if Private): Voucher Number:
RESIDENCE DATA
Permanent Home Address
Apartment Name / House No./ Street/Barangay:
City/Municipality: Province:
Country: Zip Code:
Current Contact Address (Baguio Address)
Contact Person/Guardian Name:
Apartment Name / House No./ Street/Barangay:
City/Municipality: Province: Country:
Zip Code: Email Address: Contact No.:
Emergency Contact Address (if not same as above)
Contact Person/Guardian Name:
Apartment Name / House No./ Street/Barangay:
City/Municipality: Province: Country:
Zip Code: Email Address: Contact No.:

EDUCATIONAL BACKGROUND
Name Year Graduated Honors/Awards

Elementary:
Address:

Junior High School:

Address:
 FAMILY DATA
Father’s Name (First Name / Middle Name / Last Name):
Academic Level/Degree Finished: Occupation:
Company Name: Telephone Nos.:
Company Address: Father’s Email Address:
Mother’s Maiden Name (First Name / Middle Name / Last Name):
Academic Level/Degree Finished: Occupation:
Company Name: Telephone Nos.:
Company Address: Mother’s Email Address:

Estimated Total Annual Family Income (Php): Less than 50,000 50,000-100,000 100,000-300,000 300,000-500,000 500,000-1,000,000 above 1,000,000

Brother(s) / Sister(s)
Name Date of Birth Course/Occupation School/Company

Please attach extra sheet if space is not enough

GENERAL INFORMATION

Mother Tongue
Languages
Ethnicity
Sports
Hobbies/Skills/Talents
Honors/Awards/Merits (ex “Model Student, 2010”)

Extra Curricular Activities (Organizations, Club, Volunteer Work, etc)

PHYSICAL DESCRIPTION
Height (cms): Weight (lbs): Built Eye Color Hair Color Complexion
Other Distinguishing Features: Light Black Black Fair
Medium Dark Brown Dark Brown Brown
Physical Handicap or Disability (if any): Moderately Light Brown Light Brown Dark
Heavy Gray Gray
Heavy Blue Others:
Serious illness/es or major surgery in the past or at present Others: _____________
:
_____________

REFERENCES
Write two or three references who are not directly related to you and can vouch or guarantee for your total behavior
Name Address / Tel. Nos.

I hereby certify that the above information I have provided are true and correct.

Signature over printed name of Applicant Date

Parent / Guardian’s signature over printed name

Encoded by: Date: