Application No: Application Date:

Approved Residency: Marikina Resident Non-Marikina Resident

Applying for:

Desired Program/s 2x2 Picture

First Choice: Major: (if any)

Second Choice: Major: (if any)

Name
Last Name First Name Middle Name

Present Address House/Block/Lot No. Street/Subdivision/Village Barangay City/Municipality

Contact No: Email: Gender:
Age: Birth Date: Birth Place:
Civil Status: Nationality: With Disability:
Father's Name: Occupation:
Mother's Name: Occupation:
Guardian's Name: Occupation:
Number of Sibling/s: Monthly Income of
Working Student:
Family:

EDUCATIONAL BACKGROUND
School Name
ELEMENTARY School Address
Year Graduated
School Name
School Address
SECONDARY Year Graduated
Other HS
Track/Strand
School Name
School Address
VOCATIONAL
Degree
Year of Completion
School Name
School Address
TRANSFEREE
Program
Year Last Attended

Check List Documents to be Submitted

Two (2) pcs. of recent 2x2 ID Picture with Name tag and White Background
Any Valid Government-issued Primary ID (with address) of student/parent with (1) photocopy
Photocopy of Form 138 (High School Report Card)
Birth Certificate issued by the (PSA) Philippine Statistics Authority with (1) photocopy (NSO-issued Birth Certificates will not be accepted)
Official Receipts of payment for the Testing Fee
For Marikina Residents Photocopy of Proof of Billing (Electric, Water, Telephone) with Address
For Transferees Certified True Copy (CTC) of Grades from the previous College/University
Certificate of Enrollment
For Currently Enrolled SHS Students
Certified True Copy (CTC) of grades (1st and 2nd grading period)
For ALS Certificate of Rating
For Cross Enrollees Permit to Cross Enroll
For Married Females Photocopy of Marriage Certificate

I hereby certify that above information given are true as to the best of my knowledge.

Applicant's Signature Over Printed Name

EXAMINATION DETAILS (To be filled up by the Admission Representative)

OR Number: ________________________ Verified by: ________________________

Date: ________________________ Time: ________________________
Room No: ________________________
Approved By:

Admission Officer