University of San Jose-Recoletos-Balamban Campus

SENIOR HIGH SCHOOL DEPARTMENT

Arpili, Balamban, Cebu

Grade Level: ___

Track: Academic Enrolment Form LRN: _____________ _____
Strand: STEM OLD STUDENT
ABM ID Number: _____________
SY: 20__ - 20__

PLEASE PRINT LEGIBLY: (Write N/A for Non-Applicable)

Last Name First Name Middle Name

________________________ , ________________________ _____________________

Gender: Male Female

Address: ________________________________________________________Telephone No.: _________________

Father’s Name: ________________________________ Mobile No.: _____________Office No.: ________________

Mother’s Name: ________________________________ Mobile No.: _____________Office No.: ________________

Name of Guardian: _____________________________ Mobile No.: ______________Other No.: _______________

Credentials Submitted: (Attachments) APPROVED

(To be checked by the Records Section)
1. ____________________ 4. ___________________
________________ Original Report Card Admission Committee Medical / Dental

________________ Cleared Clearance 2. ____________________ 5. ___________________

Accounting Principal

3._________ __________ 6.____________________

JPTA Insurance Records Section
Important Reminders:

1. Where tuition, entrance laboratory and library fees, are paid on a monthly basis, NO SUCH FEES WILL BE REFUNDED WHEN THE STUDENT
WITHDRAWS any time after registration, whether he/she has attended class or not.

2. Where tuition and other fees are paid in full, Bureau of Private School Memo No. 13s 1945 will be followed in the adjustment of payment when the
student withdraws within the first 30 days after registration.

3. Any student who decides to quit schooling after classes have started must accomplish the WITHDRAWAL FORM and the CLEARANCE FORM
available at the Principal’s Office. Failure to do so will not entitle him/her to any adjustment of his/her fees.

4. YOU ARE NOT CONSIDERED ENROLLED UNLESS THIS ENROLLMENT FORM IS PROPERLY ACCOMPLISHED AND NECESSARY
CREDENTIALS SUBMITTED TO THE RECORDS SECTION.

5. In consideration of my admission to the University of San Jose-Recoletos, I hereby promise to abide by and comply with the rules and regulations laid
down by competent authority in the institution, particularly in the Senior High School Department where I am enrolled.

__________________________________________ _______________________________________
Parent’s Signature over printed Name Student’s Signature over Printed Name