TO BE FILLED OUT BY PERSONNEL AUTHORIZED TO RECEIVE

APPLICATION REQUIREMENTS: Track Number

Fee
Assessment Fee
Others: ___________________________
CCF-LA Forms
Student Application Form with 2”x2” ID Picture (2 pcs.)
Parent’s Covenant with CCF-LAI*
Student’s Developmental History Form with 2”x2” ID Picture
taken within 6 months
New Parent’s Interview Form
Student Medical Record
Pastor’s Recommendation Form
Guidance Counselor’s Form
Teacher’s Recommendation Form

Other Requirements

STUDENT APPLICATION
Photocopy of report card from previous year
Photocopy of report card from current school year
Result of PEPT or PVT (if applicable)
Attendance of Bridging/Tutorial Program (if needed)

FORM
Grades 7–11: Submit an essay of autobiography that highlights
your strengths and achievements
Grades 9–11: Submit physical exam with drug test result and chest
X-ray result (taken within six months)
Grades 10–11: NCAE Result
Certificate of Good Moral Character
Please print in CAPITAL LETTERS, then submit the completed form with Photocopy and original copy of PSA-certified birth certificate
Photocopy of Marriage contract (if applicable)
application requirements. A complete list of requirements is enclosed in this For non-Filipino applicants:
form. Photocopy of Passport bio-page and latest admissions
with valid authorized stay
Incomplete application may delay admission. Likewise, credentials filed in ACR I-Card (photocopy of the front and back portions)
support of the application will not be returned and will become the property of
CCF LIFE ACADEMY.

TO BE FILLED OUT BY CCF-LA PERSONNEL:

Application for:

Preschool Lower School Middle School Junior High School Senior High School
Pre-Nursery Grade 1 Grade 4 Grade 7 Grade 9 Grade 11 Academic Strand:
Nursery Grade 2 Grade 5 Grade 8 Grade 10 ABM GAS IB
Kindergarten Grade 3 Grade 6 HUMSS STEM

Age by August: Application Date: Admissions Officer: Result of Test:

Schedule of Assessment Test (Date and Time): Test Administrator:

Years: Months:

1. STUDENT INFORMATION: Write the name that appears on the BIRTH CERTIFICATE. Learner Reference Number (LRN):

LAST NAME

FIRST NAME Staple here

MIDDLE
NAME Please attach a 2x2 ID picture
with white background
OTHER GIVEN NAME: taken within the last six months.
NICKNAME:
(Chinese/Japanese/Korean/others)
Print the name of student
at the back of the picture.
DATE OF BIRTH: PLACE OF BIRTH:
(Month, Day, Year) (City/Town, Province)

Staple here
SEX: Male Female Church Affiliation:

NATIONALITY
Citizenship: Dual Citizenship: If your other citizenship is Filipino, submit a photocopy of your child’s
No Yes Philippine Passport or Identification Certificate of Recognition (ICR).

PHILIPPINE ADDRESS
Present Address: Mobile Number:

State/Province: Country: Zip Code: Landline Number:

STUDENT’S CONTACT DETAILS:

Mobile Number (if applicable): Email Address:

CONTACT PERSON IN CASE OF EMERGENCY

Name: Relationship:

Address: Contact Number:

PASSPORT AND VISA DETAILS OF APPLICANT (for non-Filipino applicants)

Passport Number: Date Issued: Place Issued: Expiry Date:

If ACR is already available:

ACR Number: ACR Expiry Date: Please attach a photocopy of your child’s Passport, ACR.

SPECIAL STUDY PERMIT (for non-resident applicants/students with tourist visa status)
Does your child have a previously issued Special Study Permit? No Yes, in SY Where?
 INTERNATIONAL ADDRESS
Present Address: Mobile Number:

State/Province: Country: Zip Code: Landline Number:

2. SCHOLASTIC INFORMATION (start with the most recent)

PREVIOUS SCHOOLS ATTENDED ADDRESS LEVEL SCHOOL YEAR

HONORS AND AWARDS RECEIVED FROM PREVIOUS SCHOOLS

SCHOOL ACADEMIC EXTRA-CURRICULAR

3. FAMILY INFORMATION:
Check where applicable: Parents Married Parents Separated (For Mothers, please indicate preferred surname: Ms. Mrs.)
Applicant Adopted Single Parent Father Remarried Mother Remarried
Father Deceased Mother Deceased Student is living with:
Father and Mother Father Mother Guardian
Stepfather and mother Stepmother and father
Please indicate who is responsible:
for school-related decisions Father Mother Both Others: If parents are not living together, Father Mother
to receive school correspondences Father Mother Both Others: which parent has custody of child? Others

Is the applicant’s father/mother an employee of CCFLAI TMA CCF VCIS HSG

FATHER
Name: Age:
(Last Name) (First Name) (Middle Name)
Home Address: (if different from Applicant’s present address)

Citizenship: Birthplace: Residence Telephone No.: Mobile Number: Email Address:

Highest Level of Educational Attainment: Church Affiliation:

Occupation: Company: Company Address:

Company Phone Number: Company Email Address: Monthly Income: (only for those applying for scholarship)

MOTHER
Name: Age:
(Last Name) (First Name) (Middle Name)
Home Address: (if different from Applicant’s present address)

Citizenship: Birthplace: Residence Telephone No.: Mobile Number: Email Address:

Highest Level of Educational Attainment: Church Affiliation:

Occupation: Company: Company Address:

Company Phone Number: Company Email Address: Monthly Income: (only for those applying for scholarship)

GUARDIAN
Name:
(Last Name) (First Name) (Middle Name)
Address:

Relationship to the Student: Occupation: Contact Number: Email Address:

The Guardian of the student during the present school year is required to submit a Notarized Affidavit of Guardianship including decision-making.

SIBLINGS
NAME AGE STATUS OCCUPATION COMPANY/SCHOOL
 Church Affiliation: Ministry:

Attending Sunday School Youth Group Discipleship Group

LANGUAGE
FIRST LANGUAGE SECOND LANGUAGE LANGUAGE(S) SPOKEN AT HOME

Student’s Language

Father’s Language
Mother’s Language

Guardian’s Language

If your child’s first language is NOT English, please complete the following sections below as fully as possible.

a) How long has he/she been learning English (no. of years)? b) Is he/she studying a tutorial English program? Yes No

School/Center

Address: Contact Number:

4. REASON FOR TRANSFERRING:

Check your reason/s for transferring your child to this school.
Bible-based Curriculum Personalized Learning Approach Proximity
International Curriculum Christian Intensive English Training Other
Leadership Training Singapore Math TM Circles Program

How did you find out about CCF-LAI?

Referral Church (please specify):
Name: Direct Mail/Email (sent by whom):
Contact No.: Social Media (Facebook, Twitter):
Relation: Search Engine (Google, Yahoo, etc.):
CCF-LA Website Blogs (please specify):
Newspaper Ad/Article Others:
Community Bulletin Boards (where):

I/We certify that:

a. All answers made here are true, complete, and accurate.
b. All information supplied in and attached to this application may be checked against the original documents and that withholding information or giving incorrect information
may be cause for the enrollment privilege to be withheld at any time.
c. All information provided in this form may be used by CCFLA for research and I/we consent to such with the assurance that personal details will be kept confidential.

Staple here

Please attach a 2x2 ID picture of the

Father with white background taken
within the last six months.

Print the student’s name at the back

of the picture.

Staple here

Father’s Signature Over Printed Name Date

Staple here

Please attach a 2x2 ID picture of the

Mother with white background taken
within the last six months.

Print the student’s name at the back

of the picture.

Staple here

Mother’s Signature Over Printed Name Date

Staple here

Please attach a 2x2 ID picture of the

Guardian with white background taken
within the last six months.

Print the student’s name at the back

of the picture.

Staple here

Guardian’s Signature Over Printed Name Date

 CONFIDENTIAL

STUDENT’S DEVELOPMENTAL
HISTORY FORM
Name of Student: Grade Level:

Staple here

Please attach a 2x2 ID picture

with white background
taken within the last six
months.
PART 1
Print the name of student at
1. How do you rate your child’s current health? the back of the picture.
Excellent Good Fair Poor
Staple here

Current Medical diagnosis (if any):

YES NO
2. Is your child taking any medication?
If Yes, please list medications and uses:

3. Does your child have any physical limitations?

If Yes, please specify and include prescribed orders:

4. Has your child had any serious illness, injury, hospitalization, surgery,
traumatic event (e.g., diabetes, seizures, head injury, asthma, allergies, etc.)?
If Yes, please identify including child’s age at time:

5. Has your child ever been to any intervention program with a counselor,
developmental pediatrician, therapist, psychologist or psychiatrist?
If Yes, please attach the latest diagnostic report.

6. Has your child attended or currently attending any Special Education (SPED)
program (e.g., Speech/Language therapy, Audiology services,
Occupational therapy, etc.)?
If Yes, please attach latest therapist report.

Note: If “yes” to any of the above, please enclose copies of any pertinent physician
report or diagnostic statement.

PART 2

7. Has your child ever been suspended, asked to leave, or dismissed from school?
If Yes, please explain:

8. What does your child enjoy most about school?

9. What does he/she dislike about school?

10. What are your child’s special interests and abilities (e.g., basketball, swimming,
music, creative arts, etc.)?

11. What do you see as your child’s strength/s?

12. What do you see as your child’s weakness/es

13. Please describe your child’s school behavior and attitude (e.g., happy, well-adjusted,
withdrawn, distracted easily, hyperactive, etc.).

14. Please feel free to write any other information, not included above, that you think will help
us understand your child better.

I/We certify that all statements made here are true. Any false statements made may be cause for the enrollment privilege
to withheld at any time.

Signature over Printed Name of Person completing this form Relationship to student
 CONFIDENTIAL

RECOMMENDATION FORM
TEACHER
Name of Student: Grade Level:

Teacher’s Name: Subject Area:

Name of School: School Phone:

1. How long have you known this student and to what extent?

YES NO
2. Does he/she have any outstanding qualities or significant limitations that may affect
his/her school performance? If yes, please explain:

3. Has he/she ever been habitually tardy or absent? If yes, please explain:

4. Has he/she received any remedial help or learning/behavioral support from your
school or private institution/s? If yes, please explain:

5. Have his/her parents been consistently cooperative and supportive of your school
program, policies, and procedure? If yes, please explain:

6. Please describe and explain briefly his/her remarkable strengths or weaknesses that he/she can
improve on inside the class.

7. Please describe and explain briefly his/her character, behavior, personality, and social skills.

8. Please describe and explain briefly his/her intellectual ability. (Consider reading and writing skills,
comprehension, grammar, mechanics, numerical ability, and creativity.)

9. Please rank the student’s academic performance in his/her class:

Top 10% Upper 25% Middle 50% Lower 25% Bottom 10%
 CONFIDENTIAL

RECOMMENDATION FORM
TEACHER
Name of Student: Grade Level:

10. Please evaluate the student according to the following criteria by placing a check in the appropriate box.

Area of Age Area of No Basis of

Strength Appropriate Progressing Improvement Judgment

Attitude and behavior

Leadership potential
Emotional stability
Honesty/Integrity
Self-confidence
Social skills
Curiosity
Spoken
communication
skills
Written communication
skills
Study habits
Motivation
Concentration
Academic growth potential
Innovative
Attendance
Effort/Initiative
Academic achievement
Ability to work in a group
Ability to follow directions
Commitment to homework

11. Please indicate any further information that should be of consideration regarding the student or his/her
family which may be helpful.

12. Please check your recommendation for the student:

Highly With reservation due to:

Fairly Not at all due to:

Accomplished by:

Signature of Teacher Please affix the School’s Dry Seal Here

Date
 CONFIDENTIAL

STUDENT MEDICAL RECORD

Name: Year Entered:

LAST FIRST MIDDLE

Date of Birth: Gender: Contact No. (Home):
Male Female
MM DD YYYY

Home Address:

AUTHORIZED GUARDIAN
FATHER MOTHER (Please indicate relationship to
student)

Name:

Mobile No.:

Office No.:

PEDIATRICIAN / FAMILY PHYSICIAN DENTIST

Name:

Clinic Contact No.:

Mobile No.:

Hospital/Clinic Address:

MEDICAL HISTORY

RECURRENT ILLNESS:
(Please check if applicable to your child and indicate the prescribed medication and dosage given in the space provided).

Condition Prescribed Medication/s / Treatment/s

Allergy (Skin / Allergic Rhinitis)
Anemia
Asthma
Backache
Bleeding Problem
Convulsion
Cough and Colds
Chest Pain
Dizziness
Ear Problem (impacted, discharges, etc.)
Epilepsy
Fever
Headache / Migraine
Hypertension
Hyperventilation
Hypo-ventilation
Injuries (cuts, fractures, wounds, etc.)
Kidney Disease / UTI
LBM / Diarrhea
Menstrual Problems (e.g. dysmenorrhea)
Pneumonia
Stomachache / Abdominal Pain
Skin Disorder (pruritus, skin asthma, etc.)
Speech Problem
Tinnitus (ringing/buzzing sound in the ear)
Tonsillitis / Pharyngitis
Vomiting
Head Lice
Vision/Eye Problem (Astigmatism/Near or Far sightedness etc.)
Others, please specify

Page 1 of 6
 CONFIDENTIAL

STUDENT MEDICAL RECORD

OTHER IMPORTANT MEDICAL INFORMATION:

Does your child have:

1. Allergies to any medicine?

2. Allergies to certain food/drinks?

3. Any special medication? (maintenance drug/medicine that must be taken regularly?

4. Any special care/needs?

5. Did your child tested positive for COVID-19 (SARS-CoV 2) using RT-PCR swab test? If yes, when was the exact
date the swab test was done?

6. Did your child had symptoms? If yes, please enumerate the symptoms.

7. Was your child hospitalized because of COVID-19? If yes, how many days did your child stay in the hospital?

Does your child have a problem with any of the following:

(Note: these might affect his/her learning, please indicate if any treatment was given or is needed)
◻ Vision / Visual Problem
◻ Hearing
◻ Speech and Language
◻ Behavioral Problem
◻ Other learning disabilities, please specify:

Page 2 of 6
 CONFIDENTIAL

STUDENT MEDICAL RECORD

PAST ILLNESS (Please check if applicable to your child)

◻ Asthma

◻ Bleeding

◻ Convulsion

◻ Chicken Pox Date/Year:

◻ Diphtheria

◻ German Measles Date/Year:

◻ Heart Problem

◻ Hepatitis Date/Year:

◻ Measles Date/Year:

◻ Mumps Date/Year:

◻ Parasitism

◻ Primary Complex (Tuberculosis) Date/Year:

◻ Rheumatic Fever

◻ Serious Injuries / Accident: (kindly specify the date/year of occurence)

◻ Surgical Operation/s: (kindly specify the date/year of occurence)

◻ Tonsillitis / Pharyngitis

◻ Urinary Tract Infection / Kidney Problem

◻ Whooping Cough

◻ Others, please specify:

Page 3 of 6
 CONFIDENTIAL
STUDENT MEDICAL RECORD

Student’s Name: Current Grade:

VACCINATION RECORD

Recommended Date
Vaccine Dose Route Remarks Physician
Age Administered

Birth–0 Months BCG

2 Months DPT 1

4 Months 2

6 Months 3

1 1/2 years old Booster 1

4–6 years old 2

2 Months ORAL POLIO 1

4 Months 2

6 Months 3

1 1/2 years old Booster 1

4–6 years old 2

2 Months HEPATITIS B 1

4 Months 2

6 Months 3

1 1/2 years old Booster 1

2 Months HIB 1

4 Months 2

6 Months 3

1 1/2 years old Booster 1

ANTI-TETANU
S/
7 years old DIPHTHERIA 1

6–9 Months MEASLES

1 year 3 months MMR 1

4–6 years old Booster 2

Page 4 of 6
 CONFIDENTIAL
STUDENT MEDICAL RECORD

Student’s Name: Current Grade:

VACCINATION RECORD

Recommended Date
Vaccine Dose Route Remarks Physician
Age Administered

VARICELLA
(CHICKEN
1 year old POX) 1

4–6 years old Booster 2

3 years old TYPHOID 1

6 years old Booster 1

10 years old 2

13 years old 3

16 years old 4

19 years old 5

22 years old 6
MENINGOCO
2 years 2 months CCAL
PNEUMOCOC
2 years old CAL 1

Every 5 years 2

2 years old HEPATITIS A 1

2 years 7 months 2

2 years old FLU VACCINE 1

3 years old Booster 1

YEARLY 2

8
Japanese
Encephalitis Encephalitis

Page 5 of 6
 CONFIDENTIAL
STUDENT MEDICAL RECORD

Student’s Name: Current Grade:

PHYSICIAN’S CERTIFICATION

This is to certify that ____________________________________________ was examined at ____________________________

Name of Student Location

on ______________________ and that he/she is found to be:

Date

___ Physically Fit ___ Physically Fit with Limitations/Restrictions ___ Physically Unfit to perform any/all
school activities

Diagnosis:

Remarks/Recommendations:

Signature over Printed Name of Physician License No.

I, ________________________________________, hereby state to the best of my knowledge that the information I

have provided in this form are complete and correct, knowing that this will be the basis of the care for my
child during school hours and activities. I will not hold the CCF Life Academy (CCF-LA), and/or its employees
liable in case of accidents or any other mishaps or injury which might occur to my child as a result of
complying with the information I have provided here. I am also willing to continuously update my child’s
Medical and Dental Records which includes submitting a duplicate copy of any applicable medical-related
documents of my child (recent vaccinations, hospitalization/medical certificates, x-ray results, laboratory
findings, updated dental records, etc.) to the school clinic for filing.

Signature over Printed Name of Parent/Guardian Date Signed

NOTE: In case your child needs emergency medical treatment or hospitalization, the school nurse or a school
representative shall immediately notify you or the child’s guardian through the contact numbers indicated in this form
(please notify the school nurse if there is a change in any of the contact information provided here). The child shall also
be accompanied immediately by the school nurse to the nearest Hospital or Medical facility from the school (The
Medical City Ortigas Avenue, Pasig City).

Page 6 of 6
 CONFIDENTIAL
RECOMMENDATION FORM
GUIDANCE COUNSELOR
Student’s Name: Current Grade:

Previous School Name: Applying to Grade:

Previous School Address:

Previous School Contact Nos.: Guidance Counselor:

To the Student/Parent of the student: Fill in the above portion and give this form to your Guidance Counselor.
Attached the sealed recommendation form on the Application for Admission form when you submit it. Unsealed
envelope will not be accepted.
To the Guidance Counselor: Kindly accomplish this form. Type or print legibly all information needed. Return to the
parent/s of the student in a sealed envelope with your signature on the flap. Thank you.

How long has the child been in your school? _______________________________________________________________

How long have you known the student? ___________________________________________________________________

Outstanding Very Good Good Average Below Average

Leadership Potential

Self-Motivation

Emotional Maturity

Conduct / Deportment

Academic Qualifications:
Academic ranking in the class: Top 10% Top 25% Middle 50% Lower 25%
Total number of students in the class: ______

English Proficiency:
Oral
Written
Comprehension Skills:

Problem-solving Skills:

Social/Behavioral:
1. Does the student have any disciplinary record/ cases in the past? Yes No
If yes, kindly describe briefly:

2. Has the student been observed / assessed / diagnosed to have special needs? Yes No
If yes, kindly describe briefly:

3. Has the student had any family/peer/behavioral/cognitive problem/s that may have had an effect on the
student? Yes No
If yes, kindly describe briefly:

Highly Recommended with Not

Recommendation Recommended
Recommended reservation Recommended

Academic Potential

Character & Attitude

Overall Recommendation

Signature over printed name / Position Date Signed