1X1

TANAUAN CITY INTEGRATED HIGH SCHOOL

Science, Technology, Engineering and Mathematics (STEM) ID PICTURE
2020-2021

Accomplish and submit the form together with the other required documents
at the admissions office. The submitted documents in compliance with the
entrance examination requirements shall become the property of the Applicant No.
admissions office and are not to be returned to the applicant.

TCIHS STEM ADMISSION TEST APPLICATION FOR SY 2020-2021

I. Applicant’s Personal Data
__________________________________________________________________
Surname First Name Middle Name

Date of Birth: _______________ Place of Birth: _____________________________

Nationality: _________________ Gender: ____________ Religion: ______________
Present Address (Include the house number, street, Barangay, Town/City and Province)
_____________________________________________________________
Name of Guardian: __________________________ Relationship: _______________
Contact number: Landline: ________________ Mobile Number: ________________

II. Family Data:

Father’s Data Mother’s Data
Name
Highest Educational Attainment
Religion
Occupation
Present Office/ Employer’s
Address

Family’s Annual Gross Income Bracket (Please check appropriately)

__ Less than Php 100 000 __Php 100 000 __Php 101 000-200 000
__Php 201 000- 300 000 __Php 301 000-400 000

House: ___ Owned ___Rented ___ Others (please specify) _____________

_______________________________ ________________________________
Father’s signature over printed name Mother’s signature over printed name

III. Applicant’s Educational qualification

Elementary School: ____________________________________________________
School Address: _______________________________________________________

IV. Applicant’Awards Received during Intermediate Level (Grade 5 &6)

Title Level Rank
(National, Regional,
Division, District)

(Attach additional sheet if needed)

I hereby certify that the above mentioned I hereby recommend _________________

student has no grades below 85 in English,
Science, Math and elective and has no
grade below 83 for other subjects. He/she
is eligible to take the TCIHS STEM
Admission Test.
___________________________ to take
the STEM Admission Test. He/She is
qualified to take the exam.

_____________________________________ _____________________________________
CLASS ADVISER’S SCHOOL HEAD’S
SIGNATURE OVER PRINTED NAME SIGNATURE OVER PRINTED NAME
-----------------------------------------------------------------------------------------------------------------------------------------
To be filled out by the school screening committee

______ Qualified to take the exam ______ Not qualified to take the exam
1X1
Date assessed: __________________
ID PICTURE