ANNEX A; APPLICATION FOR LATERAL ADMISSION: TO BE FILLED OUT BY THE APPLICANT AND HIS/HER PARENTS Republic of the Philippines Department of Science and Technology PHILIPPINE SCIENCE HIGH SCHOOL SYSTEM Diliman, Quezon City APPLICATION FOR LATERAL ADMISSION QUALIFYING EXAMINATION (To be filled out by the applicant in his/her own handwriting using ballpen only. Application should be accompanied by @ Photocopy of the stucient's report card, with the original copy brought along for verification purposes.) Complete Name: Sag maquen Yeabelte_Vrey Simba) on ey (last Name) (First Name) * (Middle Name) Complete Home Address: ~ Purok 3 Camanse Sinacabon Misamis Occidental Tel. No: 09099146332 pithday; March 2 2010 : School Last Attended: __Makati science High School School Address: _Kalayaan Avenue &rgy. Cembo, Makati City Grade Level Finish zl Grade Point Average (GPA): Final Grades in Specific Areas: ‘Science S Math a English : Previous PSHS test data: Did you participate in any PSHS test when you were in Grade VI or Grade VII? [1 Yes, in Grade [x] No Reason/s for application for lateral admission: Change of home address APPLICANT'S AND PARENT'S CERTIFICATION This is to certify that _Yzabelle rey 6. Sa Coe ae hhas no pending application as immigrant in any foreign country. Y2ABELLE vis SAGMAQUEN Aare Bile $. SAGMAGUEN ‘Name in ‘of Applicant/ Name it Point of Parent/ Signature the Name Signature the Name 6/x0/2, Date: __@/30/22 LAST DAY FOR FILING IS ON __JULY 25, 2022.ANNEX B: CERTIFICATION FROM SCHOOL - TO BE FILLED OUT BY THE SCHOOL AUTHORITY CONCERNED CERTIFICATION This Is to certify that. ‘a bonafide student of (hiame of Student) is highly recommended to take the (Ful Name oF Present Schoo) Accreditation Examination for Grade 8/9 to be administered by the Philippine Science High School (PSHS) Campus. He/She ranks ina class of , (Warne of PSS COT) TTF ete) Warnbar oF students) He/ She has no grade lower than 85% in any subject. He s/he has not been involved in any disciplinary case and has achieved a character rating of p (Cxcelient/OutstandingHery Good/etc) Fi Harve of School ‘Namie Print of Pineal Complete Adress ‘Sinature of Prncbal Date: ‘ANNEX C: EXAMINATION PERMIT - TO BE FILLED OUT BY THE PSH5 CAMPUS REGISTRAR Republic of the Philippines Department of Science and Technology PHILIPPINE SCIENCE HIGH SCHOOL SYSTEM aD QUALIFYING EXAMINATION PERMIT This certifies that is qualified to take the Philippine Science High Schoo! Lateral Admissions Qualifying Examination on August 1, 2022 at 8:00 a.m., at Philippine Science High School ~ Main Campus, Diliman, Quezon City Philippine Science High School ~ Southern Mindanao Campus, Mintal, Davao Cty Philippine Science High School ~ Western Visayas Campus, Jaro, lilo City Philippine Science High School ~ Eastern Visayas Campus, Palo, Leyte Philippine Science High Schoo! ~ Bicol Region Campus, Goa, Camarines Sur Philippine Science High School ~ Cagayan Valley Campus, Bayomibong, Nueva Vizcaya Philippine Science High School Central Mindanao Campus, Balo- Lanao Del Norte Philippine Science High School - Ilocos Region Campus, San Tidefonso, Ilocos Sur Philippine Science High School - Central Visayas Campus, Argao, Cebu Philippine Science High School Central Luzon Campus, Angeles City, Pampanga Philippine Science High School ~ Cordillera Administrative Region Campus, Baguio City Philippine Science High School - SOCCSKSARGEN Region Campus, Koronadal Gty Philippine Science High School - Ceraga Region Campus, Butuan City Philippine Science High School - CALABARZON Campus, Batangas City Philippine Science High School - MIMARGPA Campus, Gdiongan, Romblon Philippine Science High School ~ Zamboanga Peninsula Campus, Olingan, Dipolog City Campus Registrar