APPLICATION FOR ADMISSION AND SCHOLARSHIP EXAMINATION

Application No: __________

Amount: __________ Attach
Received by: __________
1x1 picture

here.

Name of Student: __________________________________________________________ Student’s Signature: _________________

(Last) (First) (Middle)
LRN: ________________ Date of Birth: __________________ Place of Birth: ______________________ Gender: ______________
Name of Elementary School: ___________________________________________________ Division: ________________________
Address of Elementary School: _________________________________________________ School Type: Public ____ Private _____
Father’s Name: ____________________________________________________________ Occupation: ________________________
Mother’s Name: ___________________________________________________________ Occupation: ________________________
Home Address: ____________________________________________________________ Contact Number: ____________________
Guardian’s Name (if any): ___________________________________________________ Occupation: ________________________
Guardian’s Address: ________________________________________________________ Contact Number: ____________________

ᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙ
Requirements:
1. Duly accomplished application form
2. Certificate of enrollment as Grade 6 pupil
3. Two (2) copies 1x1 ID pictures (attached to the accomplished application form)
4. Non-refundable examination fee of P250.00
ᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙᵙ
EXAMINATION PERMIT

Attach ______________________________________
LRN
1x1 picture

here. ______________________________________
NAME OF STUDENT

______________________________________
_________________________
Signature of Student NAME OF SCHOOL

TO BE FILLED UP BY THE SCHOOL PERSONNEL ONLY:

Your application for the __________ MSU-SciHS Admission and Scholarship Examination is approved. Please report to the
venue on ___________________________ at the indicated schedule.

____ 1st Batch at 8:00 A.M. – 10:00 A.M. Application No. ____________
____ 2nd Batch at 10:15 A.M. – 12:15 N.N. Amount: ____________
____ 3rd Batch at 1:00 P.M. – 3:00 P.M.
____ 4th Batch at 3:15 P.M. – 5:15 P.M.

NOTE: Submit this permit to the SciHS examiner on the day of the examination. Bring your school ID card, Mongol 2 pencil/s,
pens (BLUE-inked) and snacks.

Prof. Norjanah U. Hadji Socor

Principal
Chair, Admission and Scholarship Committee