___________________________

MINDANAO MISSION ACADEMY ENROLLMENT FORM

Learner's Reference Number (LRN) The School That Offers Something Better Junior High School
New Student Old Student
Manticao, Misamis Oriental School Year: ___________________

STUDENT'S PERSONAL INFORMATION

LAST NAME:__________________________FIRST NAME:_________________________________MIDDLE NAME: ______________________SEX: ______
If Dormitorian kindlyAircon with CR Non-aircon
Grade Level: _______check: Aircon without CR Self-cook Complete Address: __________________________________________________
Religion: _____________________________If SDA: Baptized Non-Baptized Contact No.: ______________________ Email Address: _____________________
Last School Attended: _________________________________________ Vaccination Date: 1st dose________________________ 2nd dose______________________
Mother's Maiden Name: _________________________Father's Name: ____________________________Guardian's Name: ______________________
Parents/Guardian's Address: ______________________________________ Occupation:______________________ Employed in an SDA Institution
Parents/Guardian's Contact No: ____________________________________ Name of SDA Institution: ________________________________________________
*If employed in SDA Institution

Secure signatures from the following:

1. Business Office: __________________________ 4. Guidance: ______________________ Payment: ₱__________________

2. Dormitory Dean: __________________________ 5. Vice Principal:___________________ OR No. _____________________

*for Dormitorians only
Report Card Good Moral
3. Homeroom Adviser: _______________________ 6. Registrar: ______________________
*except incoming Grade 7
PSA Birth Cert. ESC Cert.
STUDENT PLEDGE
Reminder: A student who transfers and withdraws within the first week of classes will be charged 10% of the total amount, 20% within the second week
regardless of whether the student has attended the classes. The student will be charged all school fees in full if he/she withdraws any time after the second
week of classes regardless of reasons.
 

I understand clearly the policies embodied in the Mindanao Mission Academy Student Handbook, and I am in full harmony with them. I
agree to obey all these and other regulations. If at any time I find myself out of harmony with the regulations and standard of the school, I
agree to withdraw when required by the duly constituted authorities.
 
_________________________________ _______________________________
Student’s Signature Parent’s Name/Signature
_____________________________
Date Signed
SF10-JHS LACHICA, ALLYANA TRISHA TANGHAL Page 2 of 2

School: School ID: District: Division: Region:

Classified as Grade: Section: School Year: 2021-2022 Name of Adviser/Teacher: Signature:
Quarterly Rating FINAL
LEARNING AREAS REMARKS
1 2 3 4 RATING
Filipino 0
English 0
Mathematics 0
Science 0
Araling Panlipunan (AP) 0
Values Education 0
Technology and Livelihood Education (TLE) 0
MAPEH 0
Music 0
Arts 0
Physical Education 0
Health 0
Computer 0
Pathfindering 0
Homeroom 0
No. of School Days No. of Days Present General Average 0

Remedial Classes Conducted from (mm/dd/yyyy) to (mm/dd/yyyy) 0 u

Learning Areas Final Rating Remedial Class Mark Recomputed Remarks

Final Grade

78
86

School: MINDANAO MISSION ACADEMY School ID: 405164 District: MANTICAO Division: MISAMIS ORIENTAL Region: X
Classified as Grade: 10 Section: School Year: 2022-2023 Name of Adviser/Teacher: Signature:
Quarterly Rating FINAL
LEARNING AREAS REMARKS
1 2 3 4 RATING
Filipino 0
English 0
Mathematics 0
Science 0
Araling Panlipunan (AP) 0
Values Education 0
Technology and Livelihood Education (TLE) 0
MAPEH 0
Music 0
Arts 0
Physical Education 0
Health 0
Computer 0
Pathfindering 0
0
0
Conduct
No. of School Days No. of Days Present General Average 0

Remedial Classes Conducted from (mm/dd/yyyy) to (mm/dd/yyyy) 0 u

Learning Areas Final Rating Remedial Class Mark Recomputed Remarks

Final Grade

For Transfer Out / JHS Completer Only 0

CERTIFICATION

I CERTIFY that this is a true record of with LRN and that he/she is eligible for admission to Grade
Name of School: School ID: Last School Year Attended:
 Date Signature of Principal/School Head over Printed Name (Affix School Seal Here)
(May add Certifiation box if needed) SFRT Revised 2017