Republic of the Philippines

Department of Education
N a t i o n a l C a pi t a l Re g i o n
Sc h o o l s D i v i s i o n O f f i c e o f La s Pi ñ a s C i t y

SPECIAL SCIENCE ELEMENTARY CLASS CTRL No.:

APPLICATION FORM
SY 2022-2023
Instructions:
Please accomplish this form. Write legibly all information needed. DO NOT 1” x 1”
ABBREVIATE. DO NOT LEAVE ANY ITEM BLANK. Countersign all erasures and Photo
corrections made.

PERSONAL DATA:

1) NAME OF APPLICANT: (Last name, First Name, Middle Name) 2) BIRTHDATE

3) Age as of August, 2021 4) SEX MALE 5) CONTACT M M D D Y Y Y Y

NUMBERS:
FEMALE (pls. include all
possible contact
numbers)
7) COMPLETE HOME/PERMANENT ADDRESS (pls. include your zip code)

REMINDERS TO THE EXAMINEE:

1. Be at your testing center on May 20, 2022 one (1) hour before your scheduled examination.
2. Present the Examination Permit and you’re your school I.D. to the Proctor/Room Examiner.
3. Bring at least two sharpened #2 pencil, a good eraser and snacks.

_ _______________________________________________________________________________________________________________________________________________________________________________________________________________________

EXAMINATION PERMIT
1” x 1” CTRL NO.
Photo

This is to certify that ____________________________________________________, is a Kinder pupil of

_____________________________________________ located at ____________________ last school year 2021-2022.
The applicant is eligible to take the entrance examination at Las Piñas Elementary School Central, Padre Diego Cera Ave.,
E. Aldana, Las Piñas City on May 20, 2022.

REMINDERS TO THE EXAMINEE:

1. Be at your testing center on May 20, 2022 one (1) hour before your scheduled examination.
2. Present the Examination Permit and you’re your school I.D. to the Proctor/Room Examiner.
3. Bring at least two sharpened #2 pencil, a good eraser and snacks.