Republic of the Philippines

Department of Education
MIMAROPA Region

2024 SPECIAL CURRICULAR PROGRAM IN SCIENCE ADMISSION FORM

INSTRUCTIONS
Please accomplish this form in two (2) copies. Type or print legibly all information needed. 1x1
Do not abbreviate. Do not leave any form blank. No erasures, mark-overs, and/or mark-outs are allowed. Picture
Deadline of Submission: March 7, 2024

TO BE FILLED UP BY THE PUPIL - APPLICANT

Echague Avhryl Lobrido
Name of Pupil ______________________________________________________________
Last Name First Name Middle Initial
Birth Date April 29, 2008
_____________________________ Female
Sex ___________________
eavhryl@gmail.com
Email Address _____________________________ 09270386843
Contact Number ____________________
Brgy. 4, Burgos Street, Coron, Palawan
Complete Home Address _________________________________________________________________
School intended to Enroll Grade 11 : PALAWAN NATIONAL SCHOOL

I certify that the above information is true and correct.

Avhryl L. Echague
_________________________________________
Signature over Printed Name of Pupil - Applicant

TO BE FILLED UP BY THE PARENTS

Catherine L. Echague
Name of Mother __________________________Occupation Public Servant
_____________________ 09179632227
Contact Number __________
Windyl R. Echague
Name of Father __________________________Occupation 09755946907
_____________________ Contact Number __________
Brgy. 4, Burgos Street, Coron, Palawan
Name of Guardian ________________________ Address of Parents/Guardian _______________________________
Two(2)
No. of Siblings: ___________________________

I certify that the above information is true and correct.

_____________________________________
Signature over Printed Name of Parent
TO BE FILLED UP BY THE SCHOOL AUTHORITY CONCERNED
Name of School : _________________________________________
Coron School of Fisheries I hereby certify that the pupil-
Complete Address Brgy. 1, Sinamay, Coron, Palawan
: _________________________________________ applicant is of good moral
School Contact Number : _____________________________________
character.
Type of School (Please ✔): ____ Private ___ Public ES ___ SSES _____SSC

I certify that the pupil-applicant is currently enrolled in Grade 6 for S.Y. 2023-2024.
Further, I certify that the applicant does NOT have a quarterly grade lower than 85 in Signature over Printed Name of
English, Science and Mathematics and does NOT have a quarterly grade of 83 in other the Adviser / Guidance Counselor
subjects.
_________________________________________
Signature over Printed Name of School Principal

TO BE FILLED UP BY THE SCHOOL AUTHORITY CONCERNED

Document Submitted (Please ✔) ___ Photocopy of Birth Certificate __ Duly certified Photocopy of SF 9 (Report Card)

As per the data above: APPROVED: [ ] DISAPPROVED: [ ]

Reason/s for Disapproval : __________________________________________________________________________
Received and Processed by: ______________________________ Designation: _____________ Date: _____________
__________________________________
Signature over Printed Name of Secondary School Principal

SHS-REGISTRAR-RPM
H. Mendoza St., Barangay Manggahan, Puerto Princesa City
((048) 716 2786 | (048) 423-4695 | 09468152688

pns_1907@yahoo.com Palawan National School https://pns.edu.ph