Ateneo de Zamboanga University 1x1

APPLICATION FOR SENIOR HIGH SCHOOL ADMISSION PICTURE

Fill out this form carefully and PRINT or TYPE all information requested. Only Application Forms correctly and completely filled
out will be accepted. INCOMPLETE FORMS WILL NOT BE PROCESSED.

1. NAME _______________________________________________________________________
BRACAMONTE
EDLIN NICOLE ACAIN _____________________
NIKOLAY

Last First Middle Nickname

2. CITY ADDRESS __________________________________________________________________________________________
Purok 3 Labason-Liloy Road Fatima Liloy

House No. Street Barangay City

_________________________________________________________________________________________________________
Zamboanga Del Norte 09971935501 itsnyxxcole@gmail.com
https://www.facebook.com/itsnyxxcole

Province Tel No./Mobile No. Email Address Facebook URL

PROVINCIAL ADDRESS: __________________________________________________________________________________

Fatima, Liloy Zamboanga Del norte, 7115

3. FATHER’S NAME ____________________________________________

Bracamonte Rodney Colin Daarol
Living? Yes ( ) No ( )
•

If employed, name of company/employer? _____________________________ Government Employee

Contact Number:_____________________ 09212360852

MOTHER’S NAME _____________________________________________

Acain Eden Reganon
Living? Yes ( ) No ( )
•

If employed, name of company/employer? _____________________________ Housewife Contact Number:_____________________ 09971935501

Guardian (If any) _________________________________________________

Bracamonte Rodney Colin Daarol
Relationship:_________________________ Father

Contact Number:_____________________ 09212360852

4. DATE OF APPLICANT’S BIRTH ______________________ Age _________ Place of Birth __________________________

August.22.2006 17 Quezon City

5. CITIZENSHIP ______________________ Religion _____________________ Sex ______________ Civil Status ____________

Filipino Roman Catholic Female Single

Are you an International Student? No Yes, from (place of origin) ______________________________________________

6. Do you belong to any INDIGENOUS PEOPLES (IP) Community? ( ) Yes, Pls. specify: ____________________ ( ) No
(Ex.: B’laan, Bukidnon, Higaonon, Mamanwa, Mandaya, Manobo, Mansaka, Sangir, Subanen, Tagabawa, Tagakaulo, Tasaday, Tiboli)

7. PRESENT JUNIOR HIGH SCHOOL ________________________________ Section (Name, Letter or Number) ____________
Liloy National High School 10- Amethyst

8. SCHOOL ATTENDED: Beginning from the lowest grade, list in order all schools attended. This must be a complete listing of
every school in which you have enrolled. (Please indicate type of school whether Government or Private in the column provided)
Elementary Type Address
______________________
Liloy Central School ________
Public __________________________ Grade _____ to Grade _____ 20___ to 20___
Fatima, Liloy Zamboanga Del norte 1 6 13 18

______________________ ________ __________________________ Grade _____ to Grade _____ 20___ to 20___

Junior High School Type Address

_______________________ ________
Liloy National High School Public _________________________ Year ______ to Year ______ 20___ to 20___
Fatima, Liloy Zamboanga Del Norte
1st 4th 18 22

_______________________ ________ _________________________ Year ______ to Year ______ 20___ to 20___

9. Person to contact in case of emergency:

Name: _________________________________________________________
Acain Eden Reganon
Relationship: ________________________ Mother

Complete Address: ________________________________________________________________________________________

Fatima, Liloy Zamboanga Del norte

Contact Numbers: Residence: _______________ Office : _______________ Mobile Phone: _______________________ 09971935501

10. PROGRAMS OF STUDY. Check (√) the program you wish to follow. Indicate a second choice by placing the number 2 before
the name of the program. Also, make a 3rd choice by placing the number 3 before the name of the program.
ACADEMIC TRACK
_____ Accountancy, Business and Management (ABM) Strand
✔

_____ Humanities and Social Science (HUMSS) Strand

_____ Science, Technology, Engineering and Mathematics (STEM) Strand

PRIVACY CONSENT
I/We hereby certify that all the information written in this application is complete and accurate to the best of my knowledge. I agree if
accepted as a student that my admission, matriculation, and graduation are subject to the rules and regulations of the Ateneo de
Zamboanga University. I further agree that wearing of niqab on campus is strictly prohibited. All information provided are confidential
and shall not be copied, shared, distributed, and used for any other purposes unless stated by the applicant, parent/s or legal guardian
whose name is indicated herein and/or required by the law.

Student’s Signature over Printed Name: ___________________________________Edlin Nicole A. Bracamonte

Date: ______________________________
03.31.2024

Parent’s /Guardian Signature over Printed Name: ____________________________ Bracamonte Rodney Colin Daarol Date: ______________________________
03.31.2024