Republic of the Philippines

Department of Education
DepEd Complex, Meralco Avenue, Pasig City, Philippines
Bureau of Learning Delivery, Student Inclusion Division, Madrasah Education Program
Room 504-B Bonifacio Building, DepEd Complex, Meralco Avenue, Pasig City
Telephone number 834-2924 / 634-1250 / Telefax: 635-56-69

APPLICATION FORM
QUALIFYING EXAMINATION IN ARABIC LANGUAGE 1x1 ID
AND ISLAMIC STUDIES (QEALIS) PHOTO

I. PERSONAL DATA:
Name: __________________________________________________________________________
Name (If Reverted to Islam): ______________________________________________________
Address: _________________________________________________________________________
Date of Birth: ___________ Age: _______Place of Birth: _______________________________
Gender: _______________ Civil Status: ____________ Citizenship: ______________________
Contact No.: ____________________ E-Mail Address: _________________________________
Religion: ______________________________________________ Tribe: _____________________
Languages/Dialects Spoken: _____________________________________________________

II. EDUCATIONAL BACKGROUND:

A. Secular
Educational Years Year Units
Attainment School Covered Graduated Earned
Post-Graduate
College
High School
Elementary
Pre-Elementary

B. Islamic:
Educational Years Year Units
Attainment School Covered Graduated Earned
Post-Graduate
College
High School
Elementary
Pre-Elementary
 III. EMPLOYMENT BACKGROUND:
Company’s Name Address Position Years Contact No.
Covered

Other Skills: ________________________________________________________________

Government Examination Passed: __________________________________________

Reason/s for applying for the Qualifying Examination in Islamic Studies and
Arabic Language
(QEALIS):__________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

I hereby certify that the information written in the application form is true
and correct. Any misrepresentations will disqualify me from taking the (QEALIS)
to be administered on _________________, 2022 and in all to be scheduled
QEALIS under the ALIVE Program of the Department of Education (DepEd).

________________________
APPLICANT
(Signature Over Printed Name)