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    Application For Admission

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    Jhelian Adil Aticaldo
    Application

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    © All Rights Reserved
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    Application For Admission

    Uploaded by

    Jhelian Adil Aticaldo
    3 views2 pages
    Application

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    Application for Admission

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    Application

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    3 views2 pages

    Application For Admission

    Uploaded by

    Jhelian Adil Aticaldo
    Application

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    Republic of the Philippines

    UNIVERSITY OF EASTERN PHILIPPINES


    University Town, Northern Samar
    1x1
    1x1
    Web: uep.edu.ph email: [email protected]

    COLLEGE OF EDUCATION
    Signature of In-charge UEP SENIOR HIGH LABORATORY SCHOOL Learner’s Reference Number (LRN)

    APPLICATION FOR ADMISSION

    Semester: [ ] 1st Sem [ ] 2nd Sem. Track : _______________________________


    School Year: 20___ – 20____ Strand: _______________________________
    Name: _____________________________________________________________________________________
    (Surname) (Given Name) (Suffix) (Middle Name)
    Grade Level: ____ Weight: _____kg Height: ____cm Date of Birth: __________ Place of Birth: ____________
    Contact Number: ____________________ e-mail add: _________________________ Sex: [ ] Male [ ] Female
    Home Address: _____________________________________________________________________________________
    Campus Address: ___________________________________________________________________________________
    Father’s Name:__________________________________________________ Occupation: _________________
    (Surname) (Given Name) (Suffix) (Middle Name)
    Contact Number: ____________________ e-mail add: _______________________ FB Name: _____________
    Mother’s Name:__________________________________________________ Occupation: _________________
    (Surname) (Given Name) (Suffix) (Middle Name)
    Contact Number: ____________________ e-mail add: _______________________ FB Name: _____________
    Guardian’s Name:________________________________________________ Occupation: _________________
    (Surname) (Given Name) (Suffix) (Middle Name)
    Contact Number: ____________________ e-mail add: _______________________ FB Name: _____________
    School last attended:
    Level Name of School Address of School Grade School
    Completed Year
    Elementary
    Secondary

    STUDENT’S PLEDGE
    In consideration of my admission to UEP Senior High Laboratory School, and the privileges of a regular
    student of this University, I hereby pledge and promise to abide and comply with all the requirements, rules and
    regulations, such as uniform, prescribed haircut, wearing of school ID and other rules which may be required by
    the university, the school, UEPSHLS, PTA and student council.
    I also pledge to work hard and maintain high academic performance during my stay in this school and
    oblige my parents to attend meetings as required by the same. I understand that the University has the right to
    suspend me for failure to comply with the required academic and behavioral requirement.

    Student’s Signature Student Services Coordinator/ Guidance


    PARENTAL UNDERTAKING
    The undersigned parent of herein UEPSHLS student undertakes to comply with all of my obligations to
    the school to help create an academic and non-academic environment conducive to learning. I acknowledge the
    fact that I have academic and financial obligations to enable UEPSHLS to provide excellent learning opportunities
    as a laboratory school.

    Father’s Signature and/or Mother’s Signature and/or Guardian’s Signature


    SCHOOL FEES (SY 2024-2025)

    Children of Non-UEP Employees Children/Dependents of UEP Employees


    Voucher Program Voucher Program
    FEES
    Beneficiary Beneficiary
    Grade 11 Grade 12 Grade 11 Grade 12
    Tuition
    - First Sem 4,375 NA
    - Second Sem 4,375 NA
    Total 8,750.00

    Assessed by: ___________________ Date: ______________

    OR Number: ___________________ Date: ______________ Collected by: _____________________________


    Signature over Printed Name/Date

    CERTIFICATION

    This is to certify that ___________________________________ is a [ ] regular/ [ ] irregular Grade ____ student


    this School Year 20___-20___.

    School records show that s/he has advance/lack unit/s in Grade ________. (This will be filled out, if applicable)

    ______________________________
    SHS Adviser

    Date: ___________________

    CERTIFICATION
    This is to certify that the information/data of the above-named student are encoded in the SF1, and the same data
    found in the Learner’s Information System (LIS).

    CLEMENTE T. PUJANTE, EdD (CAR)


    ICT/LIS Coordinator
    Date: ___________________

    Recommending Approval:

    MRYNA E. CORNILLEZ, MAME


    SHS Coordinator
    Date: ___________________

    APPROVED:

    VERONICA A. PICZON, PhD


    OIC-School Principal
    Date: ___________________

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