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STEP-UP APPLICATION FORM
SENIOR HIGH SCHOOL – INDIGENOUS
PEOPLE
PERSONAL BACKGROUND
NAME: __________________________________________________________________________________
(Surname, First, Middle)
ADDRESS: _______________________________________________________________________________
(Number, Street, Barangay)
________________________________________ ______________________________________________
(City/Town)
(Province)
TEL (HOME): _____________________________ MOBILE: _______________________________________
E-MAIL: _________________________________ FACEBOOK NAME: ______________________________
DATE OF BIRTH: __________________________ PLACE OF BIRTH: _______________________________
GENDER: ________________________________ NO. OF SIBLINGS: _______________________________
RELIGION: _______________________________ TRIBE: ________________________________________
TRIBAL CHIEFTAIN: ________________________CONTACT NUMBER: _____________________________
HEIGHT: _________________________________ WEIGHT: _____________________________________
SKILLS/TALENTS: _______________________________________________________________________
SPECIAL CIRCUMSTANCES/MEDICAL CONDITIONS: ____________________________________________
ACADEMIC BACKGROUND
NAME OF HIGH SCHOOL: _________________________________________________________________
COMPLETE ADDRESS OF SCHOOL: _________________________________________________________
NAME OF PRINCIPAL: _____________________________ CONTACT NUMBER: _____________________
YEAR GRADUATED: _______________________________ HIGH SCHOOL GEN. AVE: ________________
AWARDS AND DISTINCTION: ______________________________________________________________
ORGANIZATIONS: _______________________________________________________________________
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Application Form
FAMILY BACKGROUND
NAME
OCCUPATION
NAME OF
COMPANY
TELEPHONE/
MOBILE NUMBER
SALARY RANGE
PER MONTH
Father
Mother
Guardian
Parents’/
Guardian’s
Address
PLEASE CHECK THE EDUCATION COURSE AND MAJOR YOU INTEND TO TAKE IN COLLEGE.
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Bachelor of Science in Elementary Education
Bachelor of Science in Secondary Education, Major in:
 English
 Mathematics
 Biology
 Chemistry
 Physical Science
Bachelor of Science in Early Childhood Education
Bachelor of Science in Special Education
PLEASE CHECK THE UNIVERSITY YOU INTEND TO ENROLL IN:
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Mariano Marcos State University (Laoag City, Ilocos Norte)
Philippine Normal University - Manila (Manila City, NCR)
Ateneo de Naga University (Naga City, Camarines Sur)
West Visayas State University (Iloilo City, Iloilo)
Cebu Normal University (Cebu City, Cebu)
Xavier University - Ateneo De Cagayan (Cagayan De Oro City, Misamis Oriental)
University of Southeastern Philippines – Obrero (Davao City, Davao Del Sur)
University of Southeastern Philippines – Tagum (Tagum City, Davao Del Norte)
APPROXIMATE DISTANCE OF PERMANENT ADDRESS TO CHOSEN UNIVERSITY (in KM):_____________
IN A SCALE OF 1-10 WITH 10 AS THE HIGHEST, PLEASE INDICATE YOUR COMMITMENT TO PURSUE A
CAREER IN TEACHING: _________________________
QUALIFICATIONS:
1. Must belong to the top 25% of the graduating batch
2. Must have a minimum overall average of 85%
3. Must not have a grade less than 85% in Math, Science, and English during senior high
school
4. Preferably a Muslim or a member of an indigenous peoples (IP) community
*Note that the financial in/capacity of the applicant will not be the basis of his/her
admission.
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Application Form
ATTACHMENTS:
1. High school principal’s certification attesting that the applicant belongs to the Top
25% of the graduating batch (see attached)
2. NSO Birth Certificate
3. Certificate of good moral character from high school principal or registrar
4. 400-500 word essay on "The First Thing I'm Going to Teach My Students...”
5. High school transcript of records or latest senior year report card
6. National Career Assessment Examination results (if available)
7. Two (2) letters of recommendation from teachers citing the level of interest and
potential of applicant
8. Certificate of Confirmation from National Commission on Indigenous Peoples (if
applicable)
9. TEI’s entrance exam results (for applicants who have already taken and passed the
partner TEI’s admission exam)
I hereby certify that all the information provided by me upon this application is accurate and complete. The information
will be accepted for all purposes as the equivalent of an affidavit and, if it contains a false statement, shall subject me
to the same penalties for perjury as if I had been duly sworn.
_________________________________________________
PRINTED NAME AND SIGNATURE OF APPLICANT
DATE: ___________________________________________
Philippine Business for Education
(02) 801-4446 or 7282031
stepup@pbed.ph
6th floor, 115 Glass Tower, C. Palanca Jr. St., Legaspi Village, Makati City
Visit www.pbed.ph for more information and form
Submit this application form along with the complete attachments via email at stepup@pbed.ph or
via snail mail at Garie Rigor, 6th floor, 115 Glass Tower, C. Palanca Jr. St., Legaspi Village, Makati
City
DEADLINE OF APPLICATION: FEBRUARY 20, 2015
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Application Form
(SCHOOL NAME AND SEAL)
CERTIFICATION
TO WHOM IT MAY CONCERN:
This is to certify that ___________________________ has graduated in this institution for the
school year 2012-2013 and is known to me personally of good moral character.
This certifies that she ranks number _____ among the _______ graduates.
This certification is issued upon request of the herein interested party for whatever legal
purpose it may serve his/her best.
Given this _____ day of (Month) 2015, at (School Name), (School Address).
________________________________
SCHOOL PRINCIPAL
(Signature over Printed Name)
(School’s dry Seal)
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Application Form