CENTRO ESCOLAR INTEGRATED SCHOOL
in cooperation with
E
S
CENTRO ESCOLAR UNIVERSITY
E
T
I
U
C
APPLICATION FOR ADMISSION
Senior High School
R
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I
C
1.5 x 1.5 inches
ID Picture (1 pc.)
V
E
Student No.:
CAMPUS APPLYING TO (Please check one)
■ MANILA
■ MAKATI
■ MALOLOS
READ THE INSTRUCTIONS CAREFULLY
REQUIREMENTS FOR APPLICATION
1. Fill out this form in PRINT (blue/black
ink).
2. Submit fully accomplished form and
bring the requirements.
FOR FILIPINO STUDENT APPLICANTS
FOR FOREIGN STUDENT APPLICANTS
1. 1.5 x 1.5 inches I.D. Picture (2 pcs.)
2. Filled out Application for Admission Form
(Resident Alien)
1. I-card
2. 1.5 x1.5 inches I.D. Picture (2 pcs.)
3. Filled out Application for Admission Form
ENTRY STATUS
STRANDS APPLYING FOR IN ACADEMIC TRACK (Please check one)
■ Grade 11
■ Grade 12
■ Accountancy, Business, and
Management (ABM)
■ Humanities and Social Sciences
(HUMMS)
(Non-resident Alien)
1. Passport size I.D. Picture (2 pcs.)
2. Police Clearance
3. Photocopy of Passport
4. Filled out Application for Admission Form
■ Science, Technology, Engineering, and
Mathematics (STEM)
PERSONAL INFORMATION
Last Name:
First Name:
Nickname:
Birthdate (MM/DD/YYYY):
Citizenship:
For Foreign Applicants:
■ Filipino
■ Resident Alien
■ Dual (Please specify):
Country of Citizenship:
Civil Status:
Middle Name:
Birthplace:
Religion:
Gender:
■ Non-resident Alien
■ Male
■ Female
Mobile Phone No.:
Email Address:
ADDRESS
City Address:
Zip Code:
Telephone No.:
Provincial Address:
Zip Code:
Telephone No.:
FAMILY INFORMATION
ACADEMIC INFORMATION
FATHER
Grades 1-6
Name:
Occupation:
Company:
Contact No.:
School Name:
Income (Monthly):
Address:
Year Graduated:
Grades 7-10
Year Graduated:
Region:
Type of School:
■ Public
Highest Educational Attainment:
School Name:
■ Private
Year Graduated:
MOTHER
Name:
Contact No.:
Address:
Region:
Type of School:
■ Public
Occupation:
Company:
Income (Monthly):
Highest Educational Attainment:
Year Graduated:
School Name:
Year Graduated:
Address:
Region:
Type of School:
Honor/Award:
General Average:
■ Public
Parents are:
■ Living Together
■ Father/Mother Working Abroad
■ Separated
■ Father/Mother Deceased
■ Private
Grades 11-12
■ Private
■ Other Situation:
SPECIAL TALENTS/HOBBIES
Living Arrangement:
■ With Parents
■ With Stepfather/Stepmother
■ In a Boarding House/Dormitory/Apartment
■ With Relatives
■ With Guardian
GUARDIAN
Name:
Contact No.:
SELF-ASSESSED HEALTH STATUS
Common Health Complaints:
Occupation:
Company:
Highest Educational Attainment:
Copy to SRMD/SRMS • Rev. 1 08-11-15
Income (Monthly):
Year Graduated:
I hereby certify that the above information given is true and correct.
_________________________________________________
Student’s Signature and Date