Senior High School Registration Form: Department of Education SY

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SECOND SEMESTER

Annex 3

Department of Education

Senior High School Registration Form


SY

TO THE STUDENT AND PARENT/GUARDIAN: Print legibly all information required. Place X marks in appropriate boxes.
2. SEX

1. NAME OF STUDENT: Print or type your full name in the following sequence: LAST, FIRST, MIDDLE.
Place one letter in each box. Leave one box blank between names.

Male

Female

3. DATE OF BIRTH (Month, Day, Year)

LAST
FIRST

MIDDLE
5. NATIONALITY

4. PLACE OF BIRTH (City/Town or Province)


6. ELEMENTARY SCHOOL (where you completed Elementary Level education / Grade 6)
Elementary School Name (Do not abbreviate)

Month/Year of Completion

Address (City/Town or Province)

Region
Month/Year of Completion

Are you a passer of Philippine Educational Placement Test (PEPT) for Elementary Level?

No

Yes

Are you a passer of Accreditation and Equivalency (A&E) Test for Elementary Level?

No

Yes

Name of Community Learning Center (Do not abbreviate)

Address (City/Town or Province)

Month/Year of Completion

7. JUNIOR HIGH SCHOOL (JHS) (where you completed/are completing JHS / Grade 10)
JHS Name (Do not abbreviate)

Month/Year of Completion

Address (City/Town or Province)

Region
Month/Year of Completion

Are you a passer of Philippine Educational Placement Test (PEPT) for JHS Level?

No

Yes

Are you a passer of Accreditation and Equivalency (A&E) Test for JHS Level?

No

Yes

Name of Community Learning Center (Do not abbreviate)

Address (City/Town or Province)

Month/Year of Completion

8. SENIOR HIGH SCHOOL (SHS) APPLIED FOR: Choose from the list of schools offering SHS (up to two choices allowed). Do not indicate the same SHS
twice. Make sure that track (Academics, TVL, Sports, Arts and Design), strand, and specialization choices are offered in the SHS indicated. Write NONE on
the blank if you do not have other choices of SHS/track/strand/specialization.
Name of First Choice SHS (Do not abbreviate)
Address (City/Town or Province)
First Choice
Track:

Specializations:
1.

Strand:

Second Choice
Track:

Specializations:
1.

2.

2.

3.

3.

4.

4.
THIS REGISTRATION FORM IS NOT FOR SALE AND MAY BE REPRODUCED.

Strand:

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