PSHS 00 F RPA 16 Ver02 Rev0 NCE Application Form

DOST-PHILIPPINE SCIENCE HIGH SCHOOL SYSTEM THESE MATERIALS ARE NOT FOR SALE.
THEY
NATIONAL COMPETITIVE EXAMINATION (NCE) MAY BE PHOTOCOPIED AND MAY BE
APPLICATION FORM DOWNLOADED FROM www.pshs.edu.ph
Instructions: Staple Only

Please accomplish this form in two copies. Type or print legibly all information needed and carefully read
the REMINDERS TO EXAMINEES. DO NOT ABBREVIATE. DO NOT LEAVE ANY ITEM BLANK. Countersign all 1” x 1”
erasures and corrections made. Photo
PERSONAL DATA:
1) NAME OF PUPIL-APPLICANT: (Last Name, First Name, Middle Name) 2) BIRTH DATE:
M M D D Y Y Y Y
3) SEX: MALE 4) CONTACT 5) EMAIL ADDRESS:

NUMBERS : NUMBERS :
(pls. include all (pls. include all
FEMALE possible contact possible email
numbers) addresses)
6) COMPLETE HOME/ PERMANENT ADDRESS: (pls. include your zip code)
NAME OF CITY/MUNICIPALITY (of your residence): ______________________________ LEARNER’S REFERENCE NO.: __________________________
7) NAME OF SCHOOL (Write full name of school): 8) COMPLETE SCHOOL ADDRESS: 9) SCHOOL
CONTACT
NOS.:
10) SCHOOL TYPE: Public 11) Pupil-Applicant’s FINAL GRADE in Grade 5: MATH ___________________
Private SCIENCE ___________________
PLS. NOTE: If final grade in Science and/or Math is below 85, submit a certification from the principal that the child
belongs to the upper 10% of the batch.
TO BE FILLED OUT BY THE PARENTS: YES NO

1. Is your child a Filipino citizen?  
2. Does your child have a pending or approved application as immigrant in any foreign country?  
3. Has your child taken the PSHS National Competitive Examination before?  
4. Is your child older than fourteen (14) years old by the year of admission to PSHS?  
5. Should your child pass the NCE, do you allow for your child’s name to be posted in the PSHS website/newspaper? (If NO, results will be mailed.)  
6. If not qualified in the Main Campus (MC), are you willing to enroll your child in a Regional Campus she/he will qualify in?  
(If NO, your child will be considered ONLY for the MC, Quezon City.)
If answer in No. 6 is YES. please check the preferred regional campus (choose only ONE)
ILOCOS REGION – San Ildefonso, Ilocos Sur ZAMBOANGA PENINSULA – Dipolog City
CAGAYAN VALLEY – Bayombong, Nueva Vizcaya CENTRAL MINDANAO – Balo-i. Lanao del Norte
CENTRAL LUZON – Clark Freeport Zone SOUTHERN MINDANAO – Tugbok, Davao City
CALABARZON – Batangas City SOCCSKSARGEN – Paraiso, Koronadal City
MIMAROPA – Odiongan, Romblon CARAGA – Ampayon, Butuan City
BICOL – Goa, Camarines Sur CORDILLERA ADMINISTRATIVE REGION – Irisan, Baguio City
WESTERN VISAYAS – Jaro, Iloilo City
CENTRAL VISAYAS – Argao, Cebu
I certify that the above information is true and correct. I understand that any false or misleading information will result to the
EASTERN VISAYAS – Palo, Leyte disapproval of application/admission/enrollment/scholarship.
Signature over Printed Name of Parents _____________________________________________________
(PLEASE DO NOT DETACH)

This serves as a proof of application. IMPORTANT: This DOES NOT serve as the test permit.
NAME OF PUPIL-APPLICANT: _______________________________________________________________________________

NAME OF SCHOOL: _____________________________________________________________________________________
Submit the following upon filing of application: Recommendation of the PSHS Registrar/DOST or PSTO Coordinator: To be accomplished by the
 Fully accomplished Application Form in two (2) As per data above: PSHS Cashier:
copies Approved: [ ] Mode of Payment: Cash only
 Two (2) identical recent 1 x 1 ID pictures Disapproved: [ ]
Payment Received by:
 Non-refundable processing fee for private school Reason/s for Disapproval: _______________________________________
students (to be paid to the PSHS Cashier’s
_______________________________________
Office)/Free for public school students
 Certified true copy of Grade 5 report card Processed by: [ ] DOST ____________________ Date: _________ __________________________
 If final grade in Science and/ or Math is below 85, Name & Signature Name & Signature
submit a certification from the principal or proof [ ] PSHS ____________________ Date: _________________
that the child belongs to the upper 10% of the Name & Signature
batch
REMINDERS TO THE EXAMINEE:

1. Be at your testing center one (1) hour before your scheduled examination (either a.m. or p.m. as indicated in the exam permit).
2. Present the Examination Permit and your school I.D. to the Proctor/ Room Examiner.
3. Bring at least two sharpened #1 pencils, a good eraser and snacks.
4. If you do not receive your examination permit two (2) weeks before the exam, you may visit or call the nearest PSHS Campus or call PSHSS-
Admissions Office at telephone no. (02) 8939-PSHS (89397747) or check at www.pshs.edu.ph.
5. In case of emergency (e.g. adverse weather conditions, impassable roads due to floods and earth quake), the NCE may be postponed. You should call the PSHSS
Admissions Office or the nearest PSHS Campus or check www.pshs.edu.ph for announcements.
6. The following are items to be submitted as enrollment requirements for qualified examinees ONLY: a) Certified true copy of Grade 6 card with character rating of at
least a satisfactory rating or its equivalent; b) Photocopy of any document with examinee’s date of birth.
PSHSS-Admissions Office
PSHS-00-F-RPA-16-Ver02-Rev0-02/01/20

PSHS 00 F RPA 16 Ver02 Rev0 NCE Application Form

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DOST-PHILIPPINE SCIENCE HIGH SCHOOL SYSTEM THESE MATERIALS ARE NOT FOR SALE.

Instructions: Staple Only

3) SEX: MALE 4) CONTACT 5) EMAIL ADDRESS:

6) COMPLETE HOME/ PERMANENT ADDRESS: (pls. include your zip code)

Private SCIENCE ___________________

TO BE FILLED OUT BY THE PARENTS: YES NO

Signature over Printed Name of Parents _____________________________________________________

(PLEASE DO NOT DETACH)

NAME OF PUPIL-APPLICANT: _______________________________________________________________________________

REMINDERS TO THE EXAMINEE:

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