SHS Application Form SY2018 2019 Revised

Recent 2x2 I.D.
picture
APPLICATION FOR SENIOR HIGH SCHOOL ADMISSION

School Year: 201__ - 201__
Application Number:
Learner’s Reference Number:
Name: _____________________________________________________________________________________________________________________________
Last Name First Name Middle Name
STRAND APPLIED FOR:

Please rank the following strands according to your preference with 1 as most preferred and 4 as least preferred.
General Academic Accountancy, Business and Management

Humanities and Social Sciences Science, Technology, Engineering, and Mathematics
INSTRUCTION:
1. Read the accompanying brochure, procedures and all instructions very carefully.
2. Fill out this form legibly in print or type all required information. Write N/A if the information is not applicable to you.
INCOMPLETE APPLICATION FORMS WILL NOT BE PROCESSED.
3. Submit this form with the following to the Guidance and Admissions Office (GAO:
a. Accomplished Recommendation Form signed by the Principal or Guidance Counselor. The form is
downloadable from www.ua.edu.ph
b. Photocopy of Grade 9 report card or Grade 10 report card with grades from the recent grading period
c. 2 copies of 2 x 2 close up picture with white background
4. Those applying for scholarship must ask for a SCHOLARSHIP APPLICATION FORM or download the same from
www.ua.edu.ph/scholarships. Fill out the form and submit it together with the requirements specified in item 4 above.
PERSONAL INFORMATION:
Permanent Address: ____________________________________________________________________________________________________
No. Street Barangay/Village Town/City Province
Telephone Number _____________________ Mobile Number ____________________________ E-mail add.: ___________________________
Birth Date: ___________________ Birth Place: __________________________________________________________________ Age:___________

mm/dd/yyyy Municipality/City Province
Religion: _________________________ Citizenship: ___________________ Civil Status: _______________ Gender:______________
FAMILY INFORMATION:
FATHER Living Deceased MOTHER Living Deceased Guardian (if applicable)
Name
Telephone Number
Mobile Number
Email Address
Occupation
Company Address
Less than P7,890 P31,561 – P78,900 P118,351 – P157,800
Monthly Family
Income
P7,891 – P15,780 P78,901 – P118,350 P157,800 and above
P15,781 – P31,560
Who will finance your studies: _______________________________________________________________________________________________________________

ACADEMIC INFORMATION 
Name of Junior High School: _____________________________________________________________________________________________________
Address of Junior High School: __________________________________________________________________________________________________
Name of Principal: ______________________________________ Name of Guidance Counselor: ____________________________________
Are you a candidate for:  With Highest Honors With High Honors With Honors
SCHOLARSHIPS AND GRANTS
Are you applying for SCHOLARSHIP or GRANT: YES  NO
If yes, please secure a copy of the SCHOLARSHIP APPLICATION FORM from the Guidance and Admissions Office or download
the same from www.ua.edu.ph/scholarships.
OTHER INFORMATION
Preferred Course/Program in College: _________________________________________________________________________________________
Please check three (3) of the following reasons why you chose the University of the Assumption. You may also write
your own reason in “others”.
adherence to Catholic tradition extra-curricular activities alumni relatives

quality education and research outreach ministry location
graduate employability sports facilities and resources
 Others, please specify: _________________________________________________________________________________________________________
How did you learn about UA?
Family Guidance Counselor/Principal School Career Orientation

Friends Trimedia (TV, Newspaper, Radio) Billboards, Posters, Flyers
Teachers UA Website/Social Media Others, ____________________________
I hereby certify that the above-written information is true and correct. I agree to comply with all the admission
requirements and procedure of the University of the Assumption. Otherwise, my admission/enrolment will be invalidated.
__________________________________________________ ______________________________________________________
Applicant’s Signature Parent/Guardian Signature over printed name
DO NOT WRITE BELOW THIS LINE
Entrance Test Date: ________________________ Test Results: RS ___________ Recommendation ________________________

Time: ________________________ PR ___________ _____________________________________________
Room: ________________________ S ___________ _____________________________________________
VI ___________
Counselor _________________________________
General Average: Science/Math ___________
___________________________________________________________________________________________________________________________________________________
GUIDANCE & ADMISSIONS OFFICE
Tel.No. (045) 961-1482 Local 104
www.ua.edu.ph

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SHS Application Form SY2018 2019 Revised

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Recent 2x2 I.D.

APPLICATION FOR SENIOR HIGH SCHOOL ADMISSION

Learner’s Reference Number:

STRAND APPLIED FOR:

General Academic Accountancy, Business and Management

Telephone Number _____________________ Mobile Number ____________________________ E-mail add.: ___________________________

Birth Date: ___________________ Birth Place: __________________________________________________________________ Age:___________

Religion: _________________________ Citizenship: ___________________ Civil Status: _______________ Gender:______________

Who will finance your studies: _______________________________________________________________________________________________________________

Name of Junior High School: _____________________________________________________________________________________________________

Address of Junior High School: __________________________________________________________________________________________________

Name of Principal: ______________________________________ Name of Guidance Counselor: ____________________________________

SCHOLARSHIPS AND GRANTS

Are you applying for SCHOLARSHIP or GRANT: YES  NO

adherence to Catholic tradition extra-curricular activities alumni relatives

How did you learn about UA?

Family Guidance Counselor/Principal School Career Orientation

DO NOT WRITE BELOW THIS LINE

Entrance Test Date: ________________________ Test Results: RS ___________ Recommendation ________________________

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Telephone Number _ Mobile Number E-mail add.: _______

Birth Date: _ Birth Place: ______________________________________ Age:_

Religion: _______________ Citizenship: _ Civil Status: _ Gender:________

Name of Principal: __ Name of Guidance Counselor:

Entrance Test Date: __________________ Test Results: RS _ Recommendation ____________________