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2OL3 PHILIPPINE SCIENCEHIGH SCHOOLSYSTEMNATTONALCOMPETTTTVEXAMTNATTONNCE)

APPLICATIONFORM

THESEMATERIALSARE NOT FOR sALE. THEY

MA Y BE PHOTOCOPIED AND MAY BE

DOWN OADED ROMwww.pshs.edu.ph

Instructions:Please accomplish this form in two copies. Type or print legibly al l information needed. DO NOT

ABBREVIATE. DO NOT LEAVEANY ITEM BLANK. Countersign all erasures and corrections made.

DEADLINEOF SUBMISSION: July 13, 2OI2

PERSONALDATA:

1) NAME OF APPLICANT: (Last Name, Firct Name, Middle Name) 2) BIRTHDATE:

M M D D Y Y Y Y

6 ) EMAIL ADDRESS:) AG Easof June ,2O1-3: 4) SEX: MALE

FEMALE

5) CONTACTNUMBERS:(p l s . i nc l ude al l

possible contact

numbers)

TO BE FILLED UP BY THE PARENTS:1, Isyour hild Fil ipinoit izen?2, Does ou rchi ldhavepending pplicat ions mmigrantn an y oreign ountry? E E

3. Ha syourchild aken he PSHS ational ompetitive xamination efore?t] E4. In which f the ol lowing SHS ampusesould ou ike ou rchi ld o study?

Indicateyour to p 2 choices f campusby writing "1 " as irst choicean d "2 " as second hoice n the box provided.

rlocos REGIoN - Sa n ldefonso, locosSu r l--l cenrml vIsAYAs - Argao,Cebu

CAGAYANVALLEY Bayombong,NuevaVizcayal_-l

EASTERNVISAYAS - Palo,Leyte

CENTRALTUZON ClarkFreeport one,Pampangal__l

CENTRALMINDANAO Balo-i. anao el Norte

BICOL REGION Goa,Camarines ur[__..1

SOUTHERNMINDANAO Tugbok,DavaoCity

MAIN - Diliman,QuezonCityl__..1

CORDILLERAADMIN. REGION BaguioCi V

WESTERNVISAYAS Jaro, loiloCity | | SOCCSKSARGEN Paraiso, oronadal ity

I certit'y hat he bow nt'ormations rtLe nd orrect. undestand hatanyt'alse r misleadingint'ormationwillesub o he

d s ppr v l of applic ion/admisi n.

Parent's ignature verPrintedName

CONSIDERHE FOLLOWINGWHENCHOOSINGCAMPUS:

1. The score n the NCE s the major basis orquati fy ingo the PSHS.

2. AtI examineesar e ranked from highest tolowest. Th e to o 240 or so ouatifiersirrespective f regionof originwitt be invited

to enrotIa t the MainCamDus ut acceDtanceto the invitation s not compulsory.

3. Qualifiers or a regiona[ campus who areresidents f that region/feeder re aar e givenprior i ty o enrot l n that campus.

4. Non-residentsf th e region/feeder rea ma y

be considered s alternate uali f iers f theirscoresare within the cut off score or thatregion, nd f s lo ts re avaitabte.

5. Requestsor change n choiceof campuswillbe entertainedONLY n he deadt' ineor filingof app l ica t ion , a t the la test .

TO BE FILLED UP BY THE SCHOOLAUTHORITY CONCERNED:

2) COMPLETE CHOOLADDRESS:) NAMEOF SCHOOL Write name of school in full):

3) SCHOOLYPE: Ll Public s) scHoolCONTACTNOS.:

4) GRADE EVEL L--l Grade6

ATPRESENT: i I GradeT

Rl Number of Pupils n theBatch (S Y 2O11-2O12):

1 Pupil's RANK n th e Batch' (s Y 2011-2012):

A\ Pupil's GENERAL VERAGEGRADE SY 2011-2O12):

I hcrcby cr t i fy hr t thc pupi l

applicant s of goodconductand

behavior.

Guida ce Counselor/Adviser'sSignature verPrintedName

l) I herebycertify hat the pupil-appiicant s officiallyenroiled n the school or SY20i2-2013.

2) I alsocertify hat the pupil-applicant Pleasecheckrheppropriatebox)

l--l hol^.'. r^ rfug pper10%of the batch (SY 2011-2012)nd doesnot havea finail radebelorv80.

Idoesno t belong o the upper O%of the batch (SY20tI-2012), ut hasa minimum final gradeof 85

or higher n Science nd Math, and a minimum final gradeof 80 n all other subjects.

Principal/Schoolead'sSignature ve rPrintedName

(PLEASEDO NOT DETACH)

This seruesas a proof of application. IMPORTANT: This DOESNOT serve as the test permit.

Submit he followingupon il ing of applicat ion:

. Futtyaccomptishedppticat ion orm n two(2 )copies

Two (2 ) dentical ecent1 x 1 lDpictures

Non-refundabtees t fe e - P 100 or private

schooI students/Free or public school

studentslf the applicantdoesnot belong o upper 10%of the batch (s Y2011-20121:. Copyof reportcard (SY 011'2012)

. Minimum inal grade of 85 in Science&Math;80 n att othersubiects

For use of the PSHS egistrar/DOSTr PSTOCoordinator

RECOMMENDATION

As per dataabove:Approved: tDisapproved:

Reasons for Disapprovat:

For use of the PSHS ashier'sOffice

Modeof Payment: tI

No .of Applicants:

AmountPaid:

I Cash

I Money rder

No .of stamos ssued:SeriesNumber:

Processedy: [l DosT

l- l PSHSDate:

PaymentReceived y:

Date:

REMINDERS O THE EXAMI EEI1. Beat your esting enteron September29, 2012 one(1) hour before ourscheduled xaminationeithera,m, or p,m,as ndicatedn he e)(am ermit).

2. Pres€nthe ExaminationPermit andyourschoolI.D. to the Proctor/RoomExaminer,

3. Eringat least wo sharpened #2 pencil,a good eraser and snacks.

4. If you do not receiveyour examination pe.mit two (2) weeks before the exam, you may visit or cal l the nearest PSHSCampus or call PSHSS-

Admissions Ofiice at te lephone no. (02) 926-5701 or check at www.pshs.edu.ph.

5. Youwill be notifiedf you qualifyo enroll t PSHS itherby mailor youmayalsocheck esults t www.pshs.edu.ph.PSHS egionalampusr callPSHSS-Admissionsff ice, el .No,: 02 )926-5701.

Youmayalso nquirerom he nearest

AdmissionsOffice

OED,PSHSS