CCSHS Application no.

20-_______ Room Assignment ____________ Time: _______

TEST PERMIT CALOOCAN CITY SCIENCE HIGH SCHOOL

Received by: P. Sevilla St., corner 10th Ave. Caloocan City
Recent
______________________ /Fax: 88755472 1x1
Date: _________________ Photo
APPLICATION FOR ADMISSION
(Incoming Grade 7, SY 2020-2021)
INSTRUCTIONS To the learner-applicants and parents: Please read the direction carefully before filling out this form
1. Please type or print clearly and correctly all information asked for in this form. Do not abbreviate . Write N/A if not applicable.
2. In writing the LEARNER'S NAME, put one letter in each box and leave a box blank between names.

PERSONAL INFORMATION
Family name

First name

Middle name

Nickname Date of Birth (mm/dd/yyyy) Place of Birth Sex Age Religion Contact Number

Complete Home Address:

Is the family resident of Caloocan City? _____Yes ______ No Number of years residing in Caloocan? _________

FAMILY BACKGROUND
Father's Name _______________________________________________________________Age _________ Contact No.__________________________________
Highest Educational Attainment (Please check): ______ High School ______College ______ Graduate Studies ______ Post Graduate Studies
Degree/Course _____________________________________________________ School _________________________________________________________
Employment Background: ___ Unemployed ____ Self-employed: Nature of business: __________________________________________________________
____ Employed: Position _______________________________Company: _______________________________________________
Mother's Name _____________________________________________________________ Age _________ Contact No.__________________________________
Highest Educational Attainment (Please check): ______ High School ______College ______ Graduate Studies ______ Post Graduate Studies
Degree/Course _____________________________________________________ School _________________________________________________________
Employment Background: ____ Unemployed ____ Self-employed: Nature of business: _________________________________________________________
____ Employed: Position ___________________ ____________Company: ______________________________________________
Contact Person in case of emergency _____________________________________________________________________________________________________
Telephone/Cell phone Number _____________________________________________ Relation ______________________________________________________
Home/Office Address __________________________________________________________________________________________________________________
Sibling's Educational Attainment (eldest to youngest; add extra sheet if necessary)
NAME SCHOOL LAST ATTENDED LEVEL/YEAR & COURSE
____________________________________________ ________________________________________________ ________________________________
____________________________________________ ________________________________________________ ________________________________
____________________________________________ ________________________________________________ ________________________________
____________________________________________ ________________________________________________ ________________________________

SCHOLASTIC BACKGROUND
School currently enrolled in: ______________________________________________________________________________ Type of School: __ Public __ Private
School Address _______________________________________________________________________________________________________________________
Highest Honors/Awards Received ________________________________________________________________________________________________________

List your elementary extra—curricular activities, including positions held or special tasks/designation (ex. Dramatics, Sports, Clubs etc.)
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
List your community and/or church activities and nature of involvement
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________

List your hobbies and/or special skills and/ or talent __________________________________________________________________________________________

____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________

*** This form is not for sale and can be reproduced. ***
 CERTIFICATION FOR ADMISSION TO CCSHS
Applicant’s Name ______________________________________________________________ LRN: ____________________________
Name of Present School __________________________________________________________________________________________

INSTRUCTIONS
To the Applicant: Fill in the required information and request your school principal and guidance teacher to accomplish the recommendation part and certification of
good moral character, respectively.

To the School Principal and Guidance Teacher: The above-named learner is an applicant for admission to Caloocan City Science High School . It is important that
the form be filled out CORRECTLY and COMPLETELY. The information about rank is EXTREMELY IMPORTANT. For applicants from public elementary schools in
Caloocan, the principal may issue a separate document certifying that the applicant is a strong contender as the HIGHEST-RANKING (Top 1) graduate of his/her batch. He/
she will be considered for automatic admission to CCSHS upon satisfying the grade requirements.

PRINCIPAL’S RECOMMENDATION

This is to certify that ___________________________________________________________ is a candidate for

graduation of the current school year. He/she belongs to the _____ percentile rank of the ______ total number of can-
didates for this school year’s graduating class.

Date Signed: ___________________ _________________________________________________

Signature over printed name of the School Head/Principal

CERTIFICATE OF GOOD MORAL CHARACTER

This is to certify that __________________________________________________________ has consistently

maintained good moral character and that no disciplinary action whatsoever has been taken against him/her as of
this date.

Date Signed: ___________________ ________________________________________________

Signature over printed name of the Guidance Teacher

LETTER OF INTENT

The Selection Test Committee

Caloocan City Science High School
Caloocan City

I, _______________________________________________________________, currently enrolled as a Grade

VI learner at _____________________________________________________________, am applying for admission to
Caloocan City Science High School. If I qualify, I promise to report for an interview and enroll promptly within the
period specified so that I will not lose my privilege to enroll.

____________________________________________
Date Signed: ________________ Signature over printed name of Applicant

PARENT’S CONSENT

I hereby give my consent to my child/ward _______________________________________________, Grade

VI pupil at ________________________________________ to take the Selection Test for admission to Caloocan City
Science High School on December 7, 2019. If my child qualifies through the examination and interview, he/she will
promptly enroll in the said school and will abide the policies, rules and regulations of the school.

Date Signed: ____________________ _________________________________________

Signature over printed name of Parent/Guardian
*If signed by the guardian, state the relationship to the
learner ____________________________________

To be accomplished by the CCSHS Admissions Committee: ____ MOEP Qualifier ____ Potential Highest Ranking Learner ///
School Location: ____ Caloocan ____ Non-Caloocan ____ Non-NCR /// Type of School: ____ Public ____ Private