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Mshs 2019 Test

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NOT FOR SALE CAN BE

REPRODUCED ALL
ENTRIES /SIGNATURE
Republic of the Philippines IN THIS FORM MUST BE
DEPARTMENT OF EDUCATION ORIGINAL
National Capital Region
Schools Division Office- Makati City
MAKATI SCIENCE HIGH SCHOOL
Kalayaan Ave., Cembo, City of Makati 1214

APPLICANT INFORMATION SHEET


for the Juan Dela Cruz
MAKATI SCIENCE HIGH SCHOOL 2020 ADMISSION TEST

Instruction: Write clearly in the box provided or check the box for the appropriate answer. Avoid erasures. For any
erasure, the applicant should countersign the item corrected along the page margin. PLEASE ANSWER ALL ITEMS
Deadline for Submission: 09 January 2020 (Thursday) Date of Examination: 11 January 2020 (Saturday)

Name of Applicant Print full name of students. Place one letter in each box and leave one box blank between names.
1. Name of Applicant Learner Reference Number (LRN)
LAST
C
FIRST C

MIDDLE Signature of Examinee

2. Sex Male Female 3. Citizenship


4. Date of Birth 5. Place of Birth
6. Contact Number: Landline Cell Phone No. Email Address

7. Permanent Address
No. Street District City/Municipality Province Zip Code
8. Number of Children in the family 9. Birth Order of Applicant (1st child, 2nd child, etc.)
10. Name Relationship Age Civil Highest Grade or Occupation of Gross Income
(Put Family to Applicant Status Educational Year Working for
Head* Attainment Attending if Family the Year (in
as first in the list; (Specify grade, Currently in Member pesos)
include name of year or degree) School
applicant)

(1) (2) (3) (4) (5) (6) (7) (8)

11. Elementary School (Where applicant completed/is completing elementary education)

12. Name of elementary School (Do not Abbreviate)

13. Former Name (if any)

14. Elementary School Mailing Address (Number and Street, Subd. Village Barangay, City Town Province)

10. Name of Elementary


15. Date Established Telephone/Mobile Nos. Email Address:

Type of School Public Private School Marking System (For letter grades, please attach a copy of the
Grading Scale with the numeric equivalent of each grade in the scale.)

Highest Possible Grade


Passing Grade
Lowest Possible Grade
School Year _____
Grade VI
SUBJECT Final Grade
1 2
English
Filipino
Mathematics
Science/Health
Heograpiya/Kasaysayan Sibika (HKS)
Edukasyon Pantahanan at Pangkabuhayan (EPP)
Musika,Sining at Edukasyon Pagpapalakas ng Katawan (MSEP)

Affixed here is the school dry seal I certify to the completeness and corrections of
This school has no dry seal correctness of the foregoing record

School Head’s Signature Official Designation


Date Over printed name

FORM A
CERTIFICATE OF GOOD MORAL CHARACTER

TO WHOM IT MAY CONCERN:


This is to certify that _____________________________________has consistently maintained good moral character, there having no
disciplinary action taken against him/her as of the date of application.
_______________________________________________
Printed Name & Signature of Principal/Guidance Counselor
Date: ___________________________________________

FORM B
PRINCIPAL CERTIFICATION

Name of Elementary School __________________________________________________________________________________


Address __________________________________________________________________________________________________
TO WHOM IT MAY CONCERN:
This is to certify that ____________________________________ is one of the ____________ candidates for graduation for school Year
2019-2020. Number
__________________________________________
Printed Name & Signature of Principal
Date: ______________________________________

FORM C
PARENT’S CERTIFICATION

This is to certify that my son/daughter, ___________________________________, has no pending application for immigration to the USA
or any other country. ___________________________________________
Printed Name & Signature of Parent

rreyes11-05-19

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