APPLICATION FOR ADMISSION FOR GRADE
School Year ________________________
Test Schedule ______________________
Instructions: ALL SECTIONS MUST BE
COMPLETED. Please print. Write NA on
the space when an item is not applicable.
If you commit a mistake, affix signature
on indicated spaces. Failure to do so can
delay processing of your application. The
status of application cannot be
determined without the accomplished
recommendation forms and required
records. Application forms are processed
on a first come first serve basis so make
sure compliance with all application
requirements is completed as soon as
possible.
11
1x1
12
PHOTO
NAME
LAST
FIRST
MIDDLE
ADDRESS
STREET NO.
STREET
CITY
VILLAGE/BARANGAY
PROVINCE
TELEPHONE
ZIP CODE
MOBILE
EMAIL ADDRESS
ACCOUNTANCY, BUSINESS AND MANAGEMENT (ABM)
GENERAL ACADEMIC (GA)
HUMANITIES AND SOCIAL SCIENCE (HUMSS)
SCIENCE, TECHNOLOGY, ENGINEERING AND MATHEMATICS (STEM)
ACADEMIC STRAND
A. PERSONAL INFORMATION
01
Date of Birth
02
Religion
Roman Catholic
03
Citizenship
Filipino
Month
Day
Place of Birth
Year
Other, specify
Dual
Other, specify
FOR NON-FILIPINOS AND FILIPINOS BORN ABROAD
05
Immigration Status/Visa Classification
06
Passport No.
07
ACR/I-Card No.
Country Issuing Passport
Date Issued
Date Issued
Month
Day
Year
Month
Day
Year
Place Issued
Place Issued
FAMILY BACKGROUND
08
Name of Father
Living?
Yes
LAST
No
Citizenship
MIDDLE
FIRST
Filipino
Dual
Alien, specify
Address
Home Telephone No.
Email Address
Mobile No.
Highest Education Attainment
Business/Occupation
Company Name
Position
Business Address
Business Telephone No.
NICKNAME
09
Name of Mother
Living?
10
Yes
LAST
FIRST
Citizenship
No
Filipino
MIDDLE
Dual
Alien, specify
Address
Home Telephone No.
Email Address
Mobile No.
Highest Education Attainment
Business/Occupation
Company Name
Position
Business Address
Business Telephone No.
Mother and Father
Mother only
Father only
Applicant lives with
Mother and Stepfather (his name) __________________
Father and Stepmother (her name) __________________
Guardian/Others, specify __________________________
11 If applicant does not live with both parents, please give the guardian’s full name and address as it should appear in mailings
and contact details (mobile number and landline):
12 If legal guardianship and/or financial responsibility are other than the parents, please give detailed information in the space
below:
13
Name of Guardian
Living?
14
Yes
No
FIRST
Citizenship
Filipino
MIDDLE
Dual
Alien, specify
Address
Home Telephone No.
Email Address
Mobile No.
Highest Education Attainment
Business/Occupation
Company Name
Position
Business Address
Business Telephone No.
Siblings (brothers and sisters)
Name/Level/Position
15
LAST
Yes
Age
No
School/Office
Do you have relatives who graduated or who are studying in Assumption?
Name/Relationship
Year Graduated/Study
If yes, specify
Grade/Year
Yes
Department (GS,HS,College)
No
If yes, specify
Location
B. ACADEMIC BACKGROUND
01
02
Present/Last School’s Official Name
School Address
Telephone No.
Principal
Guidance Counselor
Schools Attended
Address
Grade School
Year Graduated ____________
Junior High School (Grade 7-10)
Year Completed ____________
Senior High School (Grade 11)
Year Completed ____________
Senior High School (Grade 12)
Year Graduated ____________
4th Year High School
Year Graduated ____________
ACADEMIC HONORS AND DISTINCTIONS
03
Please list all academic honors, distinctions, awards earned. Use a separate sheet of paper if necessary.
Honor/Award
04
Year Level
Event
Are you a candidate for Class Valedictorian, Salutatorian, or Honorable Mention?
If yes, please specify.
Yes
No
Please submit a photocopy of your Certificate of Merit to the Admissions Office as soon as you receive it.
DISCONTINUANCE OF STUDY
05
Did you ever have to stop studying?
Yes
School Year/Reason(s)
No
If yes, please provide the details below.
ACADEMIC PROBLEMS
06 Did you fail in any subject(s) in junior high school?
Yes
No
If yes, please provide the details below. Use a separate sheet of paper, if necessary.
Subject
07
Grading Period
Grade Level
Did you ever have to repeat a grade level?
Grade Level
Yes
Reason for failure
No
Subjects failed
If yes, please provide the details below.
Reason for failure
DISCIPLINARY RECORD
08
Were you ever placed under probation, suspension, or expulsion from school?
Yes
If yes, please provide the details below. Use a separate sheet of paper, if necessary.
Offense
Penalty
Period Covered
No
09
Were you ever expelled or refused enrollment from your high school?
Yes
No
If yes, please specify.
C. ACTIVITIES
01 List all activities, hobbies, jobs, and interests outside of class. Please include positions held or other special
responsibilities. Use an additional sheet if necessary. Write SR for school related, NSR for non-school related.
Activities or Organization
02
Year Level
Number of hours involved per day/week/month
Have you ever been elected/appointed as class officer?
Yes
No
Yes
No
If yes, please specify.
03
Do you currently (or in the past) have a modeling contract?
If yes, please specify.
D. Please rank (1 being the highest) top 5 factors which helped in choosing Assumption College.
Academic Excellence
Women’s College
Character/Values
formation
Family
Security
SHS Fair
Friend
Assumption
Career talk/visit
Advertisement
Parent’s Choice
AC Student
Want to pursue
college in AC
Flyer/Brochure/
Poster
High school
counselor
Location
Strands
Prestige
Career opportunities
specify preferred course _________________
Others
_______________
E. FINANCIAL OBLIGATION
04
If your daughter is currently enrolled, are all financial obligations up to date?
Yes
No
F. AGREEMENT
The following must be read and signed by the applicant and her parent/s or guardian:
I understand that my application and admission into Assumption College are subject to the following conditions:
1.
That it is the responsibility of the applicant to provide all necessary documentary evidence of her qualification and experience. Assumption College will not consider an application
until all requirements have been provided;
2.
That confidential recommendations, interview reports, and statements from members of the Admissions Committee and the Admissions staff will be used solely for purposes of
evaluation of this application,
3.
That contents of confidential appraisals shall not be disclosed to me and members of my family;
4.
That credentials filed in support of this application which are received by the Admissions Office become the property of the Assumption College and will not be returned to the
applicant;
5.
That all forms distributed by the Admissions Office to elicit information are the property of Assumption College and therefore recognize Assumption College’s property and
confidentiality rights to the same;
6.
That I have provided accurate information in this application, and authorize the verification of my credentials;
7.
That any misrepresentation or omission of facts in my application will justify the denial or cancellation of admission;
8.
That I will notify the Admissions Office of any change in status stated in this application and supporting documents from date of application to date of formal admission in to the
College;
9.
That I agree to comply with the rules, policies, and regulations of the Assumption College when I am accepted.
DECLARATION
I have read and understood all sections of this admissions package. I declare that to the best of my knowledge the information supplied in this application and the documentation
supporting are correct and complete.
___________________________________
Signature over
Printed Name of Applicant
___________________________________
___________________
Signature over
Printed Name of Parent/Guardian
Date