Recent 2x2 I.D.
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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
