04 Enrollment Slip (With Old Format)

PSHS FORM 5OCR

Republic of the Philippines

Department of Science and Technology

PHILIPPINE SCIENCE HIGH SCHOOL - MAIN CAMPUS

Agham Road, Diliman, Quezon City

REGISTRATION CHECKLIST OF REQUIREMENTS

(for Grades 8 - 10)

SY 2015 - 2016

NAME: _________________________________________________ SECTION: ___________________

REQUIREMENTS

1. Student Alliance _________________________

_____ Membership Fee (P200.00) S. A. Representative

Date: __________________

There are amounts to be collected at the PSHS Foundation Office for PCORI (Php250), PTA(Php500) and the PSHS

Foundation (Php50 for annual contribution and Php500 for lifetime contribution). Please note that these are optional

contributions only. However, your contributions to these organizations go a long way in assisting students in their

academic, spiritual, social/developmental and material needs

2. Registrar’s Office

______Report Card (Form 138)

______PSHS lanyard (no ID jacket/case)

For those who wish to apply for additional living allowance ONLY:

______ One 2 x 2 picture, at most 6 months old

______ Duly accomplished and notarized scholarship application form (Annex 1)

______ Latest notarized Statement of Assets, Liabilities and Net Worth (SALN, or CSC form 1) of the family for

students whose parents work in the public sector; (Annex 2) or a notarized SAL form (Annex 3) for

parent/s or guardians working in the private sector

______ Income Tax Return (ITR) of the parents for the last three (3) years. If unemployed or exempt, submit a

BIR Certification of Exemption from Non-filing of ITR

______ Certified true copy of the latest Tax Declaration(s) of all real properties. If there is no real property, a

Certification that the parents have no landholding or real property duly issued by the Municipal/City

Assessors

______ Certificate/s of Registration of motor vehicles

______ Electric bills for February, March and April or a statement of electric consumption from the power utility

firm for the same period

______ Clear photos of the external of the house, living room and kitchen

__________________________ ________________________

Year Level In Charge Ms Theresa AO Diaz, ACS

Date: ____________________

For Dormers:

3. Student Services Division ___________________________

_____Pre-accommodation conference Ms Mary Jane L Turingan

Date ____________________

Please get your textbooks from the Property Office, Rm 213, SHB Bldg.

Please reserve your locker at the Property Office, right wing, front lobby, SHB Bldg.

PRESENT THIS FORM TO YOUR SUBJECT TEACHERS IN THE FIRST WEEK OF CLASSES AS PROOF OF

ENROLLMENT.

ACCOMPLISH IN DUPLICATE