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Classified as Confidential. Please do not forward this to unintended users. Otherwise, request necessary permission.
Student Registration Form
Please fill in all appropriate sections marked with “*” in “CAPITAL LETTERS”.PART 1 - STUDENT INFORMATION (Write the name that appears on the birth certificate)LAST NAME*
FIRST NAME*
MIDDLE NAME*
NICKNAME*
DATE OF BIRTH*
SEXM | F
CONTACT NUMBER*
PERMANENT ADDRESS (Please include Zip Code)*
EMAIL ADDRESS*
CITIZENSHIP*
DUAL CITIZENSHIP YES ☐ | NO ☐
INTERNATIONAL ADDRESS (For Foreign Student Only)*
CHURCH AFFILIATION/RELIGION:*
LEARNER REFERENCE NUMBER (LRN), If any:*
LANGUAGE/S OF APPLICANT/STUDENT FIRST LANGUAGE*
SECOND LANGUAGE*
LANGUAGE/S SPOKEN AT HOME*
Part 2 - SCHOLASTIC INFORMATION (Start with the most recent school attended)PREVIOUS SCHOOLS ATTENDED (Full name, do not abbreviate)*
ADDRESS*
LEVEL*
SCHOOL YEAR*
* * * *
* * * *SPECIAL STUDY PERMIT (For non-resident applicants/students with tourist visa status) Does your child have a previously issued Special Study Permit? NO ☐ YES ☐
IF YES: In School Year - * Where? *
Part 3 - FAMILY BACKGROUND
FATH
ER
FULL NAME* * *
CITIZENSHIP*
AGE*
BIRTHDAY** - ** - ****
HOME ADDRESS (If different from Applicant’s address)*
OCCUPATION*
CONTACT NUMBER*
EMAIL ADDRESS*
COMPANY*
RESIDENCE LANDLINE No.*
COMPANY ADDRESS*
MO
THER
FULL NAME* * *
CITIZENSHIP*
AGE*
BIRTHDAY** - ** - ****
HOME ADDRESS (If different from Applicant’s address)*
OCCUPATION*
CONTACT NUMBER*
EMAIL ADDRESS*
COMPANY*
RESIDENCE LANDLINE No.*
COMPANY ADDRESS*
GUAR
DIAN
FULL NAME* * *
CITIZENSHIP*
AGE*
BIRTHDAY** - **- ****
HOME ADDRESS (If different from Applicant’s address)*
OCCUPATION*
CONTACT NUMBER*
EMAIL ADDRESS*
COMPANY*
RESIDENCE LANDLINE No.*
COMPANY ADDRESS*
NOTE: Students who will be living with an authorized guardian in the duration of the school year is required to submit a NOTARIZED AFFIDAVIT OF GUARDIANSHIP.
TO BE FILLED OUT BY ADMIN STAFF:APPLICATION FOR:
PRESCHOOL PRIMARY SCHOOL INTERMEDIATE SCHOOL
☐ NURSERY ☐ K1 ☐ K2 ☐ GRADE 1 ☐ GRADE 2 ☐ GRADE 3 ☐ GRADE 4 ☐ GRADE 5 ☐ GRADE 6
EXCEPTIONAL EDUCATION ☐ SPECIAL EDUCATIONAGE OF APPLICANT/STUDENT BY DATE OF ENROLLMENT: YEARS ** MONTHS **
Revision Number: 00 Student Registration FormImplementation Date: June 15, 2020 Reference Number: DCE-FR-SRF-101
Dunamis Christian EducationC-20 Mercado de Calamba, Pabalan St., Brgy. 5, Calamba City Laguna 4027
www.dunamis-edu.com
Classified as Confidential. Please do not forward this to unintended users. Otherwise, request necessary permission.
ASSESSED BY: ________________________________________ APPLICATION DATE: ** – ** - **** (Signature over printed name of Assessor)Part 4 – INITIAL ASSESSMENT (Please answer the following questions briefly)What encouraged you to shift from traditional type of education to homeschooling? (Applicable to answer if your child was previously enrolled to a DepEd accredited Public/Private educational institution)*
LISTS OF REQUIREMENTS☐ Duly accomplished Student Registration Form ☐ Original PSA-certified Birth Certificate☐ Original copy of Report Card (F-138) or original PEPT Result☐ LRN(Learner Reference Number) provided by the local schools)☐ Authenticated Form-137 (Red-Ribbon Certificate, for families previously enrolled in the schools abroad)☐ Photocopy of College Diploma/Transcript of Records of at least one of the parents
For non-Filipino applicants:☐ Alien Certificate of Registration/ I-Card/ Special Study Permit☐ Documents and Certificate of Acquired Dual Citizenship☐ Translated and Authenticated Birth Certificate and School Records☐ Original and photocopy of Passport☐ Official Receipt of ACR payment for the current year
DECLARATION
I declare, under the penalties of falsification that this form has been made in good faith, verified by me and to the best of my knowledge and belief, is true and correct, pursuant to the provisions of Dunamis Christian Education, and the regulations issued under authority thereof. If found untrue, may lead to disqualification and injunction of my present and future application.
* *
Applicant Date
Our Accreditation and Partnership:
Revision Number: 00 Student Registration FormImplementation Date: June 15, 2020 Reference Number: DCE-FR-SRF-101
