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