Batasan Hills National High School

SCIENCE TECHNOLOGY ENGINEERING (STE) PROGRAM

IBP Road, Batasan Hills, Quezon City
1x1 Colored
Picture
APPLICATION FORM (Attached 1
PLEASE PRINT LEGIBLY copy)
I.PERSONAL DATA

Name: _________________________________________________________ Sex: _____________

(Surname) (First Name) (Middle Initial)

Date of Birth: _________________ Place of Birth: _______________________ Age: ________

Present Address: _______________________________________________________________________

Street/Barangay Municipality/City/Province

Ethnic Affiliation: ________________________________ Religion: ________________________

Contact Number (CP only): ________________________ Email Add._______________________

II. EDUCATIONAL BACKGROUND

Grade Level Name and Address of School S.Y. Attended

1
2
3
4
5

III. ELEMENTARY SCHOLASTIC RECORD

FINAL GRADE
GRADE LEVEL FILIPINO ENGLISH MATH SCIENCE HEKASI
4
5
6 Note: Attached Photo Copy of Grade 6 Report Card (1st to 2nd Grading)

IV. HONORS AND AWARDS RECEIVED (Provide extra sheet/s if necessary)

GRADE LEVEL ACADEMIC NON-ACADEMIC

1
2
3
4
5
6

V. FAMILY BACKGROUND

FATHER MOTHER
Name
Citizenship
Home Address
Occupation
Employer (name of company)
Monthly Income
Business Address
Telephone Number
Highest Educational Attainment
Last School Attended
Brothers/Sisters (from eldest to youngest. Provide additional sheets if necessary)
Highest
Civil
Name Age School Educational
Status
Attainment

VI. VERIFICATION/ AUTORIZATION:

I have carefully read the contents of this application form and I certify that the information given
herein is correct and complete.

____________________________________________ _____________ ___ __________________

Printed Name & Signature of Applicant CP No. Date
____________________________________________ ______ ______ ___ __________________
Printed Name & Signature of Parents/Guardian CP No. Date
____________________________________________ ________________ __________________
Printed Name & Signature of Class Adviser CP No. Date

Name of Principal: ________________________ SCHOOL CONTACT No.:______________________

IMPORTANT REQUIREMENTS:
 Grade in Science, Mathematics, and English must be 85% and above.
 Other subjects must be 83% and above.
 Photocopy of Form-138 (Report Card in Grade 6 with COMPLETE grades for the First
and Second Grading)
 Accomplished STE Application Form with COMPLETE data.
 Certification of Honor Student (For those who belong to the top 10 of the Class)
 Medical Certification
For Inquiries contact or see the following:
Babie Noreen P. Clemente, MT I Science, STE Coordinator

Johannsen C. Yap, MTI MAPEH, ASTP-Special Programs

Dr. Diego M. Amid, Principal IV
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Applicant’s Copy
Name: ______________________________________ School: __________________________

Date of Examination: __________________ Venue: Annie Rosa Susano Bldg. Rm. _______

Presented I.D.:____________________________

APPLICATION PERIOD: December 1, 2016 to January 13, 2017

TESTING DATES: January 28, 2017 (First Batch) 8:00 AM-12PM
February 4, 2017 (Second batch) 8:00 AM-12PM