Elementary Enrollment Form

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Kinder 1/Kinder 2/Grade 1/Grade 2/Grade 3/Grade 4/Grade 5/Grade 6 Madridejos Campus

Date of Enrollment: *

YYYY

Last Name: *

Given Name: *

Middle Name:

Suffix: (Jr., Jra., Snr., etc...)

Student's Status: *

Old Student

New Student

Student ID No.: ((for old student only)please contact EDP, 09201201724)

LRN:(Learners Reference Number(for old student only))

Sex: *

Male

Female

Age: *

Date of Birth: *

YYYY

Place of Birth: *

Current Address(Ex. Renting,Hotel,etc.): *

Permanent/Home Address

House Number and Street: *

Subdivision/ Barangay: *

City/Municipality: *

Province: *

Country: *

Tel. No./ Cell No.: *

Email Address: *

Social Media Account: *

Messenger

Viber

Line

Other

Required

If other, specify what social media account:

Specify Social Media Name: *

Name of Parent/Guardian: (if others, please specify (Ex. Juan Dela Cruz/Parent) ) *

Occupation of Parent/Guardian: *

Address of Parent/Guardian: *

Tel. No./ Cell No. of Parent/Guardian: *

Email Address of Parent/Guardian: *

Grade Level: *

Kinder 1

Kinder 2

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Grade 6

School Year Last Attended: *

Name of School Last Attended: *

Grade Level Last Attended: *

Kinder 1

Kinder 2

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Grade 6

Available Resources: *

Internet

Mobile Data

Laptop/Tablet/Smart Phone

Internet Cafe

Television

Radio

None of the above

Required

Preferred Type of Class *

Online

Face to Face (Not applicable due to government restriction)

Modular

Blended

Required

Does anyone in the family knows how to download modules from the internet? *

Yes

If Yes, please provide the name and the contact number:

Do you want to avail Pre-paid Home Wifi (to be added to your school fees)? *

Yes

Confirmation

You are officially enrolled upon payment of P500.00 enrollment fee payable at the cashier or through online payments options.
Thank you for trusting SCSIT. We will inform you soon for your schedule and more updates. For your questions and clarifications please try to contact Registrar's Office, 0920.120.1724

I hereby agree and understood the enrollment form. I also allow SCSIT to collect and keep my personal information which may be used for school purposes only. *

Agree

Disagree

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