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Senior High School Enrollment Form
Grade 11/ Grade 12 Madridejos Campus
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Date of Enrollment:
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MM
/
DD
/
YYYY
Last Name:
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Your answer
Given Name:
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Your answer
Middle Name:
Your answer
Suffix: (Jr., Jra., Snr., etc...)
Your answer
Student ID No.:
Your answer
Learner Reference Number(LRN):
Your answer
Sex:
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Male
Female
Age:
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Your answer
Date of Birth:
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MM
/
DD
/
YYYY
Place of Birth:
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Your answer
Current Address(Ex. Renting,Hotel,etc.):
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Your answer
Permanent Home Address:
House Number and Street:
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Your answer
Subdivision/ Barangay:
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Your answer
City/Municipality:
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Your answer
Province:
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Your answer
Country:
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Your answer
Tel. No./Cell No.:
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Your answer
E-mail Address:
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Your answer
Social Media Account:
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Messenger
Viber
Line
Whatsapp
Other
Required
If other, specify what social media account:
Your answer
Specify Social Media Name:
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Your answer
Name of Father:
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Your answer
Occupation of Father:
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Your answer
Name of Mother:
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Your answer
Occupation of Mother:
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Your answer
Tel. No./Cell No. of Parent/Guardian:
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Your answer
E-mail Address of Parent/Guardian:
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Your answer
Semester:
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1st
2nd
Summer
Required
School Year Last Attended:
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Your answer
Name of School Last Attended:
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Your answer
Address of School Last Attended:
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Your answer
JUNIOR HIGH SCHOOL(JHS)
Indicate where student completed fourth year high school/Grade 10.
JHS Name:(Do not abbreviate)
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Your answer
Month/Year of Completion:
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Your answer
Address(City/Municipality, Province and Country):
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Your answer
Philippine Education Placement Test(PEPT) Certificate No.:
Your answer
Month/Year of Completion:
*
Your answer
Accreditation and Equivalency (A&E) Test for JHS Certificate No.:
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Your answer
Month/Year of Completion:
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Your answer
Philippine Validation Test(PVT) for JHS Certificate No.:
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Your answer
Month/Year of Completion:
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Your answer
Name of Community Learning Center:(Do not abbreviate)
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Your answer
Address:
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Your answer
SENIOR HIGH SCHOOL(SHS) PROGRAM:
Make sure that the track (Academic, Technical-vocational-Livelihood (TVL), Sports, Arts and Design), strand (STEM, ABM, HUMSS and GAS), or TVL specialization
Program (Track-Strand or Specialization/s)
Academic Track:
Humanities and Social Sciences (HUMSS)
General Academic Strand (GAS)
Science, Technology, Engineering and Mathematics (STEM)
Accountancy, Business and Management (ABM)
Clear selection
Technical-Vocational Livelihood (TVL) Track
Home Economics Strand with specialization in:
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Bread and Pastry Production
Food and Beverage Services
Tour Guiding Services
Tourism Promotion Services
Caregiving
Housekeeping
Attraction and Theme Parks
Information and Communication (ICT) Strand with specialization in:
Computer System Servicing
Technical Drafting
Computer Programming
Animation
Clear selection
Industrial Arts (I.A.) Strand with specialization in:
Plumbing
Shielded Metal Arc
Welding
Carpentry and Masonry
Clear selection
Available Resources:
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Internet
Mobile Data
Laptop/Tablet/Smart Phone
Internet Cafe
Television
Radio
None of the above
Required
Preferred Type of Class:
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Online
Face to Face (Not applicable to government restriction)
Modular
Blended
Do you want to avail Pre-paid Home Wifi (to be added to your school fees)?
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Yes
No
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.
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