You are on page 1of 1

VALID FOR PLV SHS-AT 2019 ONLY

PAMANTASAN NG LUNGSOD NG VALENZUELA Application No.

SENIOR HIGH SCHOOL ADMISSION TEST (SHS-AT)


Examination Room Assignment / Time:
APPLICATION FORM

INSTRUCTIONS: READ APPLICATION REQUIREMENTS BELOW. DO NOT APPLY IF NOT QUALIFIED. Fill in all the required information legibly. DO NOT leave an item blank.
If item is not applicable, indicate “N/A”. Place “X” mark in appropriate boxes. Only fully accomplished forms will be accepted. Credentials led in support
of this application will become the property of this institution and will not be returned to the applicant.

A. NAME OF APPLICANT as it appears on the Birth Certicate


(Place one letter in each box and leave one box blank between names)

Last Name

First Name Name Extension

Middle Name
B. FACTS OF BIRTH
Citizenship Gender Date of Birth (MM / DD / YYYY) Place of Birth (City, Municipality / Province)
Male Female

Father’s Name (Last Name, First Name, Name Extension, Middle Initial) Mother’s Maiden Name (Last Name, First Name, Name Extension, Middle Name)

C. CURRENT DEMOGRAPHIC DATA


Address House / Room / Floor / Block / Lot / Phase No. Street Name Subdivision

Barangay City / Municipality District Zip Code Height (Meters) Weight (Kilos)
1 2 N/A

E-mail Address Mobile Number Telephone Number

D. EDUCATIONAL BACKGROUND
Name of Junior High School (Do Not Abbreviate) Section Year Graduated (If Applicable)

School Address Region School Classication


Public Private Other/s: __________

E. INTENDED TRACK G. REQUIREMENTS EVALUATION


(To be accomplished by the PLV Ofce for Admissions)
FIRST CHOICE (Track/Strand):
APPLICATION REQUIREMENTS
SECOND CHOICE (Track/Stand): 1. Certied True Copy of Grade 9 Report Card (School Year 2017-2018) with
GWA of 83% and above.

ACADEMIC TRACK 2. Certied True Copy of Grade 10 Report Card for the recent Grading Period
• ACCOUNTANCY, BUSINESS AND MANAGEMENT (ABM) STRAND (School Year 2018-2019) with no grade lower than 80% per subject during
1. Bachelor of Science in Accountancy (BSA) the time of application.
2. Bachelor of Science in Accounting Technology (BSAT)
3. Bachelor of Science in Business Administration major in Financial Management (BSBA-FM) 3. Certied True Copy of School ID (Front and Back)
4. Bachelor of Science in Business Administration
major in Human Resource Development Management (BSBA-HRDM)
5. Bachelor of Science in Business Administration major in Marketing Management (BSBA-MM) 4. Photocopy of PSA/NSO Birth Certicate
6. Bachelor of Science in Public Administration (BSPA) (Must be a Filipino Citizen)
• GENERAL ACADEMIC (GA) STRAND
1. Bachelor of Elementary Education major in Pre-School Education (BEED) 5. Proof of Residency (2018 Voter’s Registration Certicate from the
2. Bachelor of Secondary Education major in English (BSED-ENG) COMELEC that parent or the applicant is a Registered Voter of Valenzuela).
3. Bachelor of Secondary Education major in Filipino (BSED-FIL)
4. Bachelor of Secondary Education major in Mathematics (BSED-MATH) 6. Sketch of Residence (with Valenzuela City Hall as starting point).
5. Bachelor of Secondary Education major in Biological Science (BSED-BIOSCI)
6. Bachelor of Secondary Education major in Physical Science (BSED-PHYSCI)
• HUMANITIES AND SOCIAL SCIENCES (HUMSS) STRAND 7. Two (2) recent Passport Size ID Pictures with the following specications:
1. Bachelor of Science in Psychology (BSP) • Colored with white background and computerized name
2. Bachelor of Science in Social Work (BSSW) (First Name, Middle Initial, Last Name and Extension Name).
• SCIENCE, TECHNOLOGY, ENGINEERING AND MATHEMATICS (STEM) STRAND
1. Bachelor of Science in Civil Engineering (BSCE) 8. Non-Refundable amount of Php 250.00 application and examination fee.
2. Bachelor of Science in Electrical Engineering (BSEE)
3. Bachelor of Science in Information Technology (BSIT)

ARTS AND DESIGN TRACK Note:


1. Bachelor of Arts in Communication Studies major in Theater Arts (BACS) Spaces for Printed Name/Signature
and Right Thumb Mark of applicant
should be left blank. These shall
F. DECLARATION only be accomplished in the presence
of the Requirements Evaluator/Processor.
I declare under oath that I personally accomplished this application form,
and I hereby certify that the information given are true, correct, and complete
statements. Further, I understand that the acceptance and approval of my application
for the examination is based on the aforestated information.

I therefore agree that, in case of post-verication yields information


contrary to what is declared, my application shall be disapproved, and my payment will
be forfeited. I further agree that any misinterpretation made in this document may
cause the invalidation of the result of this examination. Passport Size ID Picture
(3.5 x 4.5 cm) Right Thumbmark
Further, I hereby give my consent to the Pamantasan ng Lungsod ng
Valenzuela that the abovementioned data may form part of its database that can be
used for relevant purposes but may not be limited to proling and research, and
especially as basis of data-driven decisions of the University.

Signature over Printed Name of Requirement’s Evaluator


Signature over Printed Name of Applicant

THIS FORM IS NOT FOR SALE


(Print Only in 8.5 x 13 Bond Paper)

You might also like