VALENZUELA CITY SCHOOL OF MATHEMATICS AND SCIENCE

A.Pablo st., Malinta, Valenzuela City

ADMISSION APPLICATION FORM SY 2014-2015
(This form is not for sale, it may be photocopied)
Instructions:
Fill out the data .Type or print legibly.
DO NOT ABBREVIATE. Countersign all erasures and corrections
made.
Deadline of Submission : Jan. 30, 2015 Date of First Screening ; Feb.

Application No. ______

Staple only
1x 1
Photo

PERSONAL DATA:
1.NAME OF APPLICANT
Last name:
First name:
Middle name:
___________________________________ _______________________________
____________________
2.Sex: Male
Female
3. Date of Birth _________________
4.Place of Birth _____________________________________________________________________________
5. Religion : __________________________________ 4. Contact No. ____________________
6.Address : _________________________________________________________________________________
I hereby certify that the above information are true and correct. I understand that
any false or misleading information will result to disapproval of this application for
admission.
Signature
over printed name

Attested by:_____________________________

SCHOOLS CERTIFICATION
1.NAME OF SCHOOL:
________________________________________________________________________
2.COMPLETE SCHOOL
ADDRESS:________________________________________________________________
3.School Type : Public
Private
4. School Contact No.
__________________________________
5. Gen. Ave : Grade 5 _______ 6.Gen. Ave Grade 6 : First Grading period ______ 2nd
Grading period ______
We
1.
2.
3.

hereby certify :
That the pupil applicant is officially enrolled in the school for School Year 2014-2015.
That he/she belongs to the upper 10% of the graduating class
That he/she has a grade of 85% in English, mathematics and science and without
grades lower than 83% in any other subjects in the first and second grading period
4. That the pupil-applicant is of good moral character
5. That the foregoing data /information are accurate.
_______________________________

This serves as proof of application.

IMPORTANT: This does not serve as test

permit
For VCSMS Registrar Use Only ____________________________
As per data above and submitted requirements:
Approved (
)
Disapproved
( )
Remarks
_____________________
Processed by: ____________________
Application form can also be downloaded at http://valscience.webs.com/admission

To apply for admission, the student will submit the following:

1. Duly accomplished VALMASCI Admission Test Application Form
2. Form 138 A (Report Card)
3. Proof of Valenzuelano residency of parent (voters ID and proof of billing)
4. Omnibus certification of authenticity and veracity of documents (all applicants)
5. For pupil under guardianship :
5.1 Certification of Parent that his/her child is under Guardianship;
5.2 Certification of Guardian that the pupil is under his/her Guardianship;
5.3 Proof of Valenzuelano residency of guardian (voters ID and proof of billing)

OMNIBUS CERTIFICATION OF AUTHENTICITY AND VERACITY OF DOCUMENTS

I, _______________________________, Filipino, of legal age, with permanent address at

__________________________________________________________, after being sworn in
accordance with law, hereby depose and state that:
1. I am the ___________________ of ____________________________________
(parent , guardian)
(name of student)
2.
I have submitted the following documents of my _________________, in connection
with his/her application to Valenzuela City School of Mathematics and Science Admission Test :
a.
b.
c.

VALMASCI Admission Test Application Form

Photocopy of Form 138 A (Report Card in Grade 5 and Grade 6First and Second Grading)
Proof of Valenzuelano residency of parent (voters ID and proof of
billing)

(For student under guardianship)

a. VALMASCI Admission Test Application Form
b. Photocopy of Form 138 A (Report Card in Grade 5 and Grade 6- First and
Second Grading)
c. Certification of parent that his/her child is under guardianship
d. Certification of guardian that the student is under his/her guardianship
e. Proof of Valenzuelano residency of guardian ( voters ID and proof of
billing)
3. I am executing this Certification to attest to the authenticity and veracity of all documents
submitted.
4. By executing this Omnibus Certification of Authenticity and Veracity of
Documents, I hereby authorize the Valenzuela City School of Mathematics and Science , through the
School Principal, to verify the authenticity of the abovementioned documents.
___________________________
Signature over printed name

Subscribed and Sworn to before me this _____________ day of 20___, Affiant

exhibiting his/her Residence Certificate No. ________________ issued at____________________ on
____________________.
Doc. No.
Page No.
Book No.
Series of ___________

Notary Public
__________________________