Application No.

Senior High School

APPLICATION FOR ADMISSION

SY 2018-2019
Important: Applicants may take the entrance test for Grade 11 only once.

PLEASE PRINT LEGIBLY. Write N/A if the required information is not applicable.
NAME OF APPLICANT:
________________________________________________________________________________________________________________
(Name on Birth Certificate) LAST NAME GIVEN NAME MIDDLE (Give Full Middle Name)

HOME ADDRESS _____________________________________________________________________________________________________________

_______________________________________________________________________________________________________________

TEL / MOBILE # ___________________________________________ E-MAIL ADDRESS ____________________________________

DATE OF BIRTH _________________________________

DO NOT WRITE BELOW THIS LINE.

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APPLICATION CHECKLIST:

Official Receipt No.

Privacy Policy and Terms of Agreement Consent Form (signed)

Photocopy of Grade 10 Report Card for the first grading period of SY 2017-2018

Photocopy of Final Grade 9 Report Card with complete grades for SY 2016-2017

Two (2) recent ID pictures (1" x 1") in COLOR -- Attach one ID picture on the Application Form.
Submit the other ID picture when you present the Official Receipt to claim your exam permit.

Clear photocopy of applicants Birth Certificate (NSO Copy)

i. If applicant is not a Filipino citizen, submit a photocopy of his (1) Alien Certificate of Registration
(ACR) and (2) a Special Study Permit issued by the Bureau of Immigration.

ii. If applicant has dual citizenship, submit a photocopy of his Philippine Passport or Certificate
of Recognition as a Filipino Citizen.

Two (2) Letters of Recommendation from the last school attended (The persons recommending
you may submit a recommendation letter or may use the recommendation form available in the
ASHS website.)

Handwritten autobiography on size A4 bond

NOTE: Only applications with complete requirements will be processed.

 Application No.

CLIP ONE 1x1

ID PHOTO HERE.
Senior High School
PLEASE DO NOT
USE GLUE / TAPE /
PASTE. APPLICATION FOR ADMISSION
SY 2018-2019

Credentials filed in support of this application become the property of the Ateneo de Manila University
and will not be returned to the applicant.

PERSONAL INFORMATION

(PLEASE PRINT LEGIBLY)

LEGAL NAME _______________________________________________________________________________ LRN ________________

(Name on Birth Certificate) LAST NAME GIVEN NAME MIDDLE NAME

CURRENT SCHOOL ________________________________________________________________ (Please check.)
Public
Private

HOME ADDRESS _____________________________________________________________________________________________________________

ZIP CODE ____________ GENDER
Male
Female TEL / MOBILE # ___________________________________________

E-MAIL ADDRESS ____________________________________ CITIZENSHIP _____________________ RELIGION ____________________

DATE OF BIRTH _________________________________ PLACE OF BIRTH _______________________________________________________

FATHERS NAME _______________________________________________________________ Living ( ) Deceased ( )

HOME PHONE # ______________________ MOBILE # __________________________ E-MAIL ADDRESS ________________________

OCCUPATION ____________________________ EMPLOYER/BUSINESS NAME ____________________ TEL/FAX _______________

EMPLOYERS/BUSINESS ADDRESS ______________________________________________________________________________________

MOTHERS NAME _______________________________________________________________ Living ( ) Deceased ( )

HOME PHONE # ______________________ MOBILE # __________________________ E-MAIL ADDRESS ________________________

OCCUPATION ____________________________ EMPLOYER/BUSINESS NAME ____________________ TEL/FAX _______________

EMPLOYERS/BUSINESS ADDRESS ______________________________________________________________________________________

PARENTS ARE ( ) Together ( ) Separated ( ) Widowed ( ) Not Married ( ) Marriage Annulled

APPLICANT LIVES WITH ( ) Both parents ( ) Father ( ) Mother ( ) Guardian

GUARDIANS NAME (if any) ____________________________________________________ Relation to Applicant ____________________

HOME PHONE # ____________________ MOBILE # __________________________________ E-MAIL ADDRESS ___________________

OCCUPATION _____________________________ EMPLOYER/BUSINESS NAME ____________________ TEL/FAX _______________

EMPLOYERS/BUSINESS ADDRESS _______________________________________________________________________________________

NAMES OF BROTHERS / SISTERS OF APPLICANT AGE SCHOOL / OCCUPATION

 SCHOLASTIC BACKGROUND

List all schools you attended beginning from the lowest grade:

From From
Name of School Location To Grade To SY
Grade SY

Have you ever applied to the Ateneo High School prior to this application? [ ] YES [ ] NO

If YES, when? _______________ For what grade/year level? _______________

(A separate sheet of paper may be used for this portion.)

List any honors or awards you have
List all your extra-curricular List your community or church
received for scholastic achievement
activities, including positions held. activities.
and deportment.

Considering your academic aptitude, skills, and career interests, which strand would you like to be placed in if
you are accepted to the Ateneo? Please rank the strands from 1 (as your 1st choice) to 4 (as your last choice).
Note that your strand assignment may not be your 1st choice.
[ ] Accountancy, Business & Management [ ] Science, Technology, Engineering & Mathematics
[ ] Humanities and Social Sciences [ ] General Academic

Were you ever dismissed from any school or denied re-admission? [ ] YES [ ] NO
If YES, provide name of school, school year and reason/s.
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________

Did you ever repeat a grade/year? [ ] YES [ ] NO

If YES, provide name of school, school year and reason/s.
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________

Were you ever placed on probation status? [ ] YES [ ] NO

If YES, provide name of school, school year and reason/s.
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________

Name of the Principal, Headmaster or Director of your present school _____________________________________

 AUTOBIOGRAPHY

Please write a brief handwritten autobiography touching on the following points: your chief
interests, ambitions, accomplishments, and your desire for a high school education at the Ateneo de
Manila University. This is an important part of your application and a good opportunity to make
yourself known to the Committee on Admission and Aid. Take time to think about what you will write
and give attention to the fundamentals of good writing (content, organization, and mechanics such as
grammar and spelling). Make sure not to simply repeat information already provided in other pages of
this form.

RECOMMENDATIONS

Give the names and addresses of the persons who gave you Letters of Recommendation. Make sure
you chose two (2) persons who know you well and who have held positions of authority over you in
your present school (ex. teacher, counselor or principal). Do not include relatives or friends.

Name _____________________________ Position ____________________ Address ______________________________________

Name _____________________________ Position ____________________ Address ______________________________________

CERTIFICATION

We hereby certify that all information supplied in this application is accurate and complete and
we authorize Ateneo Senior High School to verify all information supplied herein.

We consent to allowing the Ateneo Senior High School Office of Admission and Scholarships to
use, share and disclose data in this form for purposes related to my application.

We fully understand that misrepresentation of information supplied herein will be considered

sufficient reason both for refusal of admission and exclusion.

Fathers/Guardians Signature _________________________ Mothers/Guardians Signature ___________________

Applicants Signature ___________________________________ Date _________________________

 Last Name First Name Middle Name

DO NOT WRITE BELOW THIS LINE

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Date Application Received ____________________

Date of Decision ____________________
Date of Notification ____________________

Action of the Committee on Admission and Aid:

[ ] Accepted in [ ] ABM [ ] HUMSS [ ] STEM [ ] GA

[ ] Wait-listed
[ ] Rejected

Remarks
 Application for
Ateneo Senior High School Grade 11
SY 2018-2019
Recommendation Form
TO THE APPLICANT: You need two letters of recommendation sealed in letter envelopes to complete your application requirements. The
person you choose to recommend you should hold a position of authority over you (e.g. teacher, advisor, counselor) and should know you well
enough to provide the school with a helpful evaluation of your strengths and/or areas for improvement. The persons recommending you may
submit a recommendation letter or may use this form.

Write your name below using ink. Provide the person recommending you with a letter envelope.

NAME ______________________________________________________________________________________________________________
(On birth certificate) LAST NAME FIRST NAME MIDDLE NAME

TO THE PERSON RECOMMENDING: The student whose name appears above is applying for admission to the Ateneo Senior High School. Your
candid assessment of this student will assist the Admissions Committee in evaluating this students applicaton. Please fill out this form
completely. When you have filled out this form, please seal it in a letter envelope and sign across the flap before returning it to the applicant.
All information will be kept confidential.
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Please check the box that is applicable.

Above Average Average Below Average No Chance To Observe

Intellectual Ability
Oral Communication
Skills
Written
Communication Skills
Motivation
Consistency of
Performance
Adaptability

Leadership Potential

Please provide any information you think would help the Admissions Committee better understand the applicant.
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________

OVERALL RECOMMENDATION: _____ Strongly Recommended _____ Recommended

_____ Recommended With Reservation* _____ Not Recommended*

*Please state your reason/s on the lines below or on a separate sheet.

_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
RECOMMENDERS FULL NAME: _________________________________________ DESIGNATION: ________________________
CONTACT DETAILS: PHONE NUMBER/S: ____________________________ E-MAIL ADDRESS: ___________________________
HOW LONG HAVE YOU KNOWN THE APPLICANT? ____________________ IN WHAT CAPACITY? __________________________
RECOMMENDERS SIGNATURE: ______________________________________