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ANTIPOLO CITY NATIONAL SCIENCE AND TECHNOLOGY HIGH SCHOOL

QUALIFYING XAMINATION APPLICATION FORM

TO BE FILLED OUT BY THE APPLICANT

I. PERSONAL DATA
Name of Applicant 1 x 1 Photo

________________________ _______________________ ______________________ ___

Last Name First Name Middle Name Middle Initial

Birthday (mm/dd/yyyy): ____________ Age (as of June 1 of the current year): ______ Sex: ______

Student's Contact Number/s: _______________________ Email Address:

Parent/Guardian's Contact Number/s: ________________________ _________________________________
Complete Home Address: ____________________________________________________________________

___________________________________________________________________________________________
I certify that the above information is true and correct. I understand that any false or misleading information will result to the disapproval of my
application/admission.

___________________________________________
Applicant's Signature Over Printed Name
TO BE FILLED OUT BY THE PARENT
1. Does your child have pending application in other Science high school? ___ Yes ___ No
If yes, specify the school: _________________________________________________________
2. Are you willing to send your child to the ACNSTHS Campus in Sitio Cabading? ___ Yes ___ No
3. Are you willing to adhere with the conditions of ACNSTHS in terms of maintaining grades,
policies, etc., should your child qualify in the admission test? ___ Yes ___ No
4. Will your child take STEM Track in Senior High School? ___ Yes ___ No
I certify that the above information is true and correct. I understand that any false or misleading information will result to the disapproval of my
child's application/admission.

____________________________________________
Parent / Guardian's Signature Over Printed Name
TO BE FILLED OUT BY THE SCHOOL AUTHORITY CONCERNED
1. Name of School (Do not abbreviate ): __________________________________________________________
2. Complete School Address: ___________________________________________________________________
3. School Type: Government _____ Private : _____ School Contact No./s: __________________________
4. Student's General Average (From First to Third Quarter ): _______________________________________
5. Number of pupils in the BATCH : _________________ Student's RANK in the BATCH : ________________
I hereby certify that the student-applicant is of good conduct and behavior.

______________________________________________________
Guidance Counselor's/ Adviser's Signature Over Printed Name

I certify that the above information is true and correct. I understand that any false or misleading information will
result to the disapproval of our student's application/admission.

__________________________________________________________
School Head's Signature Over Printed Name

__________________________________________________________________
Reminders for the Applicants:
1. Submission of this application form, together with the other required documents, is until 3:00 PM of February 7, 2020 at
Antipolo City National Science and Technology High School, Sitio Cabading Brgy. San Jose, Antipolo City.
2. Be at the Testing Center (Antipolo City National Science and Technology High School) on Saturday, February 15, 2020,
at least 30 minutes before the scheduled time of examination. Examination starts at 8:00 AM.
3. Test on English, Science and Mathematics will be of one hour each. An interview will be conducted at 1:00PM.
4. Bring at least 2 sharpened #2 Pencil, a good eraser, snacks and food for lunch.
5. Results will be posted at www.depedantipolo.com.

Admission Office
Tel. No.: 8736-0452