Attach 2x2 picture,

white background with

Institutional Admissions and Testing Office nameplate / nametag

1962 J.P. Laurel National Highway, Lipa City 4217, Philippines

Trunkline: (043) 756-5555, loc. 259/238
Telefax: (043) 981-3575
[email protected] l www.dlsl.edu.ph

APPLICATION FOR ADMISSION FOR SCHOOL YEAR 20__ - 20__

Please print all information. Submit this form together with the Application Number :__________________
other requirements to the DLSL Institutional Admissions & Date of Application :__________________
Testing Office. Only applications with correct and complete Application is made as:
Freshman
information/requirements will be processed. If not applicable,
Transfer Student
write N/A.
Others: ________

PERSONAL DATA
Level Applied For:
Primary
Nursery 1
Nursery 2
Kinder

Grade School
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6

Junior High School
Grade 7
Grade 8
Grade 9
Grade 10

Science, Technology, Engineering and Mathematics (STEM)
Humanities and Social Studies (HUMSS)
Senior High School

Accountancy, Business and Management (ABM)
General Academics Strand (GAS)

First Choice: AB / BS __________________________ Certificate in __________________________

Tertiary School Second Choice: AB / BS __________________________

PERMANENT MAILING ADDRESS:

Last Name
Complete
Name Number & Street Subdivision/Barangay
(Leave one box
between two or First Name
more names)
Town/City Province Postal Code
Middle Name

DATE OF BIRTH: Age: CITIZENSHIP: CIVIL STATUS: Spouse’s Name:_____________________

Address:___________________________
PLACE OF BIRTH: GENDER:
Male
Female __________________________
Tel. No/ Mobile Phone No.____________
LANDLINE NUMBER: RELIGION:

Roman Catholic
MOBILE PHONE NUMBER:
Iglesia ni Cristo Guardian’s Name:___________________

Adventist Address:__________________________
E-MAIL ADDRESS:
Born-again Christian __________________________

Protestant Tel. No/ Mobile Phone No.____________

Others (Specify):__________

FAMILY BACKGROUND
FATHER (Write D for deceased) MOTHER
Name
Age
Citizenship
Home Address
Tel. No. / Mobile No.
Occupation
E-mail Address
Employer
Business / Office Address
Telephone Number/s
Educational Attainment
Last School Attended

BROTHERS AND SISTERS (Please list siblings from eldest to youngest. Attach additional sheet if necessary.)
HIGHEST
CIVIL YEAR LEVEL/
NAME AGE SCHOOL EDUCATIONAL
STATUS YR. GRADUATED
ATTAINMENT

_________________________________________________________________
 Please fill-in the blanks and mark boxes.
Combined annual income of parents Residence

100,000 and below
401,000 – 500,000
Owned

101,000 – 200,000
501,000 – 600,000
Rented

201,000 – 300,000
601,000 – 700,000
Living with relatives

301,000 – 400,000
701,000 and above
Others: _________

EDUCATIONAL BACKGROUND
LEVEL NAME & ADDRESS OF SCHOOL YEAR ATTENDED HONORS/AWARDS
GRADE SCHOOL
Nursery
Kinder
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
JUNIOR HIGH SCHOOL
Grade 7
Grade 8
Grade 9
Grade 10
SENIOR HIGH SCHOOL
Grade 11
Grade 12
SEMESTER and
NAME & ADDRESS OF
COLLEGIATE COURSE SCHOOL YEAR HONORS/AWARDS
COLLEGE/UNIVERSITY
ATTENDED
Year I
Year II
Year III
Year IV

HEALTH
Any physical or learning disability or anything that may influence future academic performance? (e.g. asthma, heart condition, hearing
and reading difficulties, allergies, students with special needs, etc.) Including Psychological Condition.

Yes, briefly describe. (attach medical certificate) ______________________________

No

Where did you first find out about De La Salle Lipa? (Please check as many as applicable)
Career Orientation Family
Posters Friends

Internet Advertisements
Referred by: Others, please specify _________________________
(Name of DLSL employee) cdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcdjcd

VERIFICATION
I certify that the information given herein is correct and complete. Falsification or withholding of information requested in this form
will automatically nullify my application and/or subject me to dismissal, even if already admitted.
_____________________________________ _____________________________________
Full name and Signature of Applicant Date
_____________________________________ _____________________________________
Full name and Signature of Parents/Guardian Date

For Freshmen College Applicants only:

This is to state that I have never enrolled in any tertiary institution here or abroad after my graduation from Senior High School and
after taking the DLSL College Entrance Test as part of my application.
_____________________________________ _____________________________________
Full name and Signature of Applicant Date
_____________________________________ _____________________________________
Full name and Signature of Parents/Guardian Date

_________________________________________________________________
*To be filled out by the IATO Staff

DE LA SALLE LIPA
INSTITUTIONAL ADMISSIONS AND TESTING OFFICE
ADMISSIONS TEST PERMIT
Attach 2x2 picture,
Applicant’s Name: ______________________________________________________________________ Classification: _____ Guidelines: ____ white background
Last First M.I. with nameplate /
nametag
Admission Test Schedule: ________________________________________ Preferred Course / Strand / Level: _______________

Remarks: _____________________________________________________ Processor’s Signature & Date: __________________