APPLICATION FORM.pdf - PAREF Southridge School

PAREF – SOUTHRIDGEPrivate School for BoysHillsborough Subd., West Service Rd., Bo. CupangAlabang, Muntinlupa City 1770Phone: (632)842-0506 to 07 Fax: (632)842-1542Please attach arecent 1” X 1”ID photoAPPLICATION FORMDate of Application _________________________ School Year 200___ - 200___ For Grade/Year ________APPLICANT INFORMATIONName: ________________________________________________________ Nickname:___________________Last Name First Name Middle NameBirth Date: ______________________ Current Level: ______________________________________Age: ______________________ Current School: ______________________________________Citizenship: ______________________ Country of Birth: _____________________________________Address:___________________________________________________________________________________Phone Number: ____________________ Languages Spoken: 1 st _______________2 nd _______________Educational History: (List all previous schools attended, starting with the current school.)Name of School From Month/Year To Month/Year Grade/Year Level Reason for leavingADDITIONAL INFORMATION ON STUDENT-APPLICANTHas your son ever repeated or skipped a grade or year level? [ ] No [ ] Yes, grade/year _________________Have you ever requested or completed a learning assessment [ ] No [ ] Yes, please elaborate. ____________of your son?______________________________Did your son receive remedial help in his previous school [ ] No [ ] Yes, please elaborate. ____________or elsewhere? (academic tutorials, speech therapy, or______________________________occupational therapy, etc.)Has your son received any citation for academic work or [ ] No [ ] Yes, please specify. ______________extra-curricular activities?______________________________Has your son had any behavioral or disciplinary problems at [ ] No [ ] Yes, please elaborate. ____________his previous school(s) or in the neighborhood?______________________________Does your son have any special health concerns? [ ] No [ ] Yes, please specify. _____________________________________________Does your son require regular medication? [ ] No [ ] Yes, please specify. ____________________________________________Does your son exhibit any notable or special skill in any area? [ ] No [ ] Yes, please specify. _______________________________________________

PARENT INFORMATIONFATHERMOTHERFull Name _________________________________ ________________________________Nickname _________________________________ ________________________________Citizenship _________________________________ ________________________________Birth Date _________________________________ ________________________________Religion _________________________________ ________________________________Home Address _________________________________ ________________________________Home Phone Number _________________________________ ________________________________Mobile Number _________________________________ ________________________________Occupation _________________________________ ________________________________Designation _________________________________ ________________________________Company _________________________________ ________________________________Nature of Business _________________________________ ________________________________Office Address _________________________________ ________________________________Office Phone/Fax _________________________________ ________________________________Email _________________________________ ________________________________Educational Background (Schools & Degree Attained)High School _________________________________ ________________________________College _________________________________ ________________________________Post Graduate _________________________________ ________________________________Marriage: [ ] Church (Year _______________ )[ ] Civil (Year _______________ )[ ] Legally Separated (Year _______________ )[ ] Remarried (Year _______________ )[ ] Divorced (Year _______________ )Name of Children Sex Age Date of Birth Current School Current Level

PERSONAL HISTORYDo all the members of the family live together? __________________________Have you attended any EduChild Course?__________________________If yes, kindly state the date and place where you attended. __________________________Does the work of the father or mother necessitate either parent being away from home for longer than one week permonth, as in the case of job circumstances? ___________ If so, please state the details ( why and how) _________________________________________________________________________________________________________How did you first come to know about PAREF? ____________________________________________________What made you apply for your child’s admission in this PAREF school? __________________________________________________________________________________________________________________________________Please rank the factors below that greatly influenced your decision to apply in Southridge. (1 being the most importantand 5 the least.)______ Doctrinal and Character Formation______Academic Reputation of the School______Proximity to present residence______Friendship with other parentsOthers, please specify. ____________________________________________________________REFERRALS SECTION: Three referrals from existing PAREF parents or friends who are familiar with the PAREFsystem. Kindly solicit the name and signature of the three people recommending you to Southridge.Recommended by:Recommended by:Recommended by:_____________________________________________________________________________________________________________________Please be advised that your son’s application could be turned down if complete and accurate information is notprovided. The school may permanently drop the student after enrollment should there be any misrepresentations onthis form. Southridge reserves the right to determine the placement of the applicant in the grade or year level deemedmost appropriate for his academic proficiency and background.To the best of my knowledge, the information submitted on this form is true and correct.____________________________ ____________________________ ______________________Signature of Father Signature of Mother Date