URS APPLICATION FORM FOR GRADE 11 - University of Rizal System

URS Admission Form for Senior High School

TO BE FILLED OUT ONLY BY THE ADMISSION OFFICER AND/ OR AUTHORIZED PERSONNEL TO RECEIVE AND/ OR PROCESS APPPLICATION

LEARNER'S REFERENCE NUMBER

UNIVERSITY OF RIZAL SYSTEM

Province of Rizal Website:

URS APPLICATION FORM FOR GRADE 11

______ Semester, SY _______

TO THE STUDENT AND PARENTS: Carefully read the Instruction before filling out the application form. Print neatly all information required. Only accomplished application forms, (URS Grade 11) will be processed.

Testing Center:

1

URS Angono

4

URS Cainta

7 URS Pililla

2

URS Antipolo

5

URS Cardona 8 URS Rodriguez

3

URS Binangonan 6

URS Morong

9 URS Tanay

10 URS Taytay

Documents/ Requirements Submitted:

2 Photos (2X2)

Birth Certificate

Testing Fee

Form 138

Good Moral

O.R. Number

Received by:

1. NAME OF STUDENT-APPLICANT. Print of type your full name in the following sequence. LAST NAME, FRIST NAME, MIDDLE NAME. Place one letter in each box. Leave one box between names. Last

First

Middle

2. GENDER

Male

Female

3. RELIGION

4. DATE OF BIRTH (Month/ Day/ Year)

AGE

CIVIL STATUS

5 PLACE OF BIRTH (City/ Town, Province)

6. CITIZENSHIP

a. Filipino ( If born abroad please submit a photocopy of a valid Philippine Passport or a BOI Identification Certificate)

b. Natural Born Filipino c. Foreign (Specify)

d. Dual (Specify)

Paste a recent 2"X2" photograph (taken within the last three months) in this box

Please print your full name at the back of the photo

7. HIGH SCHOOL (Where you completed/ are completing Junior High School / Grade 10): High School Name

(Do not abbreviate)

Address

(City/ Town, Province)

Expected Month/ Year of Completion

8. URS CAMPUS APPLIED FOR

Do not include the same campus twice. Write NONE on the blank if you do not have other choices of campus and course.

1st choice

URS CAMPUS

2nd choice

Choose from among the following (two choices allowed)

1. URS Antipolo

3. URS Cardona

2. URS Binangonan

4. URS Morong

INTENDED TRACK (See list of Academic/ Tech. Voc .Track)

1st choice 2nd choice 1st choice 2nd choice

5. URS Pililla 6. URS Tanay

7. URS Rodriguez

General Average

TRACK CODE

9. How many times have you applied for URS Grade 11 Admission? ______ What URS campus(es)? ______________________________________ 9.

10. CHILD OF A URS FACULTY OR EMPLOYEE? Place an X in the appropriate box.

Name of Parent Employed by URS

College/ Office where employed

11. PERMANENT ADDRESS

12.

No

Yes

Official Designation

Telephone No.

ARE YOU SELF-SUPPORTING?

Number & Street

No

Yes If Yes, nature of work (put an X to appropriate work)

Subd/ Village/ Brgy City/ Town & Province Postal Code Email Address

Telephone

Food Chain Crew

Gasoline Boy/ Girl

Vendor

Messenger

Household

Construction

Others (please specify) ________________________________

Facebook Account

13. SOCIO ECONOMIC Furnish all the required information on each family listed. Write DECEASED after name of deceased family

members.

Under the Column "Highest Educational Attainment", indicate the College, BSE or Ph. D., Ed. D.)

educational level which the household member actually completed. (i.e. Grade II, Third Year High School, High School Graduate, Second Year

Father Mother Legal Guardian

NAME

CITIZENSHIP

MARITAL STATUS

HIGHEST EDUCATIONAL ATTAINMENT

PRESENT OCCUPATION

MONTHLY INCOME

(In Phil. Pesos)

URS-AA-SS-ADM-F-2017-02

THIS FORM IS FREE OF CHARGE AND MAY BE PHOTOCOPIED Rev. 00

Effectivity Date: August 15, 2017

(Grade 11-- Track Code)

CAMPUS

TRACK

ACADEMIC TRACK General Academic Strand (GAS)

Humanities & Social Sciences (HumSS)

ANTIPOLO

TECHNICAL, VOCATIONAL & LIVELIHOOD TRACK Home Economics

Tour Guiding Services Bread and Pastry

BINANGONAN

ACADEMIC TRACK Accountancy, Business & Management (ABM) General Academic Strand (GAS)

Humanities & Social Sciences HumSS), Accountancy, Business & Management (ABM)

TECHNICAL, VOCATIONAL & LIVELIHOOD TRACK Information and Communication Technology (ICT)

CARDONA

TECHNICAL, VOCATIONAL & LIVELIHOOD TRACK Agri-Fishery

Aqua-culture

MORONG

ACADEMIC TRACK Humanities & Social Sciences (HumSS) Science, Technology , Engineering & Mathematics (STEM) General Academic Strand (GAS) Accountancy, Business & Management (ABM) Humanities & Social Sciences (HumSS) Science, Technology , Engineering & Mathematics (STEM)

TECHNICAL, VOCATIONAL & LIVELIHOOD TRACK Home Economics Industrial Arts Automotive Services Electronic Servicing Electrical Installations and Maintenance Information and Communication Technology (ICT)

PILILLA

ACADEMIC TRACK Accountancy, Business & Management (ABM) General Academic Strand (GAS)

Accountancy, Business & Management (ABM) Humanities & Social Sciences (HumSS)

TANAY

ACADEMIC TRACK Humanities & Social Sciences (HumSS) Accountancy, Business & Management (ABM) Science, Technology , Engineering & Mathematics (STEM) General Academic Strands (GAS)

Accountancy, Business & Management (AMB) Humanities & Social Sciences (HumSS)

Science, Technology , Engineering & Mathematics (STEM) Sports

TECHNICAL, VOCATIONAL & LIVELIHOOD TRACK Agri-fishery

Organic Agriculture Horticulture

Animal Production Information and Communication Technology (ICT)

RODRIGUEZ

ACADEMIC TRACK Accountancy, Business & Management (ABM) Science, Technology , Engineering & Mathematics (STEM) General Academic Strands (GAS)

Accountancy, Business & Management (ABM) Humanities & Social Sciences (HumSS)

TRACK CODE

A 1001 A 1002

T 1011 T 1012

A 2001

A 2010 A 2011

T 2013

T 7001

A 3001 A 3002

A 3010 A 3011 A 3012

T 3013

T 3021 T 3022 T 3033 T 3014

A 4001

A 4010 A 4011

A 5001 A 5002 A 5003

A 5010 A 5011 A 5012 A 5013

T 5021 T5022 T 5023 T 5014

A 6001 A 6002

A 6010 A 6011

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