Concordia College, Inc.

Integrated Basic Education Department Attach a

Tel. No. (02) 8518 – 2397 & (02) 8518 – 2398 1”x1”
Website: https://laconcordia.edu.ph/ Picture
E-Mail: admin@laconcordia.edu.ph

PAASCU ACCREDITED: Elementary- Level III Junior High School – Level II

EDUCATION SERVICE CONTRACTING (ESC) CERTIFIED
(Gov’t. Subsidy to Graduates of Elementary Public Schools Entering Private High School)
SENIOR HIGH SCHOOL VOUCHER PROGRAM (VP) PARTICIPATING SCHOOL
(Gov’t Subsidy for Qualified Junior High School Graduates)

APPLICATION FORM
Academic Year: _________ - _________

Grade
Level
___ K ___ 1 ___ 2 ___ 3 ___ 4 ___ 5 ___ 6 ___ 7 ___ 8 ___ 9 ___ 10 ___ 11 ___ 12
Track ____ Academic Strand ____STEM ____ABM ____HUMSS

Learner Reference Number (LRN):

Status ____New ____Continuing ____Returning
(for G1 to 12 Applicants only)

Name: _______________________ ________________________ ____________________ _________

Surname First Name Middle Name M.N.Initial
Birthdate: ________________ ________ ___________ Age: ________Gender: ___M ___ F
Month Day Year
Complete Address: _______________________________________________________________________
Telephone Number: ___________________________ Mobile Number:__________________________
Religion: _________________ Nationality: __________________ E-mail: _________________________
School Last Attended: ___________________________________________School Year: ______________
School Address: _____________________________________________________ Private______ Public

FATHER’S INFORMATION MOTHER’S INFORMATION

Name: ___________________________________ ___________________________________
Age: ___________________________________ ___________________________________
Nationality: ___________________________________ ___________________________________
Address: ___________________________________ ___________________________________
Landline Number: ___________________________________ ___________________________________
Cellphone Number: ___________________________________ ___________________________________
Email Address: ___________________________________ ___________________________________
Occupation: ___________________________________ ___________________________________

Guardian in case the parents are not available:

Name: ______________________________________________ Relation to the Student: _________________
Age: _________ Landline Number: _______________________ Cellphone Number: ____________________
Address: ____________________________________________ Email Address: _______________________
 ACADEMIC BACKGROUND
(For Grade 1 to 11 Applicants only)
Name of Present / Last School Attended: Current Grade Level:
________________________________________________ ________________________________
School Address: __________________________________ Telephone Number:______________
Name/s of School/s Attended School Address School Year
KINDERGARTEN __________________________________ _____________________ _____________
GRADE 1 __________________________________ _____________________ _____________
GRADE 2 __________________________________ _____________________ _____________
GRADE 3 __________________________________ _____________________ _____________
GRADE 4 __________________________________ _____________________ _____________
GRADE 5 __________________________________ _____________________ _____________
GRADE 6 __________________________________ _____________________ _____________
GRADE 7 __________________________________ _____________________ _____________
GRADE 8 __________________________________ _____________________ _____________
GRADE 9 __________________________________ _____________________ _____________
GRADE 10 __________________________________ _____________________ _____________
GRADE 11 __________________________________ _____________________ _____________

Data Privacy Clause: I understand and agree that by filling-out this form I am allowing Concordia College, Inc. to use, collect, and
disclose my personal information for Enrollment Application and to store it as long as necessary for the fulfillment of the stated
purpose in accordance with the applicable laws, Including the Data Privacy Act of 2012 and its Implementing Rules and Regulations,
and the School Rules and Regulations. The purpose and extent of use, collection, sharing and disclosure, and storage of my personal
information has been explained.

_____________________________________ _____________________________________ _____________________

Parent’s Name and Signature Student’s Name and Signature Date

****************************************Concordia College, Inc. Admissions Only*****************************************

STEP 1- Complete the following Initial Requirements and present to the Admissions Office:
*Credentials submitted in support of this application become the property of the school and will not be returned to the applicant.

1. Form 138/Report Card (photocopy) _____________

2. PSA Birth Certificate (photocopy) _____________
3. Baptismal Certificate (photocopy) _____________
4. Accomplished Letter of Recommendation _____________
5. Two (2) pieces 1x1 ID pictures _____________
6. ESC Certificate (Grades 8 to 11 Transferees) _____________
7. QVR Certificate (Grade 11 Transferees: Non-ESC) _____________
Received by: ___________________
Date : ___________________
STEP 2 - Pay the Entrance Fee at the Accounting Office.
OR No.: ___________________ Reference No: ________________ Date: _________________

STEP 3 - Go to the Guidance Office for the initial interview and secure the date of entrance exam.
Date of Exam: ______________ Time: _______________ Scheduled by: __________________

STEP 4 - Claim the Test Results and Final Interview by the Admissions Committee.
Date of Interview: __________________ Time: _______________ Scheduled by: _______________
Interviewed by: ____________________

STEP 5 - Go to the Registrar’s Office for enrolment on the designated date and bring the Original Documents.