ESCF01-01

Name of School:
Mailing Address:
Name of Student:
Mailing Address:
Birth Date: Age:
Birth Place: Sex
Citizenship:
Religion:
Elementary School Graduated From:
Mailing Address:
Year Graduated: Average Grade:
Age
Father
Mother
Guardian
Brothers/Sisters
Student Application for ESC Participation
For School Year ________ to ________
Student Personal Data
Elementary School Data
Family Data
Name Occupation Income
Applicant's Statement
I hereby apply for admission into the First Curriculum Year at the above named private high school
that participates in the Educational Service Contracting Program of the Department of Education. If
selected, I will abide by the policy guidelines of the ESC Program and the rules of the school where
I will be enrolled. All the information supplied above is correct to the best of my knowledge. Any
willful misrepresentation made by me shall be sufficient reason for my disqualification.
Applicant's Signature


1 x 1 ID
Picture

ESCF02-02
On the Part of the Student:
On the Part of the Parent/Guardian:
a. preventing truancy and/or absenteeism of my child/ward;
b. making my child/ward attend seriously to his/her school work; and
c. attending/participating in school activities that need my presence.
On the Part of the School:
That in case of problems relative to this contract, the parents/guardians will always be consulted.
Signed at _________________________________________ on __________________________.
Note: Signature over printed name.
ESC Grantee Enrolment Contract
We, the Undersigned Parties, do hereby bind ourselves to the following terms of this Contract:
That I _________________________ agree to study at _________________________________
under the "Educational Service Contracting" program, provided that I meet all requirements for
continued participation in the ESC program.
That I will abide by the rules and regulations of abovementioned school;
That I will comply with the school requirements and try to finish the course for each school year,
applying myself with seriousness and dedication; and
That I will consult the school authorities on problems relative to the fulfillment of the terms of this
contract.
That the ___________________________________________ will give the same attention and
training to contract students under the ESC program as that given to non-contract students in the
school;
Student Parent/Guardian
School Head
That I ____________________, parent/guardian of aforesaid student, fully agree to enroll my
child/ward at the abovementioned school under the "Educational Service Contracting" program;
That I will abide by the rules of the aforecited school;
That I will help my child/ward to finish the course for every year level during the period specified
That I will help in the best way I can in -
That since the ESC program sets for every school year a maximum amount as subsidy for
student's tuition and other fees, I agree to pay to the school any excess of the fees charged which
is not covered by the ESC subsidy; and
That in case of problems relative to the fulfillment of this contract, I will consult the school
authorities concerned or the Division Project Committee.
2010-ESCF03-01
School Id:
School Name:
School Address:
I. Tuition Fee
II. Other Standard School Fees
(Please indicate breakdown)
Total Other Standard School Fees P P P P
III. Other Non-standard School Fees
(Please indicate breakdown)
Total Other Non-standard School Fees P P P P
IV. Total Tuition and Other School Fees (Sum of Part I, Part II, and Part III)
P P P P
V. Please indicate any special concessions given to ESC grantees (e.g. tuition waiver, discounts, any forms of assistance, etc.)
P P P P
P P P P
ESC Form 3-Certification of Tuition and Other School Fees
For School Year 2014-2015
Grade 8 Grade 9 Grade 10 Grade 7
Note: Signature over printed name.
We certify, under the penalties of perjury, that the above information contained herein is true and correct and is in accordance with the ESC Implementing
Guidelines.
Please attach a true copy of the current school year's schedule of tuition and other school fees submitted and marked received by the DepEd
Regional/Division Office.
Faculty Association President/Representative Parents' Association President/Representative
School Head
School ID Name of School
Page of
Region Province Municipality Street/Barangay
Total no. of Licensed Teachersfor this page
Instructions: Please prepare 4 copies. Type the data needed. Teachers' names shall be alphabetically arranged (Last Name first and then First Name) regardless of their gender. No erasures allowed.
No. No.
Note: Signature over printed name. Note: Signature over printed name.
School Head
We certify, under the penalties of perjury, that the list above are teachers who are qualified to participate in the Teacher Salary Subsidy Program
Date of Birth Taxes Witheld Signature First Name License Number Gender Last Name Amount Released Date Issued
Faculty Association President/Representative Parents' Association President/Representative
Teacher Salary Subsidy Payroll School Year 20__ to 20__
MI