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Basic Education (Senior High School)
Office of Admission & Aid

Katipunan Avenue, Loyola Heights


Quezon City, Philippines 1108
P.O. Box 154, Manila, Philippines
Tel. (+632) 426 6001 ext. 6291-6292
URL www.ateneo.edu/hs

APPLICATION FOR GRADE 11 ADMISSION


Important: Applicants may take the entrance test for Grade 11 only once.
Application Requirements and Procedures:
1.
2.

3.
4.

Pay the non-refundable application and testing fee of Seven Hundred and Fifty Pesos (Php750.00) at the High School
Cashier, made payable to the Ateneo de Manila University (for check payments). For applicants from foreign schools,
pay an additional US$25.00 for processing fee.
Present the Official Receipt to the Office of Admission and Aid. Complete this form carefully, answering all questions.
Then return this form to the Office of Admission and Aid together with the following requirements at least two (2)
weeks before the Entrance Test date.
a. Photocopies of applicants Report Cards for the:
i. first grading period of the current school year, and
ii. the last completed school year
b. Two (2) recent ID pictures (1" x 1") in COLOR
c. Clear photocopy of applicants Birth Certificate (NSO Copy)
i. If applicant is not a Filipino citizen, submit a photocopy of his (1) Passport and (2) Alien Certificate of
Registration (ACR I-Card).
ii. If applicant has dual citizenship, submit a photocopy of his Philippine Passport or Certificate of
Recognition as a Filipino Citizen.
d. For transfer applicants: Two (2) Letters of Recommendation from the last school attended
e. Handwritten autobiography on size A4 bond
Only applications with complete requirements will be processed.
Credentials filed in support of this application become the property of the Ateneo de Manila University and will not be
returned to the applicant.

PERSONAL INFORMATION
NAME ___________________________________________________________________________________________________
(On Birth Certificate) Last Name
First Name
Full Middle Name
HOME ADDRESS ___________________________________________________________________________________________
ZIP CODE __________ TEL. NO. __________ MOBILE NO. _______________ EMAIL _____________________________________
Would you prefer to receive notification via this email address? [ ] YES [ ] NO
DATE OF BIRTH _______________ PLACE OF BIRTH _______________ CITIZENSHIP _______________ RELIGION _____________
FATHERS NAME _______________________________________________ MOBILE NO. _______________ [ ] living [ ] deceased
CITIZENSHIP _______________ RELIGION ________________ OCCUPATION __________________________________________
MOTHERS NAME______________________________________________ MOBILE NO. _______________ [ ] living [ ] deceased
CITIZENSHIP _______________ RELIGION ________________ OCCUPATION __________________________________________
GUARDIANS NAME (if applicable) _____________________________________________ RELATION TO APPLICANT __________
ADDRESS _________________________________________________________________________________________________
TEL. NO. __________ MOBILE NO. _______________ OCCUPATION _________________________________________________

SCHOLASTIC BACKGROUND
List all schools you attended beginning from the lowest grade:
Name of School

Location

From Grade

To Grade

From SY

To SY

Is the last school you attended (i.e., up to Grade 10): Check only one.
[ ] K-12 ready (offers a 12-year basic education program)?
[ ] non K-12 ready (offers a 10-year basic education program only)?
Have you ever applied to the Ateneo High School prior to this application? [ ] YES [ ] NO
If YES, when? _______________ For what grade/year level? _______________
List all your extra-curricular activities,
including positions held.

List any honors or awards you have


received for scholastic achievement and
deportment.

List your community or church


activities.

Considering your academic aptitude, skills, and career interests, which strand would you like to be placed in if you are accepted
to the Ateneo Senior High School? Please rank the strands from 1 (as your first choice) to 4 (as your last choice).
[ ] Accountancy, Business and Management
[ ] Humanities and Social Sciences
[ ] General Academic
[ ] Science, Technology, Engineering and Mathematics

Were you ever dismissed from any school or denied re-admission? [ ] YES [ ] NO
If YES, provide name of school, school year and reason/s.
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Did you ever repeat a grade/year? [ ] YES [ ] NO
If YES, provide name of school, school year and reason/s.
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Were you ever placed on probation status? [ ] YES [ ] NO
If YES, provide name of school, school year and reason/s.
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Name of the Principal, Headmaster or Director of your present school ______________________________________
School Address ______________________________________________________ Tel. No. _____________________

HEALTH AND PHYSICAL FITNESS


Immunization Record (to be accomplished by your family physician):
Catch-up immunization in middle school
and junior high school
3 doses of Hep B
2 doses of MMR
2 doses of Varicella
Tdap/Td (10 years ago)

Date/s given

Date of last physical exam ____________________


List any health problems/medical conditions which should be taken into consideration in planning the students
school activities. _________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Has the student ever been forced to stop schooling for a month or more because of poor health? [ ] YES [ ] NO
If YES, provide details and dates of hospitalization, if any. ________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Physicians Signature over Printed Name ______________________
License No. _______________ Date Signed ____________________

AUTOBIOGRAPHY
Please write a brief handwritten autobiography touching on the following points: your chief interests, ambitions,
accomplishments, and your desire for a high school education at the Ateneo de Manila University. This is an
important part of your application and a good opportunity to make yourself known to the Committee on Admission
and Aid. Take time to think about what you will write and give attention to the fundamentals of good writing
(content, organization, and mechanics such as grammar and spelling). Make sure not to simply repeat information
already provided in other pages of this form.

FINANCIAL AID
Are you applying for Financial Aid from the Ateneo? [ ] YES [ ] NO
If YES, secure a copy of the Financial Aid Questionnaire from the Admission and Aid Secretary. Fill up the
questionnaire and provide a complete set of required documents before submitting the same to the Office of
Admission and Aid together with this application form. Financial Aid Questionnaires with incomplete requirements
will not be processed.

RECOMMENDATIONS
For applicants from Ateneo High School: Give the names and addresses of the persons who may be asked to send
your Letters of Recommendation. Choose two (2) persons who know you well and who have held positions of
authority over you in your present school (ex. teacher, counselor or prefect of discipline). Do not include relatives or
friends.
Name _________________________ Position ____________________ Address ______________________________
Name _________________________ Position ____________________ Address ______________________________
CERTIFICATION
I hereby certify that all information supplied in this application is accurate and complete, and I authorize Ateneo Senior High School to
verify all information supplied herein. I further certify that I have not applied for the same grade level in Ateneo Senior High School prior
to this application. I fully understand that misrepresentation of information supplied herein will be considered sufficient reason both for
refusal of admission and exclusion.
Fathers/Guardians Signature _________________________
Mothers/Guardians Signature _________________________

Applicants Signature _________________________


Date ____________________

Last Name

First Name

Middle Name

DO NOT WRITE BELOW THIS LINE


--------------------------------------------------------------------------------------------------------------------------------------------------------Date Application Received
Date of Decision
Date of Notification

____________________
____________________
____________________

Action of the Committee on Admission and Aid:


[
[
[
[
[
[

] Accepted in [ ] ABM [ ] GA [ ] HUMSS [ ] STEM


] Wait-listed
] Rejected
] P1
] P2
] To take bridging classes in ___________________________________

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