Batasan Hills National High School

SPECIAL PROGRAM FOR THE ARTS

IBP Road, Batasan Hills, Quezon City
1x1 Colored
Picture
APPLICATION FORM (Attached 1
PLEASE PRINT LEGIBLY copy)

CHECK ONE SPECIALIZATION YOU ARE INTERESTED TO STUDY:

MUSIC (Instrument) MUSIC (Vocal) DANCE THEATER ARTS

VISUAL ARTS CREATIVE WRITING MEDIA ARTS

Remember that panel members have authority to transfer you to an art specialization based on your admission results.

I.PERSONAL DATA

Name: _________________________________________________________ Sex: _____________

(Surname) (First Name) (Middle Initial)

Date of Birth: _________________ Place of Birth: _______________________ Age: ________

Present Address: _______________________________________________________________________

Street/Barangay Municipality/City/Province

Ethnic Affiliation (if any): ______________________________ Religion:________________________

Mobile Contact No.: ___________________________________ Email Add._______________________

II. EDUCATIONAL BACKGROUND

Grade Level Name and Address of School S.Y. Attended

5

III. ELEMENTARY SCHOLASTIC RECORD

FINAL GRADE
GRADE LEVEL FILIPINO ENGLISH MATH SCIENCE HEKASI
4
5
6 Note: Attached Photo Copy of Grade 6 Report Card (1st to 2nd Grading)

IV. HONORS AND AWARDS RECEIVED (Provide extra sheet/s if necessary)

GRADE LEVEL ACADEMIC NON-ACADEMIC
5
6

V. FAMILY BACKGROUND

FATHER MOTHER
Name
Citizenship
Home Address
Occupation
Employer (name of company)
Monthly Income
Business Address
Telephone Number
Highest Educational Attainment

Brothers/Sisters (from eldest to youngest. Provide additional sheets if necessary)

Highest
Ag Civil
Name School Educational
e Status
Attainment

VI. VERIFICATION/ AUTORIZATION:

I have carefully read the contents of this application form and I certify that the information given
herein is correct and complete.

____________________________________________ ________________ __________________

Printed Name & Signature of Applicant CP No. Date

____________________________________________ ______ ______ ___ __________________

Printed Name & Signature of Parents/Guardian CP No. Date

____________________________________________ ________________ __________________

Printed Name& Signature of Class Adviser CP No. Date

 IMPORTANT REQUIREMENTS:
Grade in Science, Mathematics, and English must be 85% and above.
Other subjects must be 83% and above.
Photocopy of Form-138 (Report Card in Grade 6 with COMPLETE grades for the First
and Second Grading)
Accomplished SPA Application Form with COMPLETE data.
Certification of Honor Student (For those who belong to the top 10 of the Class)
Medical Certification from Barangay Health Center or any clinic/hospital
For Inquiries contact or see the following:
Olive D.G. Farin, T-I, SPA Coordinator
Johannsen C. Yap, MT I MAPEH, ASTP-Special Programs
Dr. Diego M. Amid, Principal IV
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Applicants Copy
Name: ______________________________________ School: __________________________

Date of Examination: __________________ Venue: GMA Bldg. Rm. 302

Presented I.D.:____________________________ Seat

No.

Remember these dates:

APPLICATION PERIOD: January 30, 2017 to February 17, 2017

TESTING DATES: February 18, 2017 (First Batch) 9:00 AM-10:00 AM

February 25, 2017 (Second batch) 9:00 AM-10:00 AM

INTERVIEW AND SKILLS TEST DATES: March 11, 2017 9:00 AM-12:00 PM

POSTING OF RESULTS: March 25, 2017

ENROLMENT AND ORIENTATION DATE: April 20, 2017 8:00 AM

Please wear your elementary school uniform and I.D. on testing date. Bring pencils,
eraser and this form. No need to bring snacks as test is good for 2 hours only.