Form 1 - SHS

2” X 2”
ATENEO DE NAGA UNIVERSITY Picture in
White
SENIOR HIGH SCHOOL
Background

APPLICATION FOR ADMISSION

Instructions: 1. Fill out this form carefully with the information requested. Only application forms correctly and
completely filled-out will be accepted. Submit this form together with the Admission Requirements.
Please refer to the checklist at the back of this form. INCOMPLETE CREDENTIALS will not be
processed.
2. MISREPRESENTATION OF INFORMATION in this application will be considered sufficient reason
for REFUSAL of ADMISSION and Exclusion.

STUDENT PERSONAL INFORMATION

Surname (as stated in Birth Certificate) First Name (as stated in Birth Middle Name (as stated in Birth Certificate) M.I.
Certificate)

Nickname Sex Birth Date (month/day/year) Birthplace Age Citizenship

Religion Parish Priest/Pastor Blood Type Height Weight ACR No. (For non-Filipino
only)

Civil Status Telephone No. Mobile No. Email Address

House No., Street, Subdivision, Barangay City/Municipality

CURRENT
ADDRESS Province Country Zip Code

House No., Street, Subdivision, Barangay City/Municipality

PERMANENT
ADDRESS Province Country Zip Code

PARENTS/GUARDIAN INFORMATION
FATHER’S Last Name First Name Middle Name
Living Deceased
NAME
House No., Street, Subdivision, Barangay City/Municipality
CURRENT
ADDRESS Province Country Zip Code Mobile Number

Email Address Occupation Employer’s Name

Employer’s Address Office Telephone No.

MOTHER’S Last Name First Name Middle Name

Living Deceased
NAME
MAIDEN Last Name First Name Middle Name
NAME
House No., Street, Subdivision, Barangay City/Municipality
CURRENT
ADDRESS Province Country Zip Code Mobile Number

Email Address Occupation Employer’s Name

Employer’s Address Office Telephone No.

GUARDIAN’S Last Name First Name Middle Name Relation to the student
NAME
(Other than Parents)
House No., Street, Subdivision, Barangay City/Municipality
CURRENT
ADDRESS Province Country Zip Code Mobile Number

Email Address Occupation Employer’s Address

 NO. OF BROTHERS AND SISTERS:
Name of Brothers and Sisters Course and
Name of School Year Graduated
(Eldest to Youngest) Year/Grade Level

EDUCATIONAL BACKGROUND
Name of Elementary School Name of Junior High School

Type of School Private Catholic Public Type of School Private Catholic Public
School Address School Address

Region Year Graduated Region Year Graduated

Awards Received Awards Received
School ID (Verify with your School Head)
LRN
OTHER JUNIOR HIGH SCHOOL ATTENDED
Name of School School Address
Type of School Private Catholic Public Reason/s for Transferring
School Year

We confirm that, to the best of our knowledge, all information provided is accurate and true. Additionally,
we acknowledge that the original copies of the documents we have submitted to this office are now property
of Ateneo de Naga University. By signing this document, we pledge to adhere to and follow the university's
rules and regulations.

Student: ________________________________ Date: ________________________

Signature Over Printed Name

Parent: _________________________________ Guardian: _______________________________

Signature Over Printed Name Signature Over Printed Name

ADMISSION REQUIREMENTS
( ) Original copy of Grade 10 Report Card
( ) Certificate of Good Moral Character (ADNU Form)
( ) Original copy of PSA (formerly NSO) Birth Certificate
( ) Medical Certificate (ADNU Form) with Chest X-Ray
( ) 4 copies of 2” x 2” size of picture in white background
( ) Long white folder

FOR FOREIGN STUDENTS AND NON-RESIDENT FILIPINOS

(Other Requirements)
( ) Student Visa or Special Study Permit and Alien Certificate of Registration
( ) Photocopy of passport pages where name, photo, birth date and birth
place appear

Processed by: Strand Checked by:

_______________________________ __________________________________
Signature Over Printed Name Signature Over Printed Name

Date: __________________________ Date: _____________________________