Ateneo de Zamboanga University 1x1
APPLICATION FOR SENIOR HIGH SCHOOL ADMISSION PICTURE
Fill out this form carefully and PRINT or TYPE all information requested. Only Application Forms correctly and completely filled
out will be accepted. INCOMPLETE FORMS WILL NOT BE PROCESSED.
1. NAME _______________________________________________________________________ _____________________
Last First Middle Nickname
2. CITY ADDRESS __________________________________________________________________________________________
House No. Street Barangay City
_________________________________________________________________________________________________________
Province Tel No./Mobile No. Email Address Facebook URL
PROVINCIAL ADDRESS: __________________________________________________________________________________
3. FATHER’S NAME ____________________________________________ Living? Yes ( ) No ( )
If employed, name of company/employer? _____________________________ Contact Number:_____________________
MOTHER’S NAME _____________________________________________ Living? Yes ( ) No ( )
If employed, name of company/employer? _____________________________ Contact Number:_____________________
Guardian (If any) _________________________________________________ Relationship:_________________________
Contact Number:_____________________
4. DATE OF APPLICANT’S BIRTH ______________________ Age _________ Place of Birth __________________________
5. CITIZENSHIP ______________________ Religion _____________________ Sex ______________ Civil Status ____________
Are you an International Student? No Yes, from (place of origin) ______________________________________________
6. Do you belong to any INDIGENOUS PEOPLES (IP) Community? ( ) Yes, Pls. specify: ____________________ ( ) No
(Ex.: B’laan, Bukidnon, Higaonon, Mamanwa, Mandaya, Manobo, Mansaka, Sangir, Subanen, Tagabawa, Tagakaulo, Tasaday, Tiboli)
7. PRESENT JUNIOR HIGH SCHOOL ________________________________ Section (Name, Letter or Number) ____________
8. SCHOOL ATTENDED: Beginning from the lowest grade, list in order all schools attended. This must be a complete listing of
every school in which you have enrolled. (Please indicate type of school whether Government or Private in the column provided)
Elementary Type Address
______________________ ________ __________________________ Grade _____ to Grade _____ 20___ to 20___
______________________ ________ __________________________ Grade _____ to Grade _____ 20___ to 20___
Junior High School Type Address
_______________________ ________ _________________________ Year ______ to Year ______ 20___ to 20___
_______________________ ________ _________________________ Year ______ to Year ______ 20___ to 20___
9. Person to contact in case of emergency:
Name: _________________________________________________________ Relationship: ________________________
Complete Address: ________________________________________________________________________________________
Contact Numbers: Residence: _______________ Office : _______________ Mobile Phone: _______________________
10. PROGRAMS OF STUDY. Check (√) the program you wish to follow. Indicate a second choice by placing the number 2 before
the name of the program. Also, make a 3rd choice by placing the number 3 before the name of the program.
ACADEMIC TRACK
_____ Accountancy, Business and Management (ABM) Strand
_____ Humanities and Social Science (HUMSS) Strand
_____ Science, Technology, Engineering and Mathematics (STEM) Strand
PRIVACY CONSENT
I/We hereby certify that all the information written in this application is complete and accurate to the best of my knowledge. I agree if
accepted as a student that my admission, matriculation, and graduation are subject to the rules and regulations of the Ateneo de
Zamboanga University. I further agree that wearing of niqab on campus is strictly prohibited. All information provided are confidential
and shall not be copied, shared, distributed, and used for any other purposes unless stated by the applicant, parent/s or legal guardian
whose name is indicated herein and/or required by the law.
Student’s Signature over Printed Name: ___________________________________ Date: ______________________________
Parent’s /Guardian Signature over Printed Name: ____________________________ Date: ______________________________
