A P P L I C A T I O N
F O R M
Please use block letters in filling up this form
CASA INTERMEDIATE COLLEGE
PRIMARY HIGH SCHOOL
GREENHILLS
ST A. ANA
LAS PIAS
ANGELES
LEVEL APPLIED FOR: ___________________________
Name : ________________________________________________________________________________________
(Last Name)
(First Name)
(Middle Name)
Nick Name _______________________ Present School _________________________________________________
Gender:
MALE FEMALE
Nationality _______________________ Religion ____________________________
Date of Birth: _________________________ Place of Birth: __________________________ Age _______________
Home Address __________________________________________________________________________________
______________________________________________________________________________________________
(Please paste
your 1x1 photo
here)
Home Phone _____________________________________ Mobile Phone __________________________________
Fax ____________________________________
E-mail _____________________________________________
EDUCA TIONAL BACKGROUND
LEVEL
SCHOOLS ATTENDED
YEARS ATTENDED
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College
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Pre-School
Grade School
High School
Please submit this application form to:
O.B. MONTESSORI CENTER, INC.
The Admissions Office
(632) 7229720 to 27 (Greenhills - Main Campus)
(632) 5647895 to 98 (Sta. Ana Branch)
(632) 8203011 to 12 (Las Pias Branch)
(045) 3227956/6261189 (Angeles Branch)
APPLICATION DATE: ___________________________
Website: [Link]
Email: registrar@[Link]
REFERRED BY: ___________________________________
FAMIL Y BACKGROUND
FATHERS NAME / LEGAL GUARDIAN
MOTHERS NAME / LEGAL GUARDIAN
Family Name _____________________________________________________
Family Name __________________________________________________
First Name ________________________________________ MI____________
First Name ______________________________________ MI___________
Date of Birth: ______________________ Nationality ______________________
Date of Birth: _____________________ Nationality ____________________
Home Address ____________________________________________________
Home Address _________________________________________________
________________________________________________________________
_____________________________________________________________
Occupation: _____________________ Position __________________________
Occupation: _____________________Position _______________________
Company Name ___________________________________________________
Company Name _______________________________________________
Address _________________________________________________________
Address ______________________________________________________
Home Phone ____________________ Office Phone ______________________
Home Phone ____________________ Office Phone ___________________
Mobile Phone: ______________________ E-mail ________________________
Mobile Phone: _____________________ E-mail ______________________
SIBLINGS
Name
Age
Educational Attainment
Last School Attended/Occupation
1.
2.
3.
4.
5.
HEAL TH
Please indicate the previous illness / sickness of the applicant.
Type of illness / sickness
Age
______________________________________________________________________________
___________________________
______________________________________________________________________________
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Specify his/her health, special needs, learning difficulties, handicap if any.
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
Do you have a regular family doctor?
If yes, please indicate the following:
YES
NO
Name of Doctor __________________________________________________
Contact Nos.: ___________________________________
Hospital/Clinic Address: _____________________________________________________________________________________________
PERSONAL TRAITS / CHARACTERISTICS
Please comment on applicants behavior. Is your child friendly, outgoing, shy, confident, cooperative, stubborn, etc?
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Comment on discipline of applicant at home?
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Applicants hobbies/interests? ______________________________________________________________________________________________________
Applicants skills/talents? __________________________________________________________________________________________________________
Applicants travel experience? (please specify)_________________________________________________________________________________________
ALUMNI / INFORMA TION SURVEY
Are there family members who are graduates of O.B. Montessori Center? Please indicate their names, relationship and contact number/s.
Name
Relationship
Contact No.
__________________________________
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__________________________________
__________________________________
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__________________________________
__________________________________
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How did you learn about O.B. Montessori Center, or who referred you to OBMCI? ____________________________________________
CERTIFICATION
I hereby certify that I have read and fully understood all instructions regarding my application for admission at O.B. Montessori Center, Inc.
and the information supplied in this application and the documents submitted herein are correct and complete. I understand that incomplete and
inaccurate information could be prejudicial to my admission. If accepted as a student of O. B. Montessori Center, Inc., I agree to abide by all its
policies and regulations.
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Applicants Signature Over Printed Name
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Parents Signature over Printed Name
___________________________________
Date
___________________________________
Date
NOTE: ALL DOCUMENTS SUBMITTED SHALL BECOME PROPERTY OF OBMCI.
