DOST-PHILIPPINE SCIENCE HIGH SCHOOL SYSTEM
THIS MATERIAL IS NOT FOR SALE. IT MAY BE
REQUIREMENT FOR ADMISSION, CRITERIA, AND PHOTOCOPIED AND MAY BE DOWNLOADED
EVALUATION (RACE) APPLICATION FORM FOR FROM [Link]
INCOMING GRADE 7, SY 2023-2024
Instructions: Staple Only
Please accomplish this form in two copies. TYPE OR PRINT LEGIBLY ALL INFORMATION NEEDED and
carefully read the REMINDER TO EXAMINEES. DO NOT ABBREVIATE. DO NOT LEAVE ANY ITEM BLANK. 1” x 1”
Countersign all erasures and corrections made. Photo
PERSONAL DATA:
1) NAME OF PUPIL-APPLICANT: (Last Name, First Name, Middle Name) 2) BIRTH DATE:
M M D D Y Y Y Y
3) SEX: MALE 4) CONTACT 5) EMAIL ADDRESS:
(pls. include all
NUMBERS : possible email
(pls. include all addresses)
FEMALE possible contact
numbers)
PRIMARY EMAIL
6) COMPLETE HOME/ PERMANENT ADDRESS: (pls. include your zip code) ADDRESS:
NAME OF CITY/MUNICIPALITY (of your residence): ______________________________ LEARNER’S REFERENCE NO.: __________________________
7) NAME OF GRADE 5 SCHOOL (Write full name of school):
8) COMPLETE SCHOOL ADDRESS: 9) SCHOOL CONTACT NOS.:
10) SCHOOL TYPE: Public 11) Pupil-Applicant’s FINAL GRADE in Grade 5: MATH ___________________
Private SCIENCE ___________________
PLS. NOTE: If final grade in Science and/or Math is below 85, submit a certification from the principal that the child
belongs to the upper 10% of the batch.
TO BE FILLED OUT BY THE PARENTS: YES NO
1. Is your child a Filipino citizen?
2. Does your child have a pending or approved application as immigrant in any foreign country?
3. Has your child previously applied for admission in PSHS?
4. If admitted to PSHS next school year, will it be the first time that your child is to enroll in Grade 7?
5. Which campus are you seeking admission to? (You will only be queued for admission in the campus of choice. The top 240 applicants nationwide will be offered a slot
in the Main Campus (MC). Those who choose MC and fail to land in the top 240 will be ranked in the MC waiting list as possible alternate qualifiers.)
Please check the preferred PSHS campus. (Choose only ONE; Change of campus choice will NOT be entertained after the release of RACE results.)
MAIN – Agham Road, Diliman, Quezon City EASTERN VISAYAS – Palo, Leyte
ILOCOS REGION – San Ildefonso, Ilocos Sur ZAMBOANGA PENINSULA – Brgy. Cogon, Dipolog City
CAGAYAN VALLEY – Bayombong, Nueva Vizcaya CENTRAL MINDANAO – Balo-i, Lanao del Norte
CENTRAL LUZON – Clark Freeport Zone SOUTHERN MINDANAO – Tugbok, Davao City
CALABARZON – Brgy. Sampaga, Batangas City SOCCSKSARGEN – Paraiso, Koronadal City
MIMAROPA – Odiongan, Romblon CARAGA – Ampayon, Butuan City
BICOL REGION – Goa, Camarines Sur CORDILLERA ADMINISTRATIVE REGION – Irisan, Baguio City
WESTERN VISAYAS – Jaro, Iloilo City
I certify that the above information is true and correct. I understand that any false or misleading information will result to the
CENTRAL VISAYAS – Argao, Cebu
disapproval of application/admission/enrollment/scholarship. Furthermore, I hereby authorize PSHS the publication of my
child’s name in the application process.
Signature over Printed Name of Parents _________________________________________________________________________
(PLEASE DO NOT DETACH)
This serves as a proof of application. IMPORTANT: This DOES NOT serve as the test permit.
NAME OF PUPIL-APPLICANT: _______________________________________________________________________________
NAME OF SCHOOL: _____________________________________________________________________________________
Submit the following upon filing of application: Recommendation of the PSHS Registrar/DOST or PSTO Coordinator: To be accomplished by the
Fully accomplished Application Form in two (2) PSHS Cashier:
As per data above:
copies
Approved: [ ] Mode of Payment: Cash only
Two (2) identical recent 1 x 1 ID pictures Disapproved: [ ]
Non-refundable processing fee for private school Payment Received by:
students, based on Grade 5 (to be paid to the Reason/s for Disapproval: _______________________________________
PSHS Cashier’s Office)/Free for public school _______________________________________
students
Certified true copy of Grade 5 report card Processed by: [ ] DOST ____________________ Date: _________ __________________________
Name & Signature
If final grade in Science and/ or Math is below 85, Name & Signature
submit a certification from the principal or proof Date: _________________
that the child belongs to the upper 10% of the [ ] PSHS ____________________
Name & Signature
batch
REMINDER TO THE EXAMINEE:
If you do not receive an email notification that your application has been processed, you may visit or call the nearest PSHS Campus or call PSHSS-Admissions Office at
telephone no. (02) 8939-PSHS (89397747) or check at [Link]. For queries or clarifications, you may call (02) 89397747 or email admissions@[Link].
PSHSS-Admissions Office