Elementary Enrollment Form
Kinder 1/Kinder 2/Grade 1/Grade 2/Grade 3/Grade 4/Grade 5/Grade 6
Date of Enrollment: *
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Last Name: *
Given Name: *
Middle Name:
Suffix: (Jr., Jra., Snr., etc...)
Student's Status: *
Student ID No.: ((for old student only)please contact EDP, 09201201724)
LRN:(Learners Reference Number(for old student only))
Sex: *
Age: *
Date of Birth: *
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DD
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Place of Birth: *
Current Address(Ex. Renting,Hotel,etc.): *
Permanent/Home Address
House Number and Street: *
Subdivision/ Barangay: *
City/Municipality: *
Province: *
Country: *
Tel. No./ Cell No.: *
Email Address: *
Social Media Account: *
Required
If other, specify what social media account:
Specify Social Media Name: *
Name of Parent/Guardian: (if others, please specify (Ex. Juan Dela Cruz/Parent) ) *
Occupation of Parent/Guardian: *
Address of Parent/Guardian: *
Tel. No./ Cell No. of Parent/Guardian: *
Email Address of Parent/Guardian: *
Grade Level: *
School Year Last Attended: *
Name of School Last Attended: *
Grade Level Last Attended: *
Available Resources: *
Required
Preferred Type of Class *
Required
Does anyone in the family knows how to download modules from the internet? *
If Yes, please provide the name and the contact number:
Do you want to avail Pre-paid Home Wifi (to be added to your school fees)? *
Confirmation
You are officially enrolled upon payment of P500.00 enrollment fee payable at the cashier or through online payments options.
Thank you for trusting SCSIT. We will inform you soon for your schedule and more updates. For your questions and clarifications please try to contact Registrar's Office, 0920.120.1724
I hereby agree and understood the enrollment form. I also allow SCSIT to collect and keep my personal information which may be used for school purposes only. *
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This form was created inside of Salazar Colleges of Science and Institute of Technology (SCSIT).