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Disclosure: By accomplishing this Registration Form, the registrant hereby consents to the collection, processing and storing of personal data by the Bureau of Education Assessment
for the exclusive purpose of facilitating his/her application for the Qualifying Examination in Arabic Language and Islamic Studies (QEALIS).
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Republic of the Philippines
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Department of Education
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BUREAU OF EDUCATION ASSESSMENT
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Qualifying Examination in Arabic Language and Islamic Studies (QEALIS)
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R E G I S T R A T I O N F O R M
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Name of Registrant
(Pangalan ng Mag-eexam)		Last Name (Apelyido)First Name (Pangalan)MI
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Mailing Address
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Email AddressDate of Birth (Petsa ng Kapanganakan)
[MONTH/DD/YYYY | June/11/2007]		Sex
(Kasarian)		Age on March 31, 2023
(Edad sa Marso 19, 2023)		PWD
[Y/N]		Contact Number
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Citizenship
(Pagkamamamayan)		Date of Registration (Petsa ng Pagrehistro)
[MONTH/DD/YYYY | June/13/2022]		Highest Educational Attainment
(Pinakamataas na Antas ng Pinag-aralan)		Background in Islamic Education
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School Currently Assigned (Paaralan na Pinagtuturuan sa Kasalukuyan)Division (Dibisyon)Region (Rehiyon)
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Testing Center/ Division - [Region of Origin of Registrant]
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I hereby declare under oath that I have personally accomplished this Registration Form and that by affixing my name below, I am certifying that all documents attached to this application is a faithful reproduction of the original, and that all statements and information provided therein are complete, true and correct to the best of my knowledge. I am assuming full responsibility and accountability on the correctness of the details provided and authenticity of the documents submitted. I am aware that any violation will automatically disqualify me and authorize the Bureau
of Education Assessment (BEA) to deny my qualification as a taker of QEALIS.
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Signature over Printed Name of Registrant
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FOR THE EVALUATOR ONLY
(Do not answer this part)
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Checklist & Requirements:
Remarks:
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Birth Certificate/Affidavit of Live Birth
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Photocopy of any valid ID/Barangay Clearance/
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Certificate of Residency
QUALIFIED
NOT QUALIFIED
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College OTR or diploma/
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High School SF10 or diploma
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Any document that shows academic background in Islamic Education, such as school records with electives related to Islamic Education or Certificate of Completion of an Islamic Education course
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Name & Signature of Evaluator / Date
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