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: www.obmontessori.edu.ph
Email: registrar@obmontessori.edu.ph

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.

______________________________________________________________________________________________________________
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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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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
________________________________________________________
Parents Signature over Printed Name

___________________________________
Date
___________________________________
Date

NOTE: ALL DOCUMENTS SUBMITTED SHALL BECOME PROPERTY OF OBMCI.