ESCF01-01
tu ent pp cat on or
art c pat on
For School Year ________ to ________
Name of School:
Mailing Address:
Student Personal Data Name of Student: Mailing Address:
Birth Date:
Age:
Birth Place:
Se
Citi!enship: "eligion:
Elementar# School Data Elementar# School $raduated From:
Mailing Address:
Year $raduated: $raduated:
A%erage $rade:
* * 'D Picture
ESCF0(-0(
ESC $rantee Enrolment Contract +e$ the ,ndersigned Parties$ do hereby bind ourseles to the fo llo%ing terms of this Contract/ &n the Part of the Student: )hat I ,,,,,,,,,,,,,,,,,,,,,,,,, agree to study at ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, under the Educational Serice Contracting program$ proided that I meet all reuirements for continued participation in the ESC program# )hat I %ill abide by the rules and regulations of aboementioned school* )hat I %ill comply %ith the school reuirements and try to finish the course for each school year$ applying myself %ith seriousness and dedication* and )hat I %ill consult the school authorities on problems relatie to the fulfillment of the terms of this contract# &n the Part of the Parent($uardian: )hat I ,,,,,,,,,,,,,,,,,,,,$ parent+guardian of aforesaid student$ fully agree to enroll my child+%ard at the aboementioned school under the Educational Serice Contracting program* )hat I %ill abide by the rules of the aforecited school*
)hat I %ill help in the best %ay I can in a# preenting truancy and+or absenteeism of my child+%ard* b# ma&ing my child+%ard attend seriously to his+her school %or&* and c# attending+participating in school actiities that need my presence#
2010-ESCF01-01
ESC Form 1-Billing Statement (ESC-Returnees) For A
Reg ons Except NCR
$is (i##ing State)ent a#so ser!es as t$e contract *et+een DeED and t$e ri!ate sc$oo# +it$ regard to t$e #atter's articiation in t$e ESC rogra) o t$e ASPE in accordance +it$ t$e rogra) g"ide#ines iss"ed or t$e sc$oo# year stated a*o!e. Instructions: Please prepare 4 copies of this form and no erasures.
Billed to:
Department o Education
Address:
Pasig City
Date:
Sc!ool "d: Sc!ool Name: Sc!ool Address: #n account o: ESC $rants or Sc!ool %ear &'11-&'1&
otal $rantees Amount Due or ESC Sc!ool %ear &'11-&'1&(ESC-Returnees) %ear *e+el
No. o $rantees
First %ear
Amount o $rant 5,500.00
Second %ear
5,500.00
!ird %ear
5,500.00
Fourt! %ear otal $rantees
otal Amount Due ,0 %ear *e+el
5,500.00 tal Amount Due
We certify, under the penalties of perjury, that the data entered above are consistent with the list of qualied ESC!eturnees listed in ESC "orm #.
arents' Association President/Reresentati!
Fac"#ty Association President/Reresentati!e
Sc$oo# %ead Note: Si$nature over printed name.
Special "nstructions: P#ease deosit ay)ents to sc$oo#'s acco"nt +it$ *and Ban o t!e /!ilippines (*B/) . $e acco"nt detai#s o +$ic$ are as o##o+s: Branc : Sc!ool Account Name: Account num,er: Requ rement % P ease attac an IMI1 or STI1 pr ntout r om s $ne
y t e an 's ranc mana$er.
Reco))ending aro!a# or ay)ent a)o"nting to P$
s. Caro na C. /or o FAPE E&ec"ti!e Director
ESC Form &-*ist o $rantees or S% &'11-&'1&(ESC-Returnees) Sc!ool "D
Name o Sc!ool
Region
/ro+ince
2010-ESCF02-01
unicipalit0
Street2Baranga0
of Page o. o grantees or t$is age
Instructions: Please prepare 4 copies. Type the data needed. (he students' names shall be alphabetically arran$ed )*ast +ame rst and then "irst +ame re$ardless of $ender, year level, or class s No. *ast Name First Name " $ender Current %ear *e+el st Sc!ool %ear Attend Reason or Dropping2*ea+ing Sc!ool No.
We certify, under the penalties of perjury, that the list of students entered above are the qualied ESC!eturneesfor School -ear #//#/#i n accordance with the ESC 0mplementin$ 1uidelines and have attended classes until 2uly /3, #/.
Parents' Association President/Reresentati!e
Note: Si$nature over printed name.
Fac"#ty Association President/Reresentati!e
Sc$oo# %ead
2010-ESCF0-01
ESC Form 3-Certi4cation o uition and #t!er Sc!ool Fees For Sc!ool %ear &'15-&'16 Sc!ool "d: Sc!ool Name: Sc!ool Address:
First ear ".
uition Fee
"".
#t!er Sc!ool Fees
Second ear
$ird ear
Fo"rt$ ear
P
P
P
P
P
P
P
P
P#ease indicate *rea3do+n4
otal #t!er Standard Sc!ool Fees """.
iscellaneous Fees
c"#ty Association President/Reresentati
arents' Association President/Reresentati!
Sc$oo# %ead Note:Si$nature over printed name. P ease attac a true copy o t e current sc oo year's sc e u e o tu t on an ot er sc oo ees su m tte an mar e received by the 4epEd !e$ional54ivision 67ce.
eac!er Salar0 Su,sid0 /a0roll Sc!ool %ear &' to &' Sc!ool "D
Name o Sc!ool
Region
/ro+ince
unicipalit0
Street2Baranga0
Instructions: Please prepare 4 copies. Type the data needed. (eachers' names shall be alphabetically arran$ed )*ast +ame rst and then "irst +ame re$ardless of their $ender. No erasures allowed. No. *ast Name First Name " $ender *icense Num,er Date o Birt! otal Su,sid0 axes ;it!eld mount Recei+e Signature
We certify, under the penalties of perjury, that the list above are teachers who are qualied to participate in the (eacher Salary Subsidy Pro$ram.
Parents' Association President/Reresentati!e
Note: Si$nature over printed name.
Fac"#ty Association President/Reresentati!e
Sc$oo# %ead
Date R
201-SSPR-01
cei+ed
No.
