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LOURDES SCHOOL OF MANDALUYONG

Shaw Blvd., Greenhills, Mandaluyong City 1552 1x1


Webpage Address: www.lsm.edu.ph
P.O. Box 12959 Ortigas Center Pasig City 1605 Photo
6311921;6329547;6316307;6316356;6339443;6316310

APPLICATION FORM

Applying for _______________________________________


(Grade/Year Level)

PERSONAL DATA
Name: __________________________________________________________________ Tel. No.: ___________________
(Last Name) (Given Name) (Middle Name)

Address: _____________________________________________________________________________________________

Date of Birth: ________________________________ Place of Birth: _________________________________________

Nationality: __________________________________ Religion: ______________________________________________

Date of Baptism: _____________________________ Church where Baptism was held: ______________________

Name of All Schools Previously Attended


School Grade/Year School Year

Brothers presently studying in Lourdes School of Mandaluyong


Name Grade/Year Level

If not living with parents, state with whom:


Name of Guardian: ___________________________________________________________________________________
Address: _____________________________________________________________________________________________
Occupation of Guardian: _____________________________________________________________________________

FAMILY DATA
FATHER MOTHER (Maiden Name)

Name:______________________________________________ ____________________________________________
Date of Birth:_______________________________________ ____________________________________________
Nationality:_________________________________________ ____________________________________________
Religion:____________________________________________ ____________________________________________
Occupation:_________________________________________ ____________________________________________
Office Address:______________________________________ ____________________________________________
Tel. No.:_____________________________________________ ____________________________________________

Educational Background
Grade School: _______________________________________ ____________________________________________
High School: ________________________________________ ____________________________________________
College: _____________________________________________ ____________________________________________
Post Graduate: ______________________________________ ____________________________________________

_____________________________________________
Signature of Parent/Guardian

______________________________
Date

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