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ESCF01-01

Student Application for ESC Participation


For School Year ________ to ________

Name of School:

Mailing Address:

Student Personal Data

Name of Student:

Mailing Address:

1 x 1 ID
Picture
Birth Date: Age:

Birth Place: Sex

Citizenship:

Religion:

Elementary School Data

Elementary School Graduated From:

Mailing Address:

Year Graduated: Average Grade:

Family Data

Name Age Occupation Income


Father
Mother
Guardian
Brothers/Sisters

Applicant's Statement

I hereby apply for admission into the First Curriculum Year at the above named private high school
that participates in the Educational Service Contracting Program of the Department of Education. If
selected, I will abide by the policy guidelines of the ESC Program and the rules of the school
where I will be enrolled. All the information supplied above is correct to the best of my knowledge.
Any willful misrepresentation made by me shall be sufficient reason for my disqualification.

Applicant's Signature
ESCF02-02

ESC Grantee Enrolment Contract


We, the Undersigned Parties, do hereby bind ourselves to the following terms of this Contract:

On the Part of the Student:

That I _________________________ agree to study at _________________________________


under the "Educational Service Contracting" program, provided that I meet all requirements for
continued participation in the ESC program.

That I will abide by the rules and regulations of abovementioned school;

That I will comply with the school requirements and try to finish the course for each school year,
applying myself with seriousness and dedication; and

That I will consult the school authorities on problems relative to the fulfillment of the terms of this
contract.

On the Part of the Parent/Guardian:

That I ____________________, parent/guardian of aforesaid student, fully agree to enroll my


child/ward at the abovementioned school under the "Educational Service Contracting" program;

That I will abide by the rules of the aforecited school;


That I will help my child/ward to finish the course for every year level during the period specified
above;
That I will help in the best way I can in -

a. preventing truancy and/or absenteeism of my child/ward;


b. making my child/ward attend seriously to his/her school work; and
c. attending/participating in school activities that need my presence.

That since the ESC program sets for every school year a maximum amount as subsidy for
student's tuition and other fees, I agree to pay to the school any excess of the fees charged which
is not covered by the ESC subsidy; and

That in case of problems relative to the fulfillment of this contract, I will consult the school
authorities concerned or the Division Project Committee.

On the Part of the School:

That the ___________________________________________ will give the same attention and


training to contract students under the ESC program as that given to non-contract students in the
school;

That in case of problems relative to this contract, the parents/guardians will always be consulted.

Signed at _________________________________________ on __________________________.

Student Parent/Guardian

School Head
Note: Signature over printed name.
2010-ESCF01-01

ESC Form 1-Billing Statement (ESC-Returnees)


For All Regions Except NCR

This Billing Statement also serves as the contract between DepED and the private school with regard to the latter's
participation in the ESC program of the GASTPE in accordance with the program guidelines issued for the school
year stated above.

Instructions: Please prepare 4 copies of this form and no erasures.

Billed to: Department of Education Date:


Address: Pasig City

School Id:
School Name:
School Address:
On account of: ESC Grants for School Year 2011-2012

Total Grantees & Amount Due for ESC School Year 2011-2012(ESC-Returnees)

Year Level No. of Amount of Grant Total Amount Due by Year


Grantees Level
First Year 5,500.00
Second Year 5,500.00
Third Year 5,500.00
Fourth Year 5,500.00
Total Grantees Total Amount Due

We certify, under the penalties of perjury, that the data entered above are consistent with the list of qualified ESC-Returnees listed in
ESC Form 2.

Parents' Association President/Representative Faculty Association President/Representative

School Head

Note: Signature over printed name.

Special Instructions:

Please deposit payments to school's account with Land Bank of the Philippines (LBP). The account details of which are as follows:

Branch:

School Account Name:

Account number:

Requirement: Please attach an IMI1 or STI1 printout from signed by the bank's branch manager.

Recommending approval for payment amounting to Php_______________________________

Ms. Carolina C. Porio


FAPE Executive Director
ESC Form 2-List of Grantees for SY 2011-2012(ESC-Returnees)
School ID Name of School 2010-ESCF02-01
Page of
Region Province Municipality Street/Barangay No. of grantees for this page

Instructions: Please prepare 4 copies. Type the data needed. The students' names shall be alphabetically arranged (Last Name first and then First Name) regardless of gender, year level, or class section. No erasures allowed.
No. Last Name First Name MI Gender Current Year Level Last School Year Attended Reason for Dropping/Leaving School No.

We certify, under the penalties of perjury, that the list of students entered above are the qualified ESC-Returneesfor School Year 2011-2012in accordance with the ESC Implementing Guidelines and have attended classes until July
15, 2010.

Parents' Association President/Representative Faculty Association President/Representative School Head

Note: Signature over printed name.


2010-ESCF03-01

ESC Form 3-Certification of Tuition and Other School Fees


For School Year 2016-2017
School Id:
School Name:
School Address:

Grade 7 Grade 8 Grade 9 Grade 10

I. Tuition Fee P P P P

II. Other School Fees

(Please indicate breakdown)

Total Other Standard School Fees P P P P

III. Miscellaneous Fees

(Please indicate breakdown)

Total Other Non-standard School Fees P P P P

IV. Total School Fees (Sum of Part I, Part II, and Part III)

P P P P

V. Please indicate any special concessions given to ESC grantees (e.g. tuition waiver, discounts, any forms of assistance, etc.)

P P P P

We certify, under the penalties of perjury, that the above information contained herein is true and correct and is in accordance with the ESC Implementing
Guidelines.
Faculty Association President/Representative Parents' Association President/Representative

School Head
Note: Signature over printed name.
Please attach a true copy of the current school year's schedule of tuition and other school fees submitted and marked received by the DepEd
Regional/Division Office.
Teacher Salary Subsidy Payroll School Year 20__ to 20__
School ID Name of School

Region Province Municipality Street/Barangay

Instructions: Please prepare 4 copies. Type the data needed. Teachers' names shall be alphabetically arranged (Last Name first and then First Name) regardless of their gender. No erasures allowed.
No. Last Name First Name MI Gender License Number Date of Birth Total Subsidy Taxes Witheld Amount Received Signature Date Received

We certify, under the penalties of perjury, that the list above are teachers who are qualified to participate in the Teacher Salary Subsidy Program.

Parents' Association President/Representative Faculty Association President/Representative School Head

Note: Signature over printed name.


dy Payroll School Year 20__ to 20__
2016-TSSPR-01

Date Received No.

Salary Subsidy Program.

School Head