A&E Form 1 Copy for Registration Officer

1x1 ID photo Republic of the Philippines

With Department of Education
Name Tag
BUREAU OF EDUCATION ASSESSMENT
2nd Flr., Bonifacio Bldg., Meralco Ave., Pasig City 1600

ACCREDITATION AND EQUIVALENCY (A&E) TEST

Registration Form
Write Legibly. Put X on applicable Items. Registration Date
Surname Given Name M.I.

Birthday Learner Reference Number Civil Name Gender

Month Day Year Single Married Seperated Male
Home Address Female

Region III Division PAMPANGA Learning SAN JUAN E/S

System
ALS Program Completed (Pls.Specify)
A&E Test Applying for Elementary Level
Junior High School

Proof of Identify Name and Address of

Testing Center SAN MATIAS E/S SAN MATIAS, STO TOMAS, PAMPANGA
Contact Number

I Certify that I validated the information supplied by the

applicationin this form based on the required I certify that all the information in this form are TRUE and CORRECT.
attachments.

RICARDO M. BALUYUT Applicant's Signature Over Printed Name

Registration Officer's Signature Over Printed Name

Required Attachments Proof of Identity Portfolio Rating Certification

ALS Program Certification (if any) Proof of Birth (NSO, Passport, Any legal Documents)

A&E Form 1 Applicant's Copy

1x1 ID photo Republic of the Philippines

With Department of Education
Name Tag
BUREAU OF EDUCATION ASSESSMENT
2nd Flr., Bonifacio Bldg., Meralco Ave., Pasig City 1600

ACCREDITATION AND EQUIVALENCY (A&E) TEST

Registration Form
Write Legibly. Put X on applicable Items. Registration Date
Surname Given Name M.I.

Birthday Learner Reference Number Civil Name Gender

Month Day Year Single Married Seperated Male
Home Address Female

Region III Division PAMPANGA Learning

System SAN JUAN E/S
ALS Program Completed (Pls.Specify)
A&E Test Applying for Elementary Level
Junior High School

Proof of Identify Name and Address of

Contact Number Testing Center SAN MATIAS E/S SAN MATIAS, STO TOMAS, PAMPANGA

I Certify that I validated the information supplied by the

applicationin this form based on the required
attachments. I certify that all the information in this form are TRUE and CORRECT.

RICARDO M. BALUYUT Applicant's Signature Over Printed Name

Registration Officer's Signature Over Printed Name

Required Attachments Proof of Identity Portfolio Rating Certification

ALS Program Certification (if any) Proof of Birth (NSO, Passport, Any legal Documents)