PEPT FORM 1 -for regular exam Republic of the Philippines

Department of Education
BUREAU OF EDUCATIONAL ASSESSMENT
PHILIPPINE EDUCATIONAL PLACEMENT TEST
NO. REGISTRATION FORM LEM's Copy
Surname First Name MI

No., Street, Barrio, Town, Province/City Contact No. Age Sex

Mailing
Address M F
Date of Birth LRN (if any) Date of Examination

Name and Address of School Last Attended Grade Level Completed/ Finished Division Code
D 1 2
Place and Date of Registration Purpose of Examination

Placement Validation Subject Completion

Examination Center

PATERNO S. MARQUEZ, JR. __________________________________

Division Testing Coordinator’s Signature Over Printed Name Applicant’s Signature Over Printed Name

INSTRUCTION TO THE PEPT DIVISION TESTING COORDINATOR

1.Before signing this form, please see to it that all entries especially those on
Check document/s Submitted
1”x1” Date of Birth, Age and grade level Finished are legible and correct.
2.Detach Applicant’s Copy and give it to the applicant. - Birth Certificate
Picture with 3.Keep the LEM’s Copy and give it to the Chief Examiner on examination day for - -School Record/s
Name Tag applicant verification purposes. - Secondary – Form 137
4. Verify through LIS if the school where the learner comes from permanent record
has a government permit. - Elementary-Form 137/138-
report card
5. For learners from private schools without government permit, place
- ID Pictures
the endorsement letter from the Regional Office inside each ETRE.

------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Republic of the Philippines

Department of Education
BUREAU OF EDUCATIONAL ASSESSMENT
PHILIPPINE EDUCATIONAL PLACEMENT TEST
NO. REGISTRATION FORM LEM's Copy
Surname First Name MI

No., Street, Barrio, Town, Province/City Contact No. Age Sex

Mailing
Address M F
Date of Birth LRN (if any) Date of Examination

Name and Address of School Last Attended Grade Level Completed/ Finished Division Code
D 1 2
Place and Date of Registration Purpose of Examination

Placement Validation Subject Completion

Examination Center __________________________________________________ __________________________________

Applicant’s Signature Over Printed Name

Notes: 1. Fill –out all blanks in the registration Form.

2.Upon registration, the registering Official will inform you of the place where you are to take the PEPT.
1”x1” 3.On the examination day, the test will start exactly at 7:30 a.m. Bring with you this form and 2 lead pencils.
You may also bring snacks and lunch that you can take during the break.
Picture with
Name Tag Certified True and Correct:

PATERNO S. MARQUEZ, JR.

Division Testing Coordinator’s Signature Over Printed Name
 PEPT FORM 1 - for special exam Republic of the Philippines FREE
Department of Education
(INDEPENDENCE DAY)
BUREAU OF EDUCATIONAL ASSESSMENT
PHILIPPINE EDUCATIONAL PLACEMENT TEST
NO. REGISTRATION FORM LEM's Copy
Surname First Name MI

No., Street, Barrio, Town, Province/City Contact No. Age Sex

Mailing
Address M F
Date of Birth LRN (if any) Date of Examination

Name and Address of School Last Attended Grade Level Completed/ Finished Division Code
D 1 2
Place and Date of Registration Purpose of Examination

Placement Validation Subject Completion

Examination Center

PATERNO S. MARQUEZ, JR. __________________________________

Division Testing Coordinator’s Signature Over Printed Name Applicant’s Signature Over Printed Name

INSTRUCTION TO THE PEPT DIVISION TESTING COORDINATOR

1.Before signing this form, please see to it that all entries especially those on
Check document/s Submitted
1”x1” Date of Birth, Age and grade level Finished are legible and correct.
2.Detach Applicant’s Copy and give it to the applicant. - Birth Certificate
Picture with 3.Keep the LEM’s Copy and give it to the Chief Examiner on examination day for - -School Record/s
Name Tag applicant verification purposes. - Secondary – Form 137-
4. Verify through LIS if the school where the learner comes from permanent record
has a government permit. - Elementary-Form 137/138-
report card
5. For learners from private schools without government permit, place
- ID Pictures
the endorsement letter from the Regional Office inside each ETRE.

------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Republic of the Philippines

Department of Education
BUREAU OF EDUCATIONAL ASSESSMENT
PHILIPPINE EDUCATIONAL PLACEMENT TEST
NO. REGISTRATION FORM LEM's Copy
Surname First Name MI

No., Street, Barrio, Town, Province/City Contact No. Age Sex

Mailing
Address M F
Date of Birth LRN (if any) Date of Examination

Name and Address of School Last Attended Grade Level Completed/ Finished Division Code
D 1 2
Place and Date of Registration Purpose of Examination

Placement Validation Subject Completion

Examination Center __________________________________________________ __________________________________

Applicant’s Signature Over Printed Name

Notes: 1. Fill –out all blanks in the registration Form.

2.Upon registration, the registering Official will inform you of the place where you are to take the PEPT.
1”x1” 3.On the examination day, the test will start exactly at 7:30 a.m. Bring with you this form and 2 lead pencils.
You may also bring snacks and lunch that you can take during the break.
Picture with
Name Tag Certified True and Correct:

PATERNO S. MARQUEZ, JR.

Division Testing Coordinator’s Signature Over Printed Name