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Student Profile

This document is a student profile form for a high school student. It collects personal information such as the student's name, date of birth, address, family details, health information, and academic history. Specifically, it asks if the student is a transferee, repeat student, student who stopped studying for a period of time, or recipient of government aid. The form is used to build a record of the student's background and circumstances.

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Angelyn Cayao Magbanua
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83 views

Student Profile

This document is a student profile form for a high school student. It collects personal information such as the student's name, date of birth, address, family details, health information, and academic history. Specifically, it asks if the student is a transferee, repeat student, student who stopped studying for a period of time, or recipient of government aid. The form is used to build a record of the student's background and circumstances.

Uploaded by

Angelyn Cayao Magbanua
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Republic of the Philippines

DEPARTMENT OF EDUCATION
Region VI-Western Visayas
Division of Cadiz City
DR. VICENTE F. GUSTILO MEMORIAL NATIONAL HIGH SCHOOL
SENIOR HIGH SCHOOL DEPARTMENT
__________________________________________________________________________________________

STUDENT PROFILE 1X1


Picture
Learners Reference Number (LRN):
PART I

Name Surname First Name Middle Name

Date of Birth Month Day Year

House/Block/Lot Number Street Subdivision/Village

Address Barangay City/Municipality Province

Zip Code Birthplace Religion

Surname First Name Middle Name


Father
Age & Date of Birth Occupation & Status Contact Number

Maiden Surname First Name Maiden Middle Name


Mother
Age & Date of Birth Occupation & Status Contact Number

Surname First Name Middle Name


Guardian
Age & Date of Birth Occupation & Relation to the child Contact Number
PART II
Height Weight Body Mass Index (BMI)
Do you have ailments?
(Attach medical record/certificate) Specify:
PART III

Are you a TRANSFEREE? YES NO


If YES, what school were you from?

Are you a BALIK-ARAL Student? YES NO

If YES, what school were you from?


What year did you stop studying?
What are your reasons for stopping?

Are you a REPEATER? YES NO

If YES, what school were you from?


What subjects did you fail?
What are your reasons for failing?

Are you a 4PS BENEFICIARY? YES NO


If YES, since what year?
Are you a student from ALIVE (Arabic Language and
YES NO
Islamic Values Education)?

Accomplished by: Date of Submission:


(Signature over printed name)

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