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STUDENT PROFILE Rev3

This document contains a student profile form for Luis Y. Ferrer Jr. Senior High School. The form collects personal information about the student such as name, address, contact details, medical information, family details, education history, and socioeconomic status. Information requested includes the student's vaccination records, interests, height, weight, birthdate, religion, gender, indigenous status, 4Ps beneficiary status, parents' names and occupations, guardian details, previous schools attended, ALS graduation details, marginalized status, disability details, location map, and student and parent signatures.

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moraleshannahchrystalfaye
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34 views

STUDENT PROFILE Rev3

This document contains a student profile form for Luis Y. Ferrer Jr. Senior High School. The form collects personal information about the student such as name, address, contact details, medical information, family details, education history, and socioeconomic status. Information requested includes the student's vaccination records, interests, height, weight, birthdate, religion, gender, indigenous status, 4Ps beneficiary status, parents' names and occupations, guardian details, previous schools attended, ALS graduation details, marginalized status, disability details, location map, and student and parent signatures.

Uploaded by

moraleshannahchrystalfaye
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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LUIS Y. FERRER JR.

SENIOR HIGH SCHOOL


South Square Village, Pasong Kawayan 2, General Trias City, Cavite
1 x 1 Photo
STUDENT’S PROFILE

INSTRUCTION: Write in all CAPITAL letters the necessary information below.


Name:

Surname First Name Middle Name Suffix (Jr, I, etc.)


LRN# Cellphone#
Address: (write below)

____________________________________________________________________________________
House No. Street Name Barangay City/Municipality Province Zip Code
Facebook Name: ______________________________ Email Address:___________________________
Personal Interests: I am interested in… Vaccination Information
 Sports 1st Dose: ___________________ Date: _________
 Arts (Painting, Drawing) Location:__________________________________
 Singing 2nd Dose: ___________________ Date: _________
 Dancing Location:__________________________________
 Acting 1st Boost: ___________________ Date: _________
 Others __________________________ Location:__________________________________
2nd Boost: ___________________ Date: ________
Do you have any Allergies or any Medical Location:__________________________________
Condition that you want us to know? (ex. Asthma)
_______________________________________ (you may attach copy of your vaccination card, if
(attached medical certificate, if available) available)
Height (cms) Weight (kgs)
Birthdate MM / DD / YYYY Birthplace Religion: Gender

Age as of Mother Do you belong to Indigenous [ ] Yes [ ] No


Aug 2023 Tongue: people? (IP)
National ID# Tribe:

4P’s Beneficiary
[ ] Yes ID No: Location
[ ] No
Mother’s Maiden Name:

Surname First Name Middle Name Suffix (Jr, I, etc.)


Occupation Cellphone#
Father’s Name:

Surname First Name Middle Name Suffix (Jr, I, etc.)


Occupation Cellphone#
Guardian’s Name:

Surname First Name Middle Name Suffix (Jr, I, etc.)


Occupation Cellphone#
Relationship Address

Student Profile Form Version 3 / Date last revised 8/28/2023 osm


Balik Aral? [ ] Yes [ ] No Previous School Attended Gen. Average Section

School Address:

ALS Passer? [ ] Yes [ ] No [ ] Not Applicable Date of Graduation:


Name and Address of Community Learning Center:

If TRANSFEREE, please list all your failed/back subjects during Grade 11, if any.
Subject Grade Teacher Year last taken Remarks

MARGINALIZED LEARNERS PROFILE


Working Student? [ ] Yes [ ] No [ ] If yes, what kind of work?
With Disability? [ ] Yes [ ] No [ ] If yes what type of disability?
Living Alone? [ ] Yes [ ] No [ ] Not living with parents? [ ] Yes [ ] No [ ]
Married? [ ] Yes [ ] No [ ] With child/ren? [ ] Yes [ ] No [ ]
Single Parent? [ ] Yes [ ] No [ ] Number of Children
With health concerns? [ ] Yes [ ] No [ ] What is your health condition
Both parents not working? [ ] Yes [ ] No [ ] Only one parent working? [ ] Yes [ ] No [ ]
Conflict with the law/s? (rehab or any related facility/ies? [ ] Yes [ ] No [ ]
ADDRESS LOCATION MAP
Sketch of the direction going to your house (to save space, USE LINES to represent the roads/street)

I confirm that all the information on this form is correct. I am also aware that all the information I
provided in this form is protected by the Data Privacy Act and the laws of the Philippines.

This box, for teacher’s use only.


_____________________________
Name and Signature of the STUDENT

_____________________________
Name and Signature of the PARENT / GUARDIAN

Date signed: _________________

Student Profile Form Version 3 / Date last revised 8/28/2023 osm

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