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Southern Philippines College

Department

Personal Information

STUDENT INFORMATION SHEET

* STUDENT ID NUMBER

:

   (To be filled by the enrollment officer)

* LRN

:

   (if Applicable)

* Name

:
FAMILY NAME GIVEN NAME MIDDLE NAME EXT. NICK NAME

 * Department:

 * Program:

 * Gender:

* Age:

 * Citizenship:

 * Religion:

 * Birth Date:

 * Mobile Number:

 * Email Address:

 * Place of Birth:

ADDRESS

 * Current Address:
 * Region  * Province  * Town/City/Municipality  * Zipcode

 * House No./Blk. No./Lot No. & Street

 * Barangay
 

Permanent Address:
(   Same as Current Address )
 * Region  * Province  * Town/City/Municipality  * Zipcode

 * House No./Blk. No./Lot No. & Street

 * Barangay

STUDENT EDUCATIONAL BACKGROUND
 * Department  * School name  * School Address  * Year Graduated Action
 
 * Areas of Interest:
 * Easiest Subject/s:
 * Most Difficult Subject/s:

CIVIL STATUS/SIBLINGS/AFFILIATIONS
Civil Status: If Married, Name of Spouse: Number of Brothers: Number of Sisters:
Government Employee:
In-School Membership in Organization (Name of Org.) Position Date Affiliated
Out-Of-School Membership in Organization (Name of Org.) Position Date Affiliated

PARENTS/GUARDIAN

FATHER

MOTHER'S MAIDEN NAME
Complete Name :
Age :
Current Address :
Contact Numbers :
Educational Attainment :
Occupation :
Business Address :
Guardian's Name(If not living with parents): Relationship w/ the Guardian:
Mobile Number : Address :
Characteristic/s that best describe you:
Have you been hospitalized? Yes No If Yes, What illness? Common Sickness/Illness:
Disabilities/Impairments: Medicines Regularly Taken:
Accident/s Experienced: Surgery Undergone:
Present Concerns/Problems:
PhilHealth ID:
Have you been vaccinated for Covid-19? Yes No If No, what reason?
 * School Year  * Term
I affirm that all information given herewith is true and correct. Date: Signature Over Printed Name:
 

   Terms of Reference:

   I certify that the information herein is correct and complete. Falsification, misrepresentation or withholding of information in this form will automatically nullify my application and will result to dismissal from the SPCCDO.

   I am willing to accept the Mission Statement of this Catholic School and the objectives of the College I am enrolled in and to abide all the rules and regulations of the Southern Philippines College.

   I am aware of the tuition and other fees of the school at the time of enrollment, and I understand that these are subject to annual increases per DEPE-ED policies and guidelines.

   Data Privacy Clause:

   I/we hereby give my/our consent to disclose the following personal information to SPCCDO, its school administrators,and concerned duly authorized personnel for the school to be able to perform its mandated duty as "special parent" to its students, particularly for record-keeping, documentation, coordination and other enrollment-related purposes. Access on these records shall be limited to those authorized personnel and administrators performing related official school functions. Strict confidentiality shall be observed.

 

I agree with terms of references and DPA Clause

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