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Republic of the Philippines

Benguet State University Office of the University Registrar
La Trinidad, Benguet

2X2 ID Picture with Name Tag

STUDENT INFORMATION SHEET
CURRENT ACADEMIC BACKGROUND Course:
This portion will be filled in by the Office of the University Registrar.

STUDENT ID Number: Cross Enrollee School year of entry: Shifter (Other) _______________________ QCE Rating

TYPE OF STUDENT:

New 1st

Old 2nd

Transferee Summer

Semester of entry at BSU:

Family Name: Sex: Male Female Birth Date: Birth Place: Address while studying at BSU: Do you stay in: your residential house E-mail: Permanent Home Address:
Street no.

PERSONAL BACKGROUND First Name: Civil Status: Single Married (month/day/year) Age: Blood Type: Religion: Citizenship: Ethnic Origin: Provincial Origin: Dialect: a Boarding house Mobile #:
Sito/Barangay

Middle Name:

with relatives

in a dormitory Special Skills:
Town/City Province

Name of Father: Address:
Barangay

FAMILY BACKGROUND Living Deceased

Telephone / Mobile #:

Town

Province

Occupation: Educational Attainment: Name of Mother: Address:
Barangay

If OFW, indicate where: Living Deceased Telephone / Mobile #:

Town

Province

Occupation: Educational Attainment: Monthly Income (in PhP) of the Family: 2,500 – 5,000

If OFW, indicate where: 6,000 – 10,000 11,000 – 15,000 16,000 – 20,000 21,000 & up

Name of Sibling/s: List the name/s of your brother/s and/or sister/s, arrange from the eldest to the youngest. Include yourself in the list. Name 1 2 3 4 5 6 7 8 9 10 11 12 Marital Status of Parents: Parents are married Parents are not married but living together Marriage is legally annulled Single Parent Age Birth date Birth Place Civil Status Educational Attainment Occupation

Company: Address: Telephone / Mobile #: Telephone / Mobile #: I hereby certify that the above information is true and correct to the best of my knowledge. Date: ____________________________________________________ . _______________________________________________ Student’s Signature over Printed Name . indicate where: Birth Date Age Birth Place Telephone / Mobile #: Town Province Person to contact in case of emergency: Name: Address: Elementary School: Address: Secondary School: Address: Post Secondary (Certificate/Diploma/Training Courses) School: Address: Baccalaureate (BS Degree) School: Address: Master’s Degree School: Address: Year of Graduation: Honor/s Received: School Type: Public / Private Year of Graduation: Honor/s Received: School Type: Public / Private Year of Graduation: Honor/s Received: School Type: Public / Private Year of Graduation: EDUCATIONAL BACKGROUND Year of Graduation: Honor/s Received: Public Private / Private / Telephone / Mobile #: School Type: Honor/s Received: School Type: Public WORK BACKGROUND 1.Student Information Sheet ……………. Page 2 of 2 Marriage is legally annulled Parents are separated (one or both have other partners) Widow/Widower Information about spouse (if any): Name of Spouse: Address: Barangay Town Province Telephone / Mobile #: Occupation: Educational Attainment: Name of Child/Children: Name 1 2 Name of Guardian Other than Parents: Address: Barangay If OFW. Company: Address: 2.