Student Information Sheet

To be accomplished by the student

Name :
___________________________________________________________________________________________
Surname

First Name

Middle Initial

Date of birth :_______________________Age:________Nickname: ____________________Tshirt Size

_____________
(mm/dd/yy)

Place of birth:
_______________________________________________________________

Please attach a
2x2
recent colored ID
picture

Sex (M/F) : _______________ Religion: _____________________ Blood type:

___________
Mailing address :
____________________________________________________________
Telephone No. _____________________________ Mobile No.
_______________________
Email address :
______________________________________________________________
University/College:
___________________________________________________________
Degree/Major :
______________________________________________________________

in the box
below

Curremtly, 3rd year in a 4year course _______________________ 4th year in a 5year course
_______________________

High School : ______________________________________ Grade School :

____________________________________

Are you receiving any financial aid ? Yes _____________________________ No

_______________________________

Any health issues? Yes ______ No _______ If yes, please indicate

___________________________________________

In case of emergency, please contact :

__________________________________________________________________
Name

Relationship

Mobile

_________________________________________________________

_________________________

Signature over printed name

Date