Republic of the Philippines

Department of Education
Negros Island region
Division of Negros Occidental
LA CASTELLANA NATIONAL HIGH SCHOOL
R. I. Ligason Drive, Brgy. Robles, La Castellana, Negros Occidental

STUDENT PROFILE

Name: __________________________________________________________ Date of birth: ___________________

Height: ____________ Weight : _________________
Home Address:
__________________________________________________________________________________________________
Mother's Name: ___________________________________________________ Age: _______
Occupation: ________________________________________ Contact Number: __________________
Father's Name: ___________________________________________________ Age: _______
Occupation: ________________________________________ Contact Number: __________________

Annual Family Income: ____________________

Number of Sibling: ________________________ Sibling Position: _________________

Neighbor Schoolmate: _________________________________ Contact Number: _________________

Person to notify in case of emergency: _________________________________ Contact Number: _________________

Map of residence
(from school to home)

____________________________
Signature over printed name