Student Control Number __________________

Republic of the Philippines

SORSOGON STATE COLLEGE
Placement Office
Sorsogon Campus
Sorsogon City

STUDENT INFORMATION SHEET

Instruction: Fill-up this form legibly. Do not leave any item unanswered.

I – Personal Data
Name: ______________________________________ Course, Year & Major: ___________________
Home Address:________________________________ Cell. No.:_____________________________
_____________________________________________ E-mail Add: ___________________________
Date of Birth: _____________ Place of Birth: _____________________________________ Age: _____
Religion: _________________ Civil Status: __________ Gender: _______ Weight: _____ Height: ____
Physical Disability (if any):______________________________________________________________

II - Family Status
Father: _______________________________________ Occupation: _____________________________
Mother: ______________________________________ Occupation: _____________________________
Address of Parents: ____________________________________________________________________
Name of Guardian (if any):______________________________________________________________
In case of emergency, please notify:
Name: ________________________________________ Relationship: ___________________________
Address: __________________________________________________Cellphone:______________

I HEREBY CERTIFY THAT THE INFORMATIONS PROVIDED HEREIN ARE TRUE AND
CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF.

_________________________________
Signature of Student

_________________________________
Printed Name of Student
Latest 2”x2”
Colored Picture _________________________________
Date Signed

IVYROSE B. GONZALES, MetE

Placement Officer/ILDO
Left Thumb mark Right
HELEN R. LARA Ed.D, RGC_______
Campus Administrator

SSC -33 – PLS – F-001