You are on page 1of 1

EIM Student Profile (EIM-SP) Form 01

ELECTRICAL INSTALLATION AND MAINTENANCE


STUDENT PROFILE 1 x 1 ID pic
Section: ______________________

NAME: _____________________________________________________________________________
(Surname) (Name) (Middle Name)

Birthday: (mm/dd/yyyy _________________________________ Age:_______________________

Gender: ___________________Height (M): _________________ Weight (Kg): ________________

Special Medical Condition: ______________________________ BMI: ______________________

Contact No.:_____________________________ Email address:____________________________

Present Address: ____________________________________________________________________

_____________________________________________________________________________________

Father’s Name: ______________________________________ Occupation __________________

Mother’s Name: _____________________________________ Occupation ___________________

Guardian’s Name: ___________________________________ Relationship. _________________

Address: ____________________________________________ Contact No. ___________________

Grade 9 TLE Elective ________________________________Teacher _______________________

Grade 9 Schedule (AM/PM) _________________________Grade 9 GWA __________________

Previous learning experience in relation with EIM: ___________________________________

Previous work experience in relation with EIM: ______________________________________

Reason for selecting EIM as your TLE Elective: ______________________________________

____________________________________________________________________________________

_________________________________
Signature over printed name

You might also like