Republic of the Philippines

Department of Education
Gregorio C. Catenza National High School
Tunga, Leyte

PERSONAL INFORMATION SHEET

Name: Nickname:
Sex: Age: Date of Birth: Place of Birth:
Landline: Cellphone #: Email: Birth Order Among Siblings:
Current Address:
Permanent Address:
Languages/Dialect Spoken at Home: Languages/Dialects Most Fluent In:
Religion from Birth: Current Religion:
Father Mother
(Mark with + if deceased) (Mark with + if deceased)
Name:
Date of Birth:
Address:
Landline/Cellphone:
Educational Attainment:
Occupation:
Name of Children in the Family School/Place of Work Age
(eldest to youngest, including yourself)
1
2
3
4
5
6
7
8
9
10
Parents
Living together Permanently Separated Temporarily Separated
Father OFW Mother OFW Annulled/Legally Separated
Father with Another Partner Mother with Another Partner Unknown Father

Guardian (if not living with parents) Relationship:

Address: Landline/Cell No.:
Person to Contact in Case of Emergency:
Name: Contact No.:
Educational Background:
Grade/Year Level School Attended Inclusive Years of Attendance
Attendance Record:
Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12
Days of School
Days Present
Days Absent
No. of Times Late