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NAME: AGE:

CONTACT NUMBER:

SCHOOL: SEX:

MOTHER’S NAME:

MOTHER’S WORK:

AGE:

FATHER’S NAME:

FATHER’S WORK:

AGE:

HOW MANY SIBLINGS:

WHAT IS THE WORK OF YOUR BROTHER/S:

WHAT IS THE WORK OF YOUR SISTER/S:

KIND OF HOUSE: ___ NIPA/KAHOY ___CONCRETE ___SEMI-CONCRETE

OWN: ____ RENTAL:

APPLIANCES IN THE HOUSE: __ TV __RADIO __DVD PLAYER __WASHING MACHINE

__ COMPUTER UNIT OTHER APPLIANCES: ________________________________________

WHY DO YOU THINK YOU FIT TO BE A DMSI International SCHOLAR?