PROFILE SHEET OF KATIPUNAN NG KABATAAN MEMBER

OFFICE OF THE SANGGUNIANG KABATAAN

BARANGAY helen, larena, SIQUIJOR

I. PERSONAL INFORMATION

(SURNAME) (NAME) (MIDDLE NAME)

DATE OF BIRTH (mm/dd/yyyy): AGE:

SEX: CITIZENSHIP:

MARITAL STATUS: RELIGION:

HEIGHT: MOBILE NO:

WEIGHT: OCCUPATION:

BLOOD TYPE:

II. FAMILY BACKGROUND

SPOUSE NAME: _____________________________________________________________

(SURNAME) (NAME) (MIDDLE NAME)

OCCUPATION:

NAME OF CHILDREN (Write in full name) DATE OF BIRTH (mm/dd/yyyy):

1.________________________________________
2.________________________________________
3.________________________________________
4.________________________________________
5.________________________________________
____________________________
____________________________
____________________________
____________________________
____________________________

FATHER’S NAME:
______________________________________________________________________________
(SURNAME) (NAME) (MIDDLE NAME)

OCCUPATION:
 MOTHER’S NAME:
______________________________________________________________________________
(SURNAME) (NAME) (MIDDLE NAME)

OCCUPATION:

III. EDUCATIONAL BACKGROUND

\ HIGHEST
LEVEL
LEVEL NAME OF SCHOOL BASIC PERIOD OF UNITS YEAR
EDUCATION/DEGREE/ ATTENDANCE EARNED GRADUATED
COURSE (FROM-TO) (if not
graduated)

ELEMENTARY

SECONDARY

VOCATIONAL/
TRADE
COURSE
COLLEGE

GRADUATE
STUDIES

IV. PLEASE CHOOSE ATLEAST 3 COMMITTEES THAT YOU WANT TO

PRIORITIZE FIRST IN YOUR BARANGAY:

__ Education and Culture

__ Environmental Protection, Climate Change Adaptation and Disaster Risk
Reduction and Resiliency
__ Youth Employment and Livelihood
__ Health, Health Services and Reproductive Health
__ Anti-Drug Abuse and Social Protection
___ Gender and Development
___ Sports Development
V. What are the needs of the youth in our Barangay? What were the issues
affecting the youth? Please specify. (Can be answer either through English
Language or Vernacular/Bisaya)