Professional Documents
Culture Documents
Instructions: Fill in all the required information. DO NOT leave an item blank. If item is not applicable, indicate “N/A”.
PERSONAL INFORMATION
NAME:
Last Name First Name Middle Name Suffix (ex.: Jr., Sr., III)
BIRTHDATE: (mm/dd/yy) ________________ SEX: ______ CIVIL STATUS: ________ Citizenship: _________ RELIGION: _______________
HOME ADDRESS:
Street No., Barangay Municipality Province
(If Boarding) ADDRESS:
Street No., Barangay Municipality Province
EDUCATIONAL BACKGROUND
SCHOOL CURRENTLY ENROLLED IN: ______________________________________________________
(If not enrolled) SCHOOL LAST ATTENDED: ______________________________________________________________
SCHOOL ADDRESS: ________________________________________________________________
LEARNING REFERENCE NUMBER (LRN): ______________________________________________
K-12 STRAND: ___________________
TYPE OF SCHOOL: (shade your answer)
o Private/Non-Sectarian (if non-religious school) o Technical-Vocational High School
o Private/Sectarian (if religious school) o Agri-Fisheries High School
o National High School o Agricultural-Technical-Vocational High School
SOCIO-ECONOMIC PROFILE: (Put a check mark on the alternative that corresponds your answer)
FAMILY INCOME:
___₱0 – ₱11,914.50 ___₱35,744 – ₱47,658.50
___₱11,915 – ₱23,829.50 ___₱47,658.50 above
___₱23,830 – ₱35,743.50
OUR FAMILY RESIDES IN:
___Our own house ___An apartment
___A rented house ___A house owned by relatives (nakikitira)
WHAT IS YOUR FATHER’S OCCUPATION?
___None ___Government Employee, Please Specify: ________________
___Farmer ___Private Employee, please specify: ____________________
___Fisherman ___ OFW, Please Specify: ______________________________
___Laborer ___If Deceased
___Self-employed, Please Specify: ___________________
WHAT IS YOUR MOTHER’S OCCUPATION?
___Housewife ___Private employee, please specify: _____________________
___Manual Laborer, please specify: __________________ ___OFW, please specify: _______________________________
___Self-Employed, please specify: ________________ ___If Deceased
___Government employee, please specify: ________________
WHO AMONG THE OTHER FAMILY MEMBER IS/ARE EARNING? __________________
HOW MANY MEMBERS ARE THERE IN YOUR HOUSEHOLD? _____________________
HOW MANY SIBLINGS (BROTHERS AND SISTERS) DO YOU HAVE? ___________________
HOW MUCH IS YOUR DAILY ALLOWANCE?
___Php50 pesos per day or below: Please Specify ________ ___Php80 pesos per day
___Php60 pesos per day ___Php90 pesos per day to 100 per day: Please specify: _______
___Php70 pesos per day ___More than Php100 per day: Please specify: ______________
ARE YOU A MEMBER OF AN INDIGENOUS CULTURAL COMMUNITY RECOGNIZED BY THE NATIONAL COMMISSION ON INDIGENOUS
PEOPLES?
___If YES, please specify: ________________________ ___NO
WHAT LANGUAGE DO YOU SPEAK AT HOME? (Please choose 1 you often use)
___Ibanag ___Itawes ___Ilocano ___Tagalog ___English OTHERS: (Please specify): ___________________
Applicant’s signature over printed name Signature over printed name of officer-in-charge
1X1 ID
Applicant’s signature over printed name Signature over printed name of officer-in-charge REGISTRATION PICTURE
NUMBER
Date of registration: ____________ Place of registration: _____________________