GTI-FORM-012-2013

DR. FILEMON C. AGUILAR MEMORIAL COLLEGE OF LAS PIÑAS

Golden Gate Subd., Talon III, Las Piñas City 1 1/2 x 1 ½
Tel. No.: 986-87-63
picture

GUIDANCE AND TESTING OFFICE

Student No.: _______________ Date of Entry:

__________________
Course/Major: _____________________________________ Date of Withdrawal: ________________

STUDENT CUMULATIVE RECORD

Student Personal Data
Name: ________________________________________________________________________________________
(Last Name) (First Name) (Middle Name)
Nickname: _____________________ Sex: ______________ Height: ____________ Weight: ____________
Home Address: _______________________________________________________________________________
Provincial Address: ____________________________________________________________________________
Contact Nos.: _______________________ Nationality: ______________ Religion: ________________________
Date of Birth: __________________ Age: ___________ Place of Birth: _______________________
E-mail Add: _________________________
Civil Status: [ ] Single [ ] Married [ ] Single Parent
Language/Dialects Spoken at Home: ______________________________________________
Hobbies/Special Skills: [ ] Musical Instrument _______________________ [ ] Sports _____________________
[ ] Computer [ ] Literary/Writing [ ] Arts/Cartooning [ ] Science
[ ] Math [ ] Speech & Drama [ ] Dancing [ ] Singing

Family Background
Father’s Name: ________________________________________ Age: __________ [ ] Living [ ] Deceased
Religion: ________________________ Educational Attainment: ____________________________________
Occupation: _________________________________________ Monthly Salary: __________________
Employed By: ________________________________________________________________________________
Mother’s Name: ________________________________________ Age: __________ [ ] Living [ ] Deceased
Religion: ________________________ Educational Attainment: ____________________________________
Occupation: _________________________________________ Monthly Salary: __________________
Employed By: ________________________________________________________________________________
Lives [ ] with parents [ ] with relatives [ ] in a dormitory [ ] as a bedspacer
No. of Extended Family [ ] Adopted [ ] Relative [ ] In-laws [ ] Step-brother/sister
Name of Brothers/Sisters Age Schools/Occupations
________________________________ _________ _______________________________________
________________________________ _________ _______________________________________
________________________________ _________ _______________________________________
________________________________ _________ _______________________________________
Rank in the Family [ ] 1st [ ] 2nd [ ] 3rd [ ] Youngest [ ] Others __________________________
Home Condition [ ] Owned [ ] Rented [ ] Mortgaged
Educational Background
Schools Attended: Name & Address of School Year Attended Honors/Award
Elementary ___________________________________ ____________ _______________________
___________________________________
High School ____________________________________ ___________ _______________________
___________________________________
College (if any) ___________________________________ ____________ _______________________
___________________________________
Vocational ___________________________________ ____________ _______________________
___________________________________
Subjects found easy _______________________________________________________________________
Subjects found difficult _______________________________________________________________________
Failures incurred (if any) _______________________________________________________________________
Extra-curricular activities _______________________________________________________________________
Leadership position held _______________________________________________________________________
Plans after college _______________________________________________________________________
Vocational Data
Course/Career Preference 1st choice _____________________________________________________________
2nd choice _____________________________________________________________
3rd choice _____________________________________________________________
Jobs Held (Part-time/Full-time) _________________________________________________________________
Type of work liked best _________________________________________________________________
Type of work liked least _________________________________________________________________
If working, write office name & address ___________________________________________________________

IBL/RBG 7/8/13
GTI-FORM-012-2013

Health and Physical Data

Vision/Hearing ______________________________________________________________________________
Hereditary illnesses ___________________________________________________________________________
Allergies ______________________________________________________________________________
Any operation had ____________________________________________________________________________
Any recent hospitalization/cause ________________________________________________________________
Physical Disabilities (if yes, specify) _____________________________________________________________

Membership and Positions held in an Organization/s:

____________________________________________________________________________________
____________________________________________________________________________________

I certify that the foregoing answers are true and correct to the best of my knowledge.

_______________________________
Signature over Printed Name

GUIDANCE AND COUNSELOR’S RECORD

Academic Year/Semester Date Nature of Interview Remarks

TEST’S RECORD
Date Tests Score Remarks

IBL/RBG 7/8/13