Please check: 9000 Cagayan de Oro City PERSONAL INFORMATION SHEET

_____ ABM Integrated Basic Education (CONFIDENTIAL)

_____ HUMSS _____ STEM Department
_____ TECH-VOC SENIOR HIGH (Guidance and
Counseling Center) SY: GCC-FO-S12
___________________ Semester:
____________

LOURDES COLLEGE Affix recent 2x2 photo

I. PERSONAL BACKGROUND:
Name _____________________________________________________________________ (Family
Name) (First Name) (Middle Name) Grade: __________ Religion: ________________ Civil Status:
_______________ Age: ________ Date of Birth: ______________ Place of Birth:
___________________ Nationality: _______________ Tribe: ______________ Contact #:
____________________ Email Address: ____________________ Current Address:
____________________________________________________________________ Permanent
Address: _________________________________________________________________

If you are not living with your parents, fill in this section:

Guardian’s Name ________________________________ Relation to you ______________________

Address: _________________________________________ Contact No. _______________________

II. Family Background: (Please indicate the following information)

Parents’ Marital Status: ____ Living Together ____ Temporary separated

____ Marriage Annulled ____ Permanently separated
Father Mother Guardian

Name

Age

Occupation

Company/
Business Address

Contact #

Highest
Educational
Attainment

Parents’ Gross Monthly Income

Father Mother Guardian Parents’ Gross
Monthly Income

___ None ___ None ___ None ___ None

___ 4, 999 and ___ 4, 999 and below ___ 4, 999 and below ___ 4, 999 and below
below ___ 5,000 – ___ 5,000 – 9,999 ___ 5,000 – 9,999 ___ 5,000 – 9,999
9,999 ___ 10,000 – 14,999 ___ 10,000 – 14,999 ___ 10,000 – 14,999
___ 10,000 – ___ 15,000 – 19,999 ___ 15,000 – 19,999 ___ 15,000 – 19,999
14,999 ___ ___ 20,000 – 24,999 ___ 20,000 – 24,999 ___ 20,000 – 24,999
15,000 – 19,999 ___ 25,000 – 29,999 ___ 25,000 – 29,999 ___ 25,000 – 29,999
___ 20,000 – ___ 30,000 – 34,999 ___ 30,000 – 34,999 ___ 30,000 – 34,999
24,999 ___ ___ 35,000 – 39,999 ___ 35,000 – 39,999 ___ 35,000 – 39,999
25,000 – 29,999 ___ 40,000 & above ___ 40,000 & above ___ 40,000 & above
___ 30,000 – Pls. specify Pls. specify Pls. specify
34,999 ___
35,000 – 39,999
___ 40,000 &
above Pls.
specify

Number of Siblings: __________ Birth Order among Siblings: _________________

 Name Age Civil Status Educational
Attainment/ Place of
Work

Describe your home life:

____________________________________________________________________________________
____________________________________________________________________________________
_____________________________________________________________.

III. HEALTH STATUS

Please indicate any health related problem (ex. Asthma/ Heart Arrhythmia)

_____________________________________________________

IV. EDUCATIONAL BACKGROUND

School Last Attended _______________________________________ Year _____________ Name of

School Address Honors/Awards Junior High ______________________
__________________ ______________ Elementary ______________________
__________________ ______________ Pre-School ______________________
__________________ ______________

V. Vocational Background

Talents: ___________________________________________________________________
Hobbies: ___________________________________________________________________

Attestation

I hereby certify that all information given above is complete & correct to the best of my knowledge. I
acknowledge that Lourdes College is required to abide the freedom of information and protection of
privacy legislation as it applies to the school.

_____________________________________
Name and Signature of Student

_________________________________ __________________________________
Parents’ Signature over Printed Name Guardians’ Signature over Printed Name (if
applicable)

Data Privacy Act

We from LOURDES COLLEGE, INC CAGAYAN DE ORO CITY make sure that all the personal information you
have provided are secured and confidential. With your consent, we collect the necessary personal information
with the intent to fulfill its purpose.