STUDENT PERSONAL INFORMATION SHEET

Please fill in all the information needed from you. We understand that this information are personal but rest
assured that the information you will provide will be kept with utmost confidentiality. Please make sure that all
items are answered/filled-up. By filling out this form, you consent to the collection, generation, use, processing,
storage, and retention of your personal data by CSUCC Guidance and Counseling Center for the purpose
described in this document. Please ensure that you have completely read and understood the terms before
submitting. Thank you.
Date Filed : November 27, I.D. No. 2021-0900
2021

Program and Year : BSBA-HRM 1

Last Name: Abrio
First Name: Angelou
NAME
Middle Mejorada
Name:
Nickname Bobong
Age: 21 Gend : Male Birth 1
er Order:
Date of November Place of Birth: Magdago-oc, Religion: Catholic
Birth: 12, 2000 Jabonga
Civil Status: Single Name of Spouse (if married)

Are you a member of ● No • N If yes,

Indigenous Peoples O please
Community? specify:
Permanent Address P-9 Calibunan Brgy. Site Cabadbaran City
Living with (please check) ✔ Parents • Relati • Guardian
ves
Current Address P-9 Calibunan Brgy. Site Cabadbaran City
✔ Fa • House of • Relative’ • Rented apartment
Nature of Residence while mil married s house
attending School (Please y brother/sister
check) ho
me
• Sch • Boarding house • Employe • Share’s apartment
ool r with
dor provide friend/relative
m d space (please underline)
• Scholarship • Relatives • Spouse
Who is supporting your grant
studies? (Please check) ✔ Parents • Working student • Others please specify:

Contact Number Mobile:09504616268 Landline: E-mail : angelou.abrio@csucc.edu.ph

Father Mother
(Indicate year of death; if (Indicate year of death; if
deceased) deceased)
Name: Angelito Abrio Marissa Abrio
Date of Birth: August 4, 1975 November 28, 1980
Place of Birth: Magdagooc, Jabonga RTR, Agusan Del Norte
Citizenship: Filipino Filipino
Current Address: P-9 Calibunan Brgy. Site Cbr. City P-9 Calibunan Brgy. Site Cbr City
Permanent Address: P-9 Calibunan Brgy. Site Cbr. City P-9 Calibunan Brgy. Site Cbr. City
Landline/Mobile N/A
No.:
Email Address: N/A
Highest Educational Elementary High School
Attainment:
Occupation: Driver OFW
Annual • Below Php5,000 • Php 30,001-Php 40,000 • Below Php5,000 / • Php 30,001-Php
Income ✔ Php 5,001-Php 10,000 • Php 40,001-Php 50,000 • Php 5,001-Php 10,000 40,000
• Php 10,001-Php 15,000 • Php 50,001-Php 80,000 ✔ Php 10,001-Php 15,000 • Php 40,001-Php
(Please
• Php 15,001-Php 20,000 • Others please specify • Php 15,001-Php 20,000 50,000
check): • Php 20,001-Php 30,000 • Php 20,001-Php 30,000 • Php 50,001-Php
80,000
• Others please specify
Religion Catholic
✔ Married and living • Not married but living • Single parent
together together
Relationship status • Married but separated due to the following reasons
of parents • death (father/ mother • legal • separated without
pls. underline) separation/ legal process
annulment
• Father/Mother • Work in other • Others please specify:
OFW please places(within ----------------------------
the
Philippines
underline
Name Age Civil status Occupation Address
Angelou Abrio 21 Single Student P-9 Calibunan Brgy. Site
Siblings Adrian Abrio 17 Single Student P-9 Calibunan Brgy. Site
Mark Laurence Abrio 16 Single Student P-9 Calibunan Brgy. Site
Christian Rhee Abrio 15 Single P-9 Calibunan Brgy. Site
Student
Special Talents
Favorite Pastime Dancing
Persons you can go Best Friends
harmoniously

EDUCATIONAL BACKGROUND
Level Name of School Inclusive Honors/Awards
Years of received
Attendance
Elementary Calibunan Elementary School
Junior High Northern Mindanao Colleges
Senior High Northern Mindanao Colleges
Track:
Track
Strand: ICT
College Caraga State University Cabadbaran City
If transferee please states the
reason of transfer:
Nature of schooling • continuous ✔ interrupted Why interrupted?

Clubs and Organizations Position Inclusive Dates

held

VOCATIONAL BACKGROUND/PLANS
Is the program/strand you enrolled your • YES ✔ NO
first choice?

Reason for taking the course Because that’s where I see myself in future
Favorite Subject : ART APP Subject you don’t like: MST
Occupation you would like to engage after graduation
Occupation your parents/ guardians would you like to engage
after graduation:
Do you have any work • YES ✔ NO If YES) Name of latest company or agency you are connected.
experience? (e.g. Food chain, Households, School)

Position held: Inclusive dates

HEALTH BACKGROUND
Disabilities/Impairments: NO Have you ever been diagnosed of an illness? NO
Medicines Regularly Taken: NONE Have you ever met an accident? YES
Have you been into surgical experience? NO Immunizations :
PREVIOUS PSYCHOLOGICAL EXPERIENCE
Have you consulted a Psychiatrist before • YES ✔ • NO
If yes why:
If yes how many sessions/how
long:
For
what?
Have you consulted a Psychologist before? • YES ✔ • NO
If yes why:
If yes how many sessions/how
long:
For
what?
Have you consulted a Psychologist before? • YES ✔ • NO
If yes why:
If yes how many sessions/how
long:
For
what?
WHICH OF THE FOLLOWING YOU WOULD LIKE TO DISCUSS WITH YOUR COUNSELOR? ( Please check)

• Abuse (physical/sexual/verbal/emotional) • Relationship with special

someone
• Academic • Self-esteem ✔

concern/difficulties
• Addiction • Self-
(alcohol/drugs/gaming/food/shopping/gambling harm
)
• Decision-making/ Career decision-making • Sexual concerns
• Emotional • Sexual identity/ Orientation
disturbance/status issues
• Family • Suicidal thoughts
 problem/situation/relationship
• Marital concerns • Traumatic experience
• Peer relationship • Others specify:
In case of emergency person to contact Name : Mobile No:

I hereby certify that the information are true and correct: If below 18 years old:

_ Angelou Abrio Angelou M. Abrio_________

Signature over Printed Name Signature over Printed Name of Parent/Guardian