INDIANA LEARNING CENTER

STUDENT’S PROFILE
School Year: 2020-2021

Year Level & Section: _______________________________ Adviser: ________________________________

LAST NAME: FIRST NAME: MIDDLE NAME:

LRN: SCHOOL ID: TRACK/STAND:

AGE: BIRTHDATE: BIRTH PLACE:

MOBILE NO: TELEPHONE NO: RELIGION:

LANGUAGE: ADDRESS: SCHOOL LAST ATTENDED:

FATHER’S LAST NAME: FATHER’S FIRST NAME: FATHER’S MIDDLE NAME:

MOTHER’S LAST NAME: MOTHER’S FIRST NAME: MOTHER’S MIDDLE NAME:

GUARDIAN’S LAST NAME: GUARDIAN’S FIRST NAME: GUARDIAN’S MIDDLE NAME:

MOTHER’S CONTACT NO: FATHER’S CONTACT NO: GUARDIAN’S CONTACT NO:

FATHER’S OCCUPATION: MOTHER’S OCCUPATION: GUARDIAN’S OCCUPATION:

DATE OF COMPLETION: ________________________________________________

GENERAL AVERAGE: _________________________________________________ STUDENT’S SIGNATURE: _____________________
DATE : __________________________