Bicol University Polangui Campus

Office of Guidance Services

Polangui, Albay
Email:bupcguidance@gmail.com

STUDENT PROFILE FORM

I. PERSONAL INFORMATION
1. Name SILERIO GLEN CYANN SAMANIEGO 7. Telephone No.
(Last) (First) (Middle ) 8. Contact No. +639274652367
2. Date of Birth JULY 30 2002 9. Email Address glencyannsamaniego.silerio@bicol-u.edu.ph
3. Place of Birth BALINAD, POLANGUI, ALBAY 10. Religion ROMAN CATHOLIC PHOTO
4. Gender MALE 11. Nationality FILIPINO 2X2
5. Civil Status SINGLE 12. Spouse (if any)
6. Address BALINAD, POLANGUI, ALBAY 13. Occupation

I. FAMILY BACKGROUND
Father Mother Guardian
Name GLEN L. SILERIO NANCY S. SILERIO Total Annual Family Below P 60,000 a year
Age 54 53 Income P 60,001 to P 100,000 a year
Religion ROMAN CATHOLIC ROMAN CATHOLIC P 100, 001 to P 150,000 a year
Nationality FILIPINO FILIPINO Above P 150,000 a year
Educational Bachelor of Secondary Status of Parents Married
Attainment Education Not Married
Occupation ELECTRICIAN TEACHER Married, living Apart
Position/ BARANGAY OFFICIAL TEACHER 3 Living Together
Employer Separated
Office Address Ilaor Norte Oas Albay Legally Separated
Contact No. +639197977449 +6397207537 Father Remarried
living deceased living deceased Relationship:___________ Mother Remarried

Name of Siblings Age Educational Attainment Occupation Name of Child/ren Age Highest Grade Completed
Glen Cyann S. Silerio II 18

II. EDUCATIONAL RECORD

Level Name of School Degree/Course Year Graduated Inclusive Dates of Attendance Scholarship/ Awards/ Honors
 From To Received
Kindergarten Salle Learning Center 2008 2006-2008 2 awards
Elementary Salle Learning Center 2014 2008-2014 6 honors
Junior High School PGCHS 2018 2014-2018
Senior High School PGCHS STEM 2020 2018-2020 1 honor
College Bicol University BS-CPE 2020-current

Please sketch the specific location of your house, including landmarks near it for easy
IV. SPECIAL RECORD identification. If you are a boarder please sketch the location of your boarding house
A. Friends in School Address Contact Number/s
Lester Angelo MIrabueno Balinad, Polangui, Albay +639057059182

B. Friends outside School Address Contact Number/s

During school days, I stay in: with: no one My present course is influenced by
on our own house whole family relative/s own choice friend/s
relative’s house both parents friend/s parent’s choice relatives
rented house/ apartment father spouse teacher media
rented room mother child/ren guidance counselor
boarding house sibling/s in- laws person who will finance my studies
dormitory room guardian/s landlord/lady scholarship available
I attend parties: Always Frequently Seldom Never
Do you have a part time job? YES (where?___________________) NONE (Do you like to have one?yes_____)
V. Health Record
Allergies No Yes (Specify:___________) Family Diseases: (Please check) Past Disease/s:
Medication No Yes (Specify:___________) Cancer Heart Disease High Blood Pressure Dengue
Physical Defects No Yes (Specify:___________) Diabetes Peptic Ulcer Nervous Breakdown
Eye glasses/Contact Lens No Asthma: No Yes Epilepsy Tuberculosis Others:______________________
Yes Describe vision problem:______________________ Types Date Result
Measles DPT(Diphteria, pertussis, Tetanus) Psychological
Immunization Record Mumps BGC (Anti-TB) Others:________ Test Record
Rubella OPV(Polio)
BU-F-OSAS –SWSD-02 Rev. 3
Effectivity Date: June 5, 2018