Republic of the Philippines

Department of Education
Region II – Cagayan Valley
Schools Division of Cagayan
Buguey South District
BUGUEY SOUTH CENTRAL SCHOOL

PUPIL’S PERSONAL INFORMATION SHEET

LRN: ________________________ Date Filled:

_________________________

Name: ________________________________________ Nickname:

__________________________

Age: ___ Date of Birth: __________ Place of Birth:

____________________________________

Sex: M ( ) F( ) Birth Order among Siblings: ___________

Permanent Home Address:

________________________________________________

Cellphone: _____________________ Email/FB Account: ___________________

Dialect/s Spoken at Home:________ Religion: ___________________________

Grade: ________________________ 4P’s ( ) Yes ( ) No

Father Mother
(Indicate year of death if deceased) (Indicate year of death if deceased)

Name: ________________________________

_____________________________________

Address: Pattao, Buguey, Cagayan, 3511

Contact Nos.: 0950-562-8876
Email Address: 102570@deped.gov.ph
 Republic of the Philippines
Department of Education
Region II – Cagayan Valley
Schools Division of Cagayan
Buguey South District
BUGUEY SOUTH CENTRAL SCHOOL

Date of Birth: ________________________

____________________________________

Place of Birth: _______________________

____________________________________

Permanent Address: _________________________

___________________________________

Cellphone: ________________________

___________________________________

Educational Attainment: _______________________

______________________________

Occupation: ______________________

_______________________________

Monthly Income: ______________________

_______________________________

Dialect Spoken: _______________________

_______________________________

Religion: ________________________

Address: Pattao, Buguey, Cagayan, 3511

Contact Nos.: 0950-562-8876
Email Address: 102570@deped.gov.ph
 Republic of the Philippines
Department of Education
Region II – Cagayan Valley
Schools Division of Cagayan
Buguey South District
BUGUEY SOUTH CENTRAL SCHOOL

_______________________________

(Please name below siblings from eldest to youngest. Indicate yourself.)

Name of Siblings School/Place of Work Age

________________________ ___________________

___________

________________________ ___________________

___________

________________________ ___________________

___________

________________________ ___________________

___________

________________________ ___________________

___________

Parents

____Living together _____Father OFW

____Separated since when________ _____Mother OFW

____Father remarried _____Mother Widowed

____Mother remarried _____Father Widowed

Address: Pattao, Buguey, Cagayan, 3511

Contact Nos.: 0950-562-8876
Email Address: 102570@deped.gov.ph
 Republic of the Philippines
Department of Education
Region II – Cagayan Valley
Schools Division of Cagayan
Buguey South District
BUGUEY SOUTH CENTRAL SCHOOL

Guardian (if not living with parents):

___________________________________________

Address:

_________________________________________________________________

Contact Number:

__________________________________________________________

Relationship with Guardian:_____________________________________________

Person Contact in case of Emergency:

Name: _____________________________________________________

Contact Number: ___________________________

Easiest Subject/s:

_________________________________________________________

Most Difficult Subject/s:

___________________________________________________

Subject/s with Lowest grades:_____________________________________________

Subject/s with highest grades: ___________________________________________

Plan after Senior High School:_____________________________________________

Membership in Organizations

Address: Pattao, Buguey, Cagayan, 3511

Contact Nos.: 0950-562-8876
Email Address: 102570@deped.gov.ph
 Republic of the Philippines
Department of Education
Region II – Cagayan Valley
Schools Division of Cagayan
Buguey South District
BUGUEY SOUTH CENTRAL SCHOOL

Name of Organization Position/Title

___________________________ ______________________

___________________________ ______________________

___________________________ ______________________

Unique Features

Friends: In School: ____________________________________________

Special Interests: ________________________________________________

Special Skills/Talents: ____________________________________________

Hobbies/Recreational Activities: ____________________________________

Ambition/Goals: ________________________________________________

Characteristics that describes you best: ______________________________

_______________________________________________________________

Health

Disabilities/Impairments: _________________________________________

Chronic Illness: _________________________________________________

Medicines Regularly Taken: _______________________________________

Address: Pattao, Buguey, Cagayan, 3511

Contact Nos.: 0950-562-8876
Email Address: 102570@deped.gov.ph
 Republic of the Philippines
Department of Education
Region II – Cagayan Valley
Schools Division of Cagayan
Buguey South District
BUGUEY SOUTH CENTRAL SCHOOL

I hereby certify that the above information is true and correct to the best of my

knowledge and belief.

_________________________

Signature and Date

Address: Pattao, Buguey, Cagayan, 3511

Contact Nos.: 0950-562-8876
Email Address: 102570@deped.gov.ph