Student's Info Sheet

Name:

____________________Haney

Larida_____________________

Course:___________________BSCE___________ Year

level: _______2nd Year______

Address while on Online Distance Learning:

______________________STA. CATALINA NEGROS

ORIENTAL___________

_______________________________________________
_______________________________

Are you currently a recipient of a scholarship grant or an

honor student? (Yes/No): ___No________ If Yes, provide
a proof of your scholarship grant or award as an honor
student. It can be a scanned copy of your scholarship
contract or honor certificate to be attached to your
response. What is the required minimum grade to
maintain your scholarship/honor? __________________
What is/are the usual problem/s related to ODL you
encountered during the semester?
 1. _____________________________________
________________________________

2. _____________________________________
________________________________

3. _____________________________________
________________________________

I hereby certify that the data contained herein are true

and correct to the best of my knowledge and belief.

____________________________________________

Signature over Printed Name