ST. MARY’S COLLEGE OF TAGUM, INC.

BASIC EDUCATION DEPARTMENT SMCTI

National Highway, Magugpo East, Tagum City, 8100 Davao del Norte, Philippines
Email Address: shsprincipal@smctagum.edu.ph
QTIME
Faith • Excellence • Service
Quality Transformative Ignacian Marian Education

INDIVIDUAL STUDENT’S PROFILE

NAME: ___________________________ GRADE LEVEL: _____

STRAND AND SECTION: ________________________________
COMPLETE HOME ADDRESS:
______________________________________________________
______________________________________________________
______________________________________________________
CELLPHONE NUMBER: _________________________________
EMAIL ADDRESS: ______________________________________

In case of emergency, you may contact any of the following persons:

Mother’s Name: _____________________________ Mother’s Contact Number: _________________
Father’s Name: _____________________________ Father’s Contact Number: _________________
Guardian (if any): ____________________________ Guardian’s Contact Number: _______________

CONSULTATION SESSIONS
SUMMARY OF DISCUSSION and AGREEMENT DATE SIGNATURE
Summary:
Student’s Signature:

__________________

Agreement: Adviser’s Signature:

__________________

Summary:
Student’s Signature:

__________________

Agreement: Adviser’s Signature:

__________________

Summary:
Student’s Signature:

__________________

Agreement: Adviser’s Signature:

__________________
 ST. MARY’S COLLEGE OF TAGUM, INC.
BASIC EDUCATION DEPARTMENT SMCTI
National Highway, Magugpo East, Tagum City, 8100 Davao del Norte, Philippines
Email Address: shsprincipal@smctagum.edu.ph
QTIME
Faith • Excellence • Service
Quality Transformative Ignacian Marian Education

Summary:
Student’s Signature:

__________________

Agreement: Adviser’s Signature:

__________________

Summary:
Student’s Signature:

__________________

Agreement: Adviser’s Signature:

__________________

Summary:
Student’s Signature:

__________________

Agreement: Adviser’s Signature:

__________________

Dear Learners/Parents/Legal Guardians:

In line with the school’s Vision to form holistic and integral learners, we would like to collect the above-
mentioned details for the purpose of close-monitoring of their progress, needs, and concerns in their
learning processes. Furthermore, we would like to build a stronger bond between the school and you,
our partners in the student’s holistic growth.

We ensure that the information collected are used properly as we make comply with the Data Privacy Act of
2021 (RA 10173) and their implementing rules and regulations as well as other relevant policies and issuances
of the National Privacy Commission (NPC).
By affixing your signature, you are giving your voluntary consent to allow your son’s or daughter’s class adviser
to collect aforementioned information.

______________________________________ ___________________
SIGNATURE OVER PRINTED NAME OF THE STUDENT DATE

_______________________________________________________ ____________________
SIGNATURE OVER PRINTED NAME OF THE PARENT/ GUARDIAN DATE