Document Code No.

DAVAO ORIENTAL FM-DOrSU-ODI-05

STATE UNIVERSITY
Issue Status Rev No. Effective Date Page No.
01 00 07.22.2022 1 of 2
“A University of excellence, innovation, and inclusion”

Student’s Profile Form

INSTRUCTIONS:
a) Fill out this form completely and correctly.
b) Write legibly. Mark all appropriate boxes/spaces with a check mark (/).
Paste your
2x2 photo
I. APPLICATION FOR ADMISSION here
1. DOrSU Student ID Number:
(To be filled up by the Admissions Office)
2. Semester Academic Year
3. First Year Transferee Returnee

4. LRN: _______________________________________________________
5. Campus:
6. Preferred Courses:
1.
2.
3.
II. PERSONAL INFORMATION
SURNAME FIRST NAME MIDDLE NAME
7.
8. Date of Birth (mm/dd/yyyy): 9. Sex: Male Female

10. Place of Birth:

(Municipality/City) (Province) (Country)
11. Civil Status: Single Married Widowed Separated/Annulled 12. Citizenship:

13. Height (ft): 14. Weight (kg): 15. Religion: 16. Tribe/Ethnic Group

17. E-mail Address: 18. Contact Number:

19. Permanent Address: Zip Code:

III. FAMILY BACKGROUND

20. Name of Spouse (if married): Occupation: No. of Children:

21. Father’s Name: Occupation: Contact No.:
22. Mother’s Name: Occupation: Contact No.:
23. Parents are: Living Together Permanently Separated Marriage Annulled/Legally Separated
Temporarily Separated Father w/another partner Mother w/another partner
24. Monthly Family Income (estimated):
25. Person to Contact in Case of Emergency: Contact Number:
Address:

IV. SCAST Result (Please indicate the INDEX)

General Ability: Spatial Aptitude: Verbal Aptitude:
Perceptual Aptitude: Numerical Aptitude: Manual Dexterity:
V. UNIQUE FEATURES
Hobbies/Recreational Activities: Motto:
Special Skills/Talents: Special Interests:
VI. EDUCATIONAL BACKGROUND
26. Elementary: Year Graduated: __________________
27. Senior High School: Strand: _________Year Graduated:
28. Vocational: Course: _________Year Graduated:
29. College: Degree: Year graduated:
 Document Code No.

DAVAO ORIENTAL FM-DOrSU-ODI-05

STATE UNIVERSITY
Issue Status Rev No. Effective Date Page No.
01 00 07.22.2022 2 of 2
“A University of excellence, innovation, and inclusion”

For Transferee
30. Last School Attended: Course: Last School Year Attended:

31. Are you enrolling as a scholar? YES NO If Yes, what Scholarship Grant?
32. Why did you decide to take the course you are enrolling?
33. Is it your own choice to enroll in DOSCST? ( ) YES ( ) NO, If NO, who influenced you?
34. Why did you decide to enroll in DOSCST?
35. What is your plan or ambition in life?
36. What are your Expectations on?
School: Course:
Instructors: Students:
Subject you like least: Subject you like most:

VII. SELF ASSESSMENT

37. What traits/characteristics do you think you possess? (You may check as many)
( ) tense/jittery ( ) easily troubled ( ) happy-go-lucky ( ) friendly
( ) confident ( ) responsible ( ) loner ( ) imaginative
( ) submissive ( ) relaxed/calm ( ) suspicious ( ) dominant
( ) independent ( ) dependent ( ) stubborn ( ) sentimental
( ) sensitive ( ) perceptive ( ) idealistic ( ) practical
( ) trusting ( ) insecure ( ) worrier ( ) Others:
38. What bothers you most at the moment?
( ) Financial difficulty ( ) Health problems, Please specify:
( ) Difficulties in adjusting a new school ( ) Interpersonal relationship (parents;friends;siblings)
( ) Study habits ( ) Student-Instructor relationship
( ) Developing self-confidence ( ) Others, please specify:
39. What was your most embarrassing experience in life?
_______________________________________________________________________________________________________
40. Things you would like to talk and discuss with:
Friends: Parents:
Teachers: Counselor:

VIII. OTHER INFORMATION

41. Are you a person with disability (PWD)? Yes No If yes, give details (type of disability):
42. Are you a single parent? Yes No If yes, give details (number of children):
43. Are you a working-student? Yes No If yes, give details (employer):

PLEDGE
In consideration of my admission to the Davao Oriental State University, I hereby promise and pledge to abide by and comply with all the rules and regulations laid down
by competent authority in the State University and in the institute in which I am enrolled. By providing information to the Admission Office, I am confirming that all data
supplied are true, complete and correct. I understand that giving false and lacking information will make me ineligible for admission, and that DOrSU reserves the right
to revise any decision made on the basis of the Information I have provided, should the information be found to be untrue and incorrect.

STUDENT’S DATA PRIVACY CONSENT

As a student, I understand and agree that by providing my personal data, I am agreeing to the Data Privacy Policy and Terms of the Davao Orientation State University
(DOrSU) and giving my full consent to the institution and its affiliates as well as its partners and service providers, if any, to collect, store, access and/or process any
personal data I may provide herein, whether manually or electronically for the period AY until the Academic Year of my graduation or withdrawal/transfer
from the institution, for the purpose of my admission, enrollment, research and other legitimate records processing under this office concerned. I acknowledge that the
collection and processing of my personal data is necessary for such purposes.

Student’s Signature over Printed Name Date Signed

Admitted by: Date: