Republic of the Philippines

CATANDUANES STATE UNIVERSITY

Virac, Catanduanes

Guidance Counceling Testing Office

INDIVIDUAL STUDENT PROFILE

PROFILE:
(Please write the information needed in-print)

Name:____________________________________________________________________________________________________________________________________
Bolivar Ann Mae
Last Name First Name Middle Name
Gender:___________
Female Age:______________
24 Religion:_____________________________________________________
Roman Catholic Date of Birth:_____________________
1999-07-03

Place Of Birth:_________________________________________
Batong Paloway San Andres Catanduanes Home Address:_______________________________________________________
Bislig, San Andres Catanduanes

Boarding House Address:________________________________________________________________________________________

Nationality:__________________________________
FILIPINO Contact Number:__________________________________
09677623871

FAMILY BACKGROUND:
(Please write the information needed in-print)

PARENTS INFORMATION FATHER MOTHER

Name Jose Gianan Ruby Pria Bolivar

Age 48 46

Religion Roman Catholic Roman Catholic

Nationality FILIPINO FILIPINO

Highest Educational Attainment High School Graduate High School Graduate

Occupation None Housekeeper

Place of Work None None

Work Address None None

Home Address None Bislig San Andres Catanduanes

Contact Number None 09677623871

Marital Status:_________________________________
Single Family's Monthly Income:_________________________________
Below Php 10,000.00

Name of Siblings Age Sex Civil Status School/Place of Work Grade/Year Level/Occupation
Ashley Bolivar 23 Female Single Catanduanes State University Second Year College

Janna Kate Bolivar 19 Female Single Cabcab National High 12

Page 1/3
 Republic of the Philippines
CATANDUANES STATE UNIVERSITY
Virac, Catanduanes

STUDENTS SOCIAL, EMOTIONAL AND PERSONAL MAKEUP:

(Please answer the following questions)

Identify and Discuss four (4) of your distinct personality traits:

(You may choose from this list: Openness: open to try new things and tackle new ideas, resist new ideas, very imaginative;
Conscientiousness: thoughtfulness, good impulse control, goal-directed behaviors, likes structure and schedules, mindful;
Extraversion/Introversion: outgoing, excitability, sociability, assertiveness, emotional expressiveness, reserved, prefers solitude;
Agreeableness: trust, kindness, affection, altruism, cares about others, empathetic; Neuroticism: sadness, moodiness, emotional instability,
irritability, worrisome, easily get upset, feels anxious, difficulty in bouncing back after stressful event.)
Openness: open to try new things and tackle new ideas, resist new ideas, very imaginative;

Identify your special skills/talents/interests:

(Example: public speaking, writing, self-management, communication skills- virtual and person-to-person, decision making skills, critical
thinking, research, arithmetic, graphics, gaming, science, music, arts, photography, sculpting, video creation, foreign language, financial
management, negotiating skills, leadership, time management, etc.)
Music,self management,time management, communication skills virtual and person to person

What is your ultimate goal?:________________________________________________________________________________________________

My ultimate goal it to finish my studies and to help my parents.Also to have a good work with a nice salary.

What is your guiding principle in life?:_______________________________________________________________________________________

-Respect for Self and Others -Take responsibility
Do you discuss problems with your parents? if yes, to whom?:__________________________________________________________________
Yes
Do you discuss problems with your siblings? if yes, to whom?:__________________________________________________________________
Yes
Do you discuss problems with your friends? if yes, to whom?:___________________________________________________________________
Yes
Do you enjoy the company of others? What makes you enjoy the company of others?:_______________________________________________
Yes,I enjoy to others company because when you feel that your bos
People friends you goes outside the school, please specify?:_____________________________________________________________________
None
Are you a loner?:___________________________
No Are you afraid of teachers?:____________________________________________________
No
What type of friends do you prefer? All
:__________________________________________________________________________________________
Ages
What are your strenghts:__________________________________________________________________________________________
My strength is my family --I have a positive attitude and easily to adapt to new environments.I always looking forw
What are your weakness?_________________________________________________________________________________________
My weakness is public speaking,shyness and lack of confidence
What are your capacities?_________________________________________________________________________________________
Quick Learner,Finishes the tasks easily,Orderly
Areas where you might need help?_________________________________________________________________________________________
None
Comments/Suggestions?_________________________________________________________________________________________________
None

HEALTH AND BACKGROUND:

(Please answer the following questions)

What is the condition of your general health?________________________________________________________________________

Excellent
Do you have any serious illness?__________________________________________________________________________________
No
If yes please specify?____________________________________________________________________________________________
Have you been hostipalized/operated due to an illness?_______________________________________________________________
No
If yes please specify?____________________________________________________________________________________________

I declare that i have personally accomplished this Individual Student Profile which is a true, correct and complete statement according to the
best of my knowledge. I also declare that I am consenting the Guidance Counseling Testing Office to use my data with utmost confidence for
the best interest of me and the students, welfare

______________________________________________________ _________________________
Students Signature over Printed Name Date

Page 2/3
 Republic of the Philippines
CATANDUANES STATE UNIVERSITY
Virac, Catanduanes

Guidance Counceling Testing Office

COLLEGE ENTRANCE EXAM FORM

Course to Take:
1st Choice: ____________________________________________________________________________
Bachelor of Elementary Education

PROFILE:
(Please write the information needed in-print)

Name:____________________________________________________________________________________________________________________________________
Bolivar Ann Mae
Last Name First Name Middle Name
Gender:___________
Female Age:______________
24 Religion:_____________________________________________________
Roman Catholic Date of Birth:_____________________
1999-07-03
Place Of Birth:_________________________________________
Batong Paloway San Andres Catanduanes Home Address:_______________________________________________________
Bislig, San Andres Catanduanes
Boarding House Address:________________________________________________________________________________________
Nationality:__________________________________
FILIPINO Contact Number:__________________________________
09677623871

SCHOLASTIC INFORMATION:

School Last Attended:_______________________________________________________________________________________________________

Cabcab National High
School Address:____________________________________________________________________________________________________________
Cabcab San Andres Catanduanes
Month and Year of Graduation:________________________________________________________________________________________________
July 8 2024

CERTIFICATION:

(To Be filled-out by your School Head/Guidance Counselor)

GOOD MORAL CHARACTER CERTIFICATION

This is to certify that ________________________________________________ is a graduating student/graduate of
__________________________________________________________________________________, School Year
_________________.

Furthermore he/she [ ] has been subjected to any disciplinary action (please specify)_____________________
[ ] has not been subjected to any disciplinary action.

Issued this_____day of __________, 20____ for CatSU College Entrance Exam purposes.

__________________________________________________________
School Head/Guidance Counselor/Designate

[ ] Affixed here is the school dry seal

[ ] This school has no dry seal
Contact Number:_______________
Email Address:_________________

Affix school dry seal here

Date:______________

I affirm that:
1. All information uplied in this application form is true, complete and accurate;
2. I have not taken CatSU Entrance Assesment previously;
3. I will abide by the institutions rules and policies on test administration, and screening process

I am aware that any or all the information in this application may be checked against the original documents and i understand that i will be
allowed to take the examination upon the submission of complete requirements

Furthermore, I understand that all information I provide in this form as well as during the College Entrance Assessment may be used by the
University for research and I believe that my personal details will be treated with utmost confidentiality

___________________________ I certify that all information here are true and correct.
Signature of Student __________________________________________
Date:______________ Parent/Guardians Signature over Printed name
Date:______________

Page 3/3