DAVAO ORIENTAL STATE UNIVERSITY “A University of excellence, innovation, and inclusion” ‘Student's Profile Form SS FM-DOrSU-ODI-05 INSTRUCTIONS: a) Fillout this form completely and correctly p b) Write legibly. Mark all appropriate boxes/spaces with a check mark (/). aste your 2x2 photo 1 APPLICATION FOR ADMISSION here 1. DOFSU Student 1D Number: (oe led wp by he Admissions Oe) Semester Academic Year First Year |__| Transferee |] Retumee [ 4. LRN: 5. Campus: 6. Preferred Courses: 1 His PERSONAL INFORMATION SURNAME FIRST NAME MIDDLE NAME 1 8. Date of Birth (mm/dd/yy) 9 Sex: Male [~] Femate [~] 10, Place of Birth ‘iampaigrCiyy Crovnes) (Covniny 11, Civil Status: Single Married Widowed 1 Separaved/Annutted 12, Citizenship: 13, Height (A): 14, Weight (ka) 15, Religion: 16, Tribe/Ethnie Group 17, E-mail Address: 18. Contact Number: 19, Permanent Address: Zip Co ML FAMILY BACKGROUND 20, Name of Spouse (if mame Occupation: No. of Children: 21, Father's Name: ‘Occupation: Contact No.: 22, Mother's Name: _ Occupation: Contact No.: 23, Parentsare: Living Together Permanently Separated ‘Marriage Annulled/Legally Separated “Temporarily Separated (Father wianother 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 Apritud Verbal Apiitud Perceptual Aptitude Numerical Manual Dexterity V. UNIQUE FEATURES Hobbies/Recreational Activitie: Special Skills Talents EDUCATIONAL BACKGROUND Motto: Special Interests: Elementary: Year Graduated: . Senior High School: Strand: Year Graduated: Vocational Course: ‘Year Graduated: College: Degree: Year graduated: ‘Please continue at the back...DAVAO ORIENTAL STATE UNIVERSITY "A University of excellence, innovation, and inclusion” For Transferee 30, Last School Attended: Course: Last School Year Attended: Are you enroling asa scholar? [—] YES [—] NO 1Yes, what Scholarship Gran? ‘Why did you decide to take the course you are enrolling? Ist your own choice to enroll in DOSCST? ( ) YES ( )NO, INO, whi Why did you decide to enroll in DOSCST: ‘What is your plan or ambition in life? What are your Expectations on? iuenced you' Schoo: Course: Instructors Students: Subject you like least, Subject you like most: VII. SELF ASSESSMENT 37, What trits/characteristis do you think you possess? (You may cheek as many) C )tensefitery (easily troubled C ) happy-go-lucky © fiiendly ( ) confident (responsible ( ) loner (imaginative ( ) submissive (_ )rolaxed/caim (_) suspicious (dominant (independent () dependent (stubborn ( ) sentiment ( sensitive (perceptive ( idealistic () practical ( ) trusting (insecure ( ) worrier () Others: 38, What bothers you most atthe moment? C ) Financial difficulty (Health problems, Please specify (_) Difficulties in adjusting a new schoo! (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 VILL OTHER INFORMATION ae 41. Areyoua person with disability (PWD)? Yes __] No|_] 42. Are you a single parent? Yes |_| No[_| _Ifyes, give details (number of children}: 43. Are you a working-student? ‘Yes[~ | No[_] tyes, give details employer): _ PLEDGE In consideration of my aision othe Davao Oriental late University, hereby promise at pede to bide by and comply with all he rules nd regulations aid down by competent suber in stl are tse, complete and coret I uaderstand tht ving false king formation will make me inciibe for admin, ad that DOrs {o evse any decision made onthe basso he Information Ihave provide, should he aformation he found 1 be univ and income STUDENT'S DATA PRIVACY CONSENT Suite Univesity and in theists in which Tar elle, By providing iformaton tthe Adassioo Office an config tat all data ‘As a student, I undersiand and ages that by providing my personal data, lam apreing fo the Data Privacy Policy and Terms of he Davao Oreuation Sate Univesity (DOS) and siving my fll onsen to the aston and is alflists as well a ss partners and sevice providers if any, o collet, store, acess and/or peoces a ‘pemonal dats I may provide Horan, whether manly or electronically forthe period AY. te Academic Year of my graduation oe witha emer Fm the istiuton othe pose of my adessien,crollmnt, research sad oer lpia aos processing under this office concerned, I acknowledge thatthe collection and prosesing of my posonal datas nesessary for such purposes ‘Student's Signature over Printed Name Date Signed Admitted by: