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:____________________________________________________________________________________________________________________________________
BALMACEDA JINALYN CONCHE
Last Name First Name Middle Name
Gender:___________
Female Age:______________
19 Religion:_____________________________________________________
Born Again Christian Date of Birth:_____________________
2004-12-26

Place Of Birth:_________________________________________
SOBOC,VIGA, CATANDUANES Home Address:_______________________________________________________
VIGA, VIRAC, CATANDUANES

Boarding House Address:________________________________________________________________________________________

VILLARO BOARDING HOUSE

Nationality:__________________________________
FILIPINO Contact Number:__________________________________
09515794487

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

PARENTS INFORMATION FATHER MOTHER

Name SANNY CMIGAL BALMACEDA ERLINDA CONCHE BALMACEDA

Age 58 47

Religion Roman Catholic Roman Catholic

Nationality FILIPINO FILIPINO

Highest Educational Attainment HIGH SCHOOL LEVEL HIGH SCHOOL LEVEL

Occupation FARMER HOUSEWIFE

Place of Work VIGA VIRAC CATANDUANES None

Work Address NONE None

Home Address SOBOC VIGA VIRAC CATANDUANES SOBOC VIGA VIRAC CATANDUANES

Contact Number None None

Marital Status:_________________________________
Married, Living Together Family's Monthly Income:_________________________________
Below Php 10,000.00

Name of Siblings Age Sex Civil Status School/Place of Work Grade/Year Level/Occupation
Jessica balmaceda 21 Female Single None Nons

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 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.)
Conscientiousness

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.)
speaking and writing

What is your ultimate goal?:________________________________________________________________________________________________

MY ULTIMATE GOAL IN LIFE IS TO FINISH MY STUDIES, HAVE A STABLE JOB AND HELP MY SIBLINGS

What is your guiding principle in life?:_______________________________________________________________________________________

I BELIEVE THAT PATIENCE AND HARDWORK ARE THE KEYS
Do you discuss problems with your parents? if yes, to whom?:__________________________________________________________________
NO
Do you discuss problems with your siblings? if yes, to whom?:__________________________________________________________________
No
Do you discuss problems with your friends? if yes, to whom?:___________________________________________________________________
YES, WITH MY TRUSTED FRIENDS
Do you enjoy the company of others? What makes you enjoy the company of others?:_______________________________________________
No
People friends you goes outside the school, please specify?:_____________________________________________________________________
WITH MY FRIENDS AND SIBLINGS
Are you a loner?:___________________________
No Are you afraid of teachers?:____________________________________________________
No
What type of friends do you prefer? Younger,Same
:__________________________________________________________________________________________
Age,Female
What are your strenghts:__________________________________________________________________________________________
MY STRENGTH ARE MY PERSEVERANCE AND THE SUPPORT FROM MY SIBLINGS AND FRIENDS
What are your weakness?_________________________________________________________________________________________
MY WEAKNESS IS MY SHYNESS SOMETIMES
What are your capacities?_________________________________________________________________________________________
Quick Learner,Imaginative,Creative,Somewhat Slow,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?________________________________________________________________________

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

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

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 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:____________________________________________________________________________________________________________________________________
BALMACEDA JINALYN CONCHE
Last Name First Name Middle Name
Gender:___________
Female Age:______________
19 Religion:_____________________________________________________
Born Again Christian Date of Birth:_____________________
2004-12-26
Place Of Birth:_________________________________________
SOBOC,VIGA, CATANDUANES Home Address:_______________________________________________________
VIGA, VIRAC, CATANDUANES
Boarding House Address:________________________________________________________________________________________
VILLARO BOARDING HOUSE
Nationality:__________________________________
FILIPINO Contact Number:__________________________________
09515794487

SCHOLASTIC INFORMATION:

School Last Attended:_______________________________________________________________________________________________________

CATANDUANES NATIONAL HIGH SCHOOL
School Address:____________________________________________________________________________________________________________
CONSTANTINO VIRAC CATANDUANES
Month and Year of Graduation:________________________________________________________________________________________________
June 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:______________

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