Reference No.

GOLDENSTATE COLLEGE OF KORONADAL, INC. KOR-SW005-002

STUDENT’S INFORMATION FORM Page 1 of 2

2x 2 photo

(Attach Here)

Name:
_____________________________________________________________________
(Last Name) (First Name) (Middle Name)
Date of Birth: ____________________________ Sex: ______________________
Religion: _______________________________ Ethnicity: __________________
Mobile Number: ________________________ E-mail Address: ____________
Home Address: ________________________________________________________
School Last Attended:

Name of School School Address

Elementary

Junior High
School
Senior High
School
College:

Mother’s Name: ___________________________ Mobile Number: ____________

Father’s Name: ___________________________ Mobile Number: ____________
Name of Guardian: ________________________ Mobile Number: ____________
Address: _____________________________________________________________
Hobbies: ____________________________________________________________________

Motto in Life: ________________________________________________________________

_________________________________________________

Signature over Printed Name