OFFICE OF THE UNIVERSITY REGISTRAR

STUDENT DIRECTORY

PLEASE WRITE IN BLOCK LETTERS. USE A (/ ) MARK IN ANSWERING INFORMATION PRECEEDED BY A BOX.

COLLEGE
STUDENT NUMBER NAME: LAST, GIVEN, MIDDLE. IF MARRIED, WRITE MAIDEN NAME DEGREE MAJOR

SEX: CIVIL STATUS: AGE: _____ RELIGION: DATE OF BIRTH:

MALE SINGLE ANNULLED NATIONALITY:

FEMALE SOLO PARENT SEPARATED _______________ PHYSICAL CONDITION: PLACE OF BIRTH:

LESBIAN NO. OF CHILDREN MARRIED PWD PREGNANT

TRANSGENDER WIDOW/WIDOWER WOMAN

GAY
LANGUAGE SPOKENCULTURAL GROUP: LIVELIHOOD/EMPLOYNMENT: PRESENT ADDRESS: MOBILE NO:

TAGALOG INDIGENEOUS PEOPLE (IF WORKING STUDENT) ___________________________________

ENGLISH PLEASE SPECIFY:________________ PERMANENT HOME ADDRESS: MOBILE NO:

OTHERS ___________________________________
PLEASE SPECIFY:
______________
SCHOOLS ATTENDED STARTING FROM HIGH SCHOOL: DIPLOMA/TITLE/DEGREE: DATE OF GRADUATION HONORS RECEIVED:
_____________________________________________________
______________________________ _______________ _______________
_____________________________________________________
_______________________________ ________________ ________________
_____________________________________________________
________________________________ _______________ _______________

ENROLLMENT IN PALAWAN STATE UNIVERSITY:

FIRST ENROLLMENT: PSU ________________________________ SEMESTER & ACADEMIC YEAR:________________________________
LAST ENROLLMENT:PSU _________________________________ SEMESTER & ACADEMIC YEAR:________________________________
DEGREE OBTAINED,I ANY:________________________________ SEMESTER & ACADEMIC YEAR:________________________________

Do you have a disability?_______Yes ______No If yes, pls specify: ___________________________(Pursuant to RA 7277 & RA 9442)
PARENTS/GURADIAN/SPOUSE Living/ Deceased Address Tel.No. Occupation
1.Father's Name: ______________________________ 1.___________________________________ __________________

2.Mother's Name: ______________________________ 2.___________________________________ __________________

2.Guardian's/Spouse Name: ________________________ 3.___________________________________ __________________
PERSON TO BE NOTIFIED IN CASE OF EMERGENCY: ADDRESS: MOBILE NO.

DATE: SIGNATURE OF STUDENT:

PLEASE INFORM THE OFFICE OF THE UNIVERSITY REGISTRAR ABOUT ANY CHANGE IN THE ABOVE DATA.