STUDENT PROFILE

GENERAL INSTRUCTION:
1. SAVE this file as WORD DOCUMENT.
2. RENAME your file as: INSERT
[LAST NAME, FIRST NAME, MIDDLE INITIAL]
Example: SANTOS, JUAN Y. PICTURE
HERE
4. Fill out the STUDENT INFORMATION (page 1)
and SKETCH OF YOUR RESIDENCE (page 2)
5. SEND through email at: shsoss@adzu.edu.ph
STUDENT INFORMATION
Full Name:
Last Name First Name Middle
Initial

Strand:

ID Number:
Mobile Number:

LRN Number:
Complete Address (Street Number, Street Name, Barangay/Subdivision, City/Municipality, Province):
OTHER INFORMATION
Email Address:

Date of Birth (Month, Day, Year):

Gender: Religion:

Father’s Name:
Last Name First Name Middle
Initial

Father’s Occupation:

Contact Number:
Mother’s Name:
Last Name First Name Middle
Initial
Mother’s Occupation:

Contact Number:
IN CASE OF EMERGENCY, PERSON TO CONTACT
Parent/Guardian’s Name:
Last Name First Name Middle
Initial

Contact Number:

Relationship:
Address:
RESIDENCE
 SCREENSHOT FROM GOOGLE MAPS or DRAW A MAP from your residence to the main
highway/road.
 Include important landmark, street signs/names, etc.
 Attach the image of the map or you may use a scanned document. You may also take a photo of
the map on a clean bond paper.
 You may use the Google Maps or any other application to draw your map.

Residence: