FILAMER CHRISTIAN UNIVERSITY

Roxas Avenue, Roxas City, Capiz

5800, Philippines
Tel. No. (036) 6213-317 Loc. 186 Fax (036) 6213-075

STUDENT INFORMATION SHEET

Name: ____________________________________________________.
Surname First Name Middle Name

Present Address: ____________________________________________.

Contact Number: ___________________________________________.

Date of Birth: ___________________ Age: _________ Sex: _________.

Civil Status: ____________________ Religion: ___________________ Citizenship: ________________.

Father’s Name: _______________________________________ Occupation: _____________________.

Mother’s Name: _______________________________________ Occupation: _____________________.

Address: _____________________________________________ Contact Number/s: _______________.

Elementary: ___________________________________________ Year Graduated: _________________.

Junior High: ___________________________________________ Year Graduated: ________________.

IN CASE OF EMERGENCY:

Name: ________________________________________ Relation: ________________________

Address: ________________________________________ Contact No. ____________________

Office Address: ___________________________________ Contact No: ___________________

*** I h e r e b y c e r t I f y t h a t a l l I n f o r m a t i o n i s t r u e a n d c o r r e c t .

______________________________________________
Signature Over-Printed Name