Occupation : ______________________________
Monthly Income : ___________________________
2x2
ID UNIVERSITY OF THE EAST
PICTURE Basic Education (Senior HS)
Manila
STUDENT’S PROFILE
S.Y. 2020 – 2021
STUDENT DATA
Last name : ____PASCUAL__________________
First name: _____NINA ANNE MARIE__________
Middle name : ___________N/A_______________
Extension : _N/A_(e.g. Jr,Sr) Religion: CATHOLIC_
Student Number : ____________________
Learners Reference Number : ________________
Date of birth : JANUARY 24 2004 Age : _______
Gender : ___________ Citizenship : ___________
Grade level:_11__ Strand & Section : _
Class Adviser : ____________________________
Mother Tongue: _TAGALOG___ No. of siblings:_2_
Student’s mailing address:
House number/unit : __________________
Street : ____________________________
Barangay / District: ___________________
City/Municipality : ____________________
Province : __________________________
Cell phone/Telephone no.: _____________
PREVIOUS SCHOOL DATA
Name of Junior High School completed from :
___San Juan City Science High School____
School Type: Private Public
School address : _____________________
__________________________________
Average Grade : _____________________
Year Completed : ____________________
Honors Received : __________________
Are you a QVR Recipient? Yes No
Private ESC : SID no. ____________
Private non ESC : QVR Cert. no. ________
Public QVR
FAMILY DATA
Mother
Last name : ______PASCUAL________________
First name : ______MARITESS________________
Middle name : ____SIOCO__________________
Highest Educational Attainment: _______________
Age : ___________ Religion : ________________
Contact number : __________________________
Signature : _______________________________
Father
Last name : ___________CRUZ_______________
First name : ___________EMILO______________
Middle name : _________SUMINTAC___________
Extension : __________________(e.g. Jr,Sr)
Highest Educational Attainment: _______________
Occupation : ______________________________
Monthly Income : __________________________
Age : ___________ Religion : ________________
Contact number : __________________________
Signature : _______________________________
Guardian (if living separately from parents)
Relationship : _____________________________
Last name : _______________________________
First name : ______________________________
Middle name : _____________________________
Extension : __________________(e.g. Jr,Sr)
Occupation : ______________________________
Monthly Income : __________________________
Age : ___________ Religion : ________________
Contact number : __________________________
Signature : _______________________________
SIBLING/S
(For working)
Name : __________________________________
Civil Status : ______________ Age : ___________
Occupation : ______________________________
Monthly Income :___________________________
(For Student)
Name : __________________________________
Year/Grade Level : _________________________
Name of school : __________________________
Tuition Fee (in a year ) : _____________________
Note :
If you have three or more siblings please use
the back page and follow the format accordingly.
I hereby certify that all information above is true and
correct.
__________________________________________
Student’s Signature Over Printed Name Date
____________________________________________
Parent/Guardian’s Signature Over Printed Name Date