I.

STUDENT INFORMATION

LRN: with PSA BC? (Yes/No)  

           
Name:
Last First Middle
Place of
Gender: Birthdate: Birth
Current Address:  
STVE Major: STVE Major Teacher:
Scholarship Grant:          
Disability:
Has a disability?   Yes   No * if yes, specify the type of disability  

II. PARENT INFORMATION

Mother's Maiden Name: Civil Status: Age  

Religion
Educational Background: : Occupation:
Father's Name: Civil Status: Age
Religion
Educational Background: :   Occupation:
Guardian's Name: Relationship to the Guardian:
Address: Contact No.
Valued Activities in the Family:

III. Student's Interest:

Skills:
Hobbies:
 

Preferred Companions/Barkadas:

Strengths and Weaknesses:

Dreams in life: