GUIDANCE INFORMATION FORM (For 1st Year)

F-SSM-023a | Rev. 1 | 01/08/20 | Page 1 of 2

Fill-in ALL information needed. Indicate N/A if item is not applicable and put a check ✓for the chosen
answer. Rest assured that all information on this form will be treated CONFIDENTIAL.

STUDENT I.D. NUMBER:______________________

( ) New Student ( ) Transferee ( ) Returning Student
PASTE YOUR
PERSONAL DATA
2 X 2 ID
Name:______________________________________________
Course & Year:_______________________________________ PICTURE
Are you a/an: ( ) Day Program Student ( ) Evening Program Student HERE
Date of Birth:________________________________________
Age:_______________________________________________
Sex: ( ) Male ( ) Female
Civil Status: _________________________________________

Name of Spouse (if married):_____________________Occupation of Spouse:___________No.of Children:_____

Residential Address:__________________________________________________________________________
Current Address (if living in boarding house):_______________________________________________________
E-mail Address:________________Facebook Account:________________Cellular Phone No.:_______________
Tribe/Ethnic Group:_____________Religion:__________Languages/Dialects Fluent In:_____________________
Are you a: ( ) Full Time Student ( ) Working Student
If Working Student, where or to whom do you work? _________________________________________________

PARENT’S INFORMATION
Father’s Name:_____________________________________
Contact Number:_______________________ Address:___________________________________________
Employment: ( ) Private ( ) Government Agency ( ) OFW where:________________________
( ) Entrepreneurial ( ) None ( ) Others Specify:______________________
Mother’s Name:_____________________________________
Contact Number:_______________________ Address:___________________________________________
Employment: ( ) Private ( ) Government Agency ( ) OFW where:________________________
( ) Entrepreneurial ( ) None ( ) Others Specify:______________________

Parents are: ( ) Living Together ( ) Permanently Separated ( ) Marriage Annulled/Legally Separated

( ) Temporarily Separated ( ) Father w/another partner ( ) Mother w/another partner
Monthly Family Income (estimated):_____________________
Number of: Siblings:______ Working Siblings:________ College Siblings:_______ High School Siblings:______
Guardian (if not living w/parents):________________________________ Contact No.:______________________

SCAST Result (Please indicate the INDEX)

General Ability:___________ Verbal Aptitude:_____________ Numerical Aptitude:_________
Spatial Aptitude:__________ Perceptual Aptitude:__________ Manual Dexterity:___________

UNIQUE FEATURES
Hobbies/Recreational Activities: __________________________ Motto:________________________________
Special Skills/Talents: __________________________________ Special Interests:________________________

Please continue at the back.

 GUIDANCE INFORMATION FORM (For 1st Year)
F-SSM-023a | Rev. 1 | 01/08/20 | Page 2 of 2
EDUCATIONAL & CAREER PLAN:
Elementary School:______________________________________Year Graduated:_________________________
Secondary School:_______________________________________Year Graduated:_________________________
Vocational School:__________________________Course: ____________Year Graduated:___________________
Last School Attended (if Transferee):_____________________Course Taken:________Year last Attended:______
Honors/Awards received:_______________________________________________________________________
Are you enrolling as a scholar? ( ) YES ( ) NO If Yes, what Scholarship Grant?_______________________
Why did you decide to take the course you are enrolling?______________________________________________
Is it your own choice to enroll in DOSCST? ( ) YES ( ) NO, If NO, who influenced you?_________________
Why did you decide to enroll in DOSCST?_________________________________________________________
What is your plan or ambition in life?______________________________________________________________
What are your Expectations on?
School:___________________________________ Course:_______________________________________
Instructors:________________________________ Students:______________________________________
Subject you like least:_______________________ Subject you like most:____________________________
SELF ASSESSMENT
What traits/characteristics do you think you possess? (You may check as many)
( ) tense/jittery ( ) easily troubled ( ) happy-go-lucky ( ) friendly
( ) confident ( ) responsible ( ) loner ( ) imaginative
( ) submissive ( ) relaxed/calm ( ) suspicious ( ) dominant
( ) independent ( ) dependent ( ) stubborn ( ) sentimental
( ) sensitive ( ) perceptive ( ) idealistic ( ) practical
( ) trusting ( ) insecure ( ) worrier ( ) Others:_____________
What bothers you most at the moment?
( ) Financial difficulty ( ) Health problems, Please specify:________________
( ) Difficulties in adjusting a new school ( ) Interpersonal relationship (parents;friends;siblings)
( ) Study habits ( ) Student-Instructor relationship
( ) Developing self-confidence ( ) Others, please specify: ____________________________
What was your most embarrassing experience in life?
____________________________________________________________________________________________
Things you would like to talk and discuss with:
Friends: ______________________________________ Parents: _______________________________________
Teachers: ______________________________________Counselor:_____________________________________

HEALTH INFORMATION:
Medicines taken regularly:____________________________ Vitamins taken regularly:______________________
Medical operations experienced/effect:__________________ Accident experienced/effect:___________________
Physical disabilities:_________________________________ Chronic illness:_____________________________
Allergy (please specify):________________________________________________________________________

STUDENT’S DATA PRIVACY CONSENT

As a student, I understand and agree that by providing my personal data, I am agreeing to the Data Privacy Policy and Terms of
the college and giving my full consent to Davao Oriental State University (DOrSU) and its affiliates as well as its partners and service
providers, if any, to collect, store, access and/or process any personal data I may provide herein, such as but not limited to my name and
email address, whether manually or electronically for the period AY ________________ for the purpose of my admission, enrollment,
research and other legitimate records processing under this office concerned. I acknowledge that the collection and processing of my
personal data is necessary for such purposes.

Data Privacy Officer

Administration Building
dorsu.hrmo28@gmail.com

By my signature below I, hereby certify that all information I have provided in this form is true and
accurate.

______________________________________ ___________________
Student’s Signature over printed name DATE