Republic of the Philippines

Bicol University
Legazpi City
2x2 picture
with name tag

STUDENT PROFILE
Course :
Student Name :
Last First Middle Name
Complete Address :
Date of Birth : Cellphone Number :
Place of Birth : E-mail Address :
Age :
Gender :
Status :

Father's Name :
Last First Middle Name
Occupation : Contact No.: _______________________
Complete Address :
Mother's Name :
Last First Middle Name
Occupation : Contact No.: _______________________
Complete Address :
Guardian :
Last First Middle Name
Occupation : Contact No.: _______________________
Complete Address :
Family Gross Monthly
Income :

RECORDS OF PRELIMINARY EDUCATION

Name of School Address Date Graduated

Elementary :
Junior High :
Senior High :
Honors Received : Learner's Reference Number (LRN): __________________________________
4P'S Beneficiary ( ) Yes ( ) No If Yes, indicated DSWD Household ID No.: ______________________________________________

I HEREBY CERTIFY that the above data are true and correct:

Signature

CHECKLIST OF REQUIREMENTS FOR INCOMING FRESHMEN

1 BUCESS Result (Original) ____9 Police Clearance
2 Form 138 ( Senior High School 1st & 2nd Semester) ____10 3 pcs 2x2 picture (white background with nametag)
3 2 pcs Long Folder ____11 Waiver and parents permit
4 Certificate of Good Moral ____12 COVID Vaccine card (Photocopy)
5 2 pcs Long Brown Plastic Envelope ___13 1 Window mailing envelope with mailing stamp
6 Medical Certificate ___14 Certificate of attendance to stakeholders meeting
7 3 pcs PSA Birth Certificate (5 pcs for laderized program) ___15 Photocopy of panunumpa with
DSWD Household ID Number.(If 4P's beneficiaries)

NOTE: PLEASE RETAIN PERSONAL COPY OF ALL SUBMITTED DOCUMENTS.

Cheked by :
Dept./Prog. Chair :
Date :