Document Code No.

DAVAO ORIENTAL FM-DOrSU-ODI-05

STATE UNIVERSITY
Issue Status Rev No. Effective Date Page No.
01 00 07.22.2022 1 of 2

“A University of excellence, innovation, and inclusion”

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STUDENT PROFILE FORM

Instructions:
a) Fill out this form completely and correctly.
b) Write legibly. Mark all appropriate boxes/spaces with a check mark(/)

I. APPLICATION FOR ADMISSION

1. DOrSU Student ID Number ____________________________________
(To be filled up by the Admission Office)
2. Semester _____________________ Academic Year _________________
3. First Year Transferee Returnee
4. Campus: ____________________________________________________
5. Preferred Course:
1. ____________________________________________________
2. ____________________________________________________
3. ____________________________________________________

II. PERSONAL INFORMATION

SURNAME FIRST NAME MIDDLE NAME
6. ______________________________________________________________________________________
7. Date of Birth (mm/dd/yyyy): _____________________8. Sex: Male Female
9.Place of Birth: __________________________________________________________________________
(Municipality/City) (Province) (Country)

10. Civil Status: Single Married Widowed Separated 11. Citizenship:___________

12.Height(ft): _______Weight(kg): ________ 13. Religion: ______ 14. Tribe/Ethnic Group___________
15. E-mail Address: _____________________________ 16. Contact Number: ___________________
17. Permanent Address: _____________________________ Zip Code: _________________

III. FAMILY BACKGOUND

18. Name of Spouse(if married): ________________ Occupation: ________ Number of Children: ______
19. Father’s Name: __________________________ Occupation: _________ Contact No.:____________
20. Mother’s Name: _________________________ Occupation:___________ Contact No.:___________
21. Person to Contact in Case of Emergency: _____________________ Contact No.:________________
Address: ______________________________________________________________________
22. Elementary: _______________________________________ Year Graduated: __________________
23. Senior High School: _____________________ Strand: _________ Year Graduated: ______________
 Document Code No.

DAVAO ORIENTAL FM-DOrSU-ODI-05

STATE UNIVERSITY
Issue Status Rev No. Effective Date Page No.
01 00 07.22.2022 2 of 2

“A University of excellence, innovation, and inclusion”

IV. EDUCATIONAL BACKGROUND

24. Vocational: _______________________________ Course: ____________ Year graduated:__________

25. College: ___________________________ Degree: ____________ Year graduated: ________________

For Transferee

26. Last School Attended: ______________________ Course: ____________________________________

Last School Year Attended: __________________

V. OTHER INFORMATION

27. Are you a person with disability(PWD)? Yes No If yes, give details (type of disability): _______
28. Are you a single parent? Yes No If yes, give details (number of children):______
29. Are you a working-student? Yes No If yes, give details (employer):______________

PLEDGE

In consideration of my admission to the Davao Oriental State University, I hereby promise and pledge to abide by
and comply with all the rules and regulation laid down by competent authority in the State University and in the
institute in which I am enrolled. By providing information to the Admission Office, I am confirming that all data
supplied are true, complete and correct. I understand that giving false and lacking information will make me
ineligible for admission, and that DOrSU reserves the right to revise any decision made on the basis of the
Information I have provided, should the information be found to be untrue and incorrect.

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 Davao Oriental State University(DOrSU) and giving my full consent to the institution 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 here in, whether manually or electronically for the period AY_________ until the Academic
Year of my graduation or withdrawal/transfer from the institution, for the purpose of my admission, enrolment,
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.

___________________________ __________________________
Student’s Signature Printed Name Date Signed

Admitted by: _____________________________