Republic of the Philippines

Department of Education
REGION IV-A CALABARZON
SCHOOLS DIVISION OF CALAMBA CITY
CALAMBA CITY SCIENCE INTEGRATED SCHOOL
CHIPECO AVE., BRGY. 3, CALAMBA CITY

STUDENT DATA SHEET 1x1 ID pic

NAME(LS, FN,MN): __________________________________________ SEX: ____________________

BIRTHDAY (month-day-year): ____________________________ BLOOD TYPE: ___________

HEIGHT: _____________cm WEIGHT: ______________kg

ORDER OF BIRTH (eldest, second, etc. ) : ____________ of ______ children

ADDRESS: __________________________________________________________________________________________________________

CONTACT NUMBER: ________________________________________________________________________________________________

ALLERGIES:
_________________________________________________________________________________________________________

SPECIFIC DIAGNOSED HEALTH CONDITION (If there is any): _______________________________________________________________

PARENT/GUARDIAN

NAME OF MOTHER: ________________________________________ CONTACT NUMBER:_________________________

OCCUPATION: ____________________________________________

OFFICE: ___________________________ OFFICE ADDRESS: _______________________________

NAME OF FATHER: _________________________________ CONTACT NUMBER:_____________________

OCCUPATION: ____________________________________________

OFFICE: __________________________________________________ OFFICE ADDRESS: _________________________________

GUARDIAN: ______________________________________________ CONTACT NUMBER:_________________________

OCCUPATION: ___________________________________________

OFFICE: __________________________________________________ OFFICE ADDRESS: _______________________________

EDUCATIONAL BACKGROUND:

ELEMENTARY: ________________________________________________________ ADDRESS: ___________________________________

AWARD/S RECEIVED: ______________________________________________________________________________________________

JUNIOR HIGH SCHOOL: _______________________________________________ ADDRESS: ___________________________________

AWARD/S RECEIVED: _______________________________________________________________________________________________

COURSE TO TAKE IN COLLEGE:

FIRST CHOICE: ________________________ SECOND CHOICE: _____________________

DRAW A MAP OF THE LOCATION OF YOUR HOUSE. INCLUDE SPECIFIC LANDMARKS IF POSSIBLE. (From our
school to your house)