DATA PRIVACY NOTICE

The College of Business, Entrepreneurship and Accountancy of Cagayan State University - Andrews Campus has a policy regarding the data it gathers,
uses, shares, and/or processes, which is described in this data privacy notice. In order to protect and guarantee the privacy, safety and security, and
responsible use of your personal data under its control and custody, CBEA - Andrews is committed to comply with the Philippine Republic Act No.
10173, also known as the Data Privacy Act of 2012 (DPA). In general, CBEA - Andrews will only share your personal information with other parties
with your permission and in accordance with any laws that may be in force.
Sensitive personal data (such as a personal data sheet, private educational records, age, birthday, civil status, health, ethnicity, etc.) may be processed
or revealed with the data owner's consent if it is legally permitted to do so.
Rest assured that only authorized CBEA - Andrews employees are allowed to process your personal information as part of their official duties.

STUDENT PROFILE

A. PERSONAL DATA:
Name: ____________________________________________________________________________________________
(Family Name) (First Name) (Middle Name) (Nickname)
Date of Birth: _________________________ Age: _________ Sex: _________ Nationality: _______________________
Place of Birth: ______________________________________ Civil Status: ______________ Religion: ______________
Home Address: ____________________________________________ Telephone/Cellphone No.: __________________
Name of Guardian/Landlady/Landlord: __________________________________________________________________
Address in Tuguegarao City: __________________________________________________________________________
Hobbies/Talents/Interests/Skills: _______________________________________________________________________

B. FAMILY DATA:
Father: ( )Living ( )Deceased Mother: ( )Living ( )Deceased
Name: _____________________________________________ _____________________________________________
Address: ___________________________________________ _____________________________________________
Telephone/ Cellphone No.: ____________________________ _____________________________________________
Occupation/ Position: ________________________________ _____________________________________________
Business/ Office Address: _____________________________ _____________________________________________
Telephone/ Cellphone No.: ____________________________ _____________________________________________
Number of children in the family: _______________________
Name of brothers/sisters Date of birth Age Remarks (whereabouts)
___________________________________ _______________ ______ ______________________________
___________________________________ _______________ ______ ______________________________
___________________________________ _______________ ______ ______________________________
___________________________________ _______________ ______ ______________________________
___________________________________ _______________ ______ ______________________________

C. EDUCATIONAL DATA: Year Graduated Honors Received

1. Elementary: _______________________________________ _____________ _________________________
School Address: ____________________________________________________________________________________
2. Secondary: ________________________________________ _____________ _________________________
School Address: ____________________________________________________________________________________
3. College: __________________________________________ _____________ _________________________
School Address: ____________________________________________________________________________________
Are you a scholar? ( ) Yes ( ) No
If yes, what scholarship program? ______________________________________________________________________
Are you a transferee? ( ) Yes ( ) No
If yes, what school and course? ________________________________________________________________________
What organizations are you a member or have been a member?
Name of Organization Position
_____________________________________________________________ ________________________________
_____________________________________________________________ ________________________________
_____________________________________________________________ ________________________________

I certify that the statements above are true and correct to the best of my knowledge.
Latest ID
Picture

_______________________________ _______________________________
Date Signature over printed name

F-CBEA-7312 REV 0, JULY 19, 2023