University of Luzon

Guidance Center
Dagupan City

PERSONAL DATA SHEET

_______________________ _________________
Course and Year Date

To the Student:
The purpose of this form is to bring together all essential information about you. These data
are considered confidential so please feel free in answering the questions as honestly and
completely as possible.

PERSONAL DATA

1. Name: _____________________________________________________Age: __________ Sex: __________

Surname First Name Middle Initial
2. Birthdate: _________________ Birthplace: _______________ Nationality: ____________________
3. Civil Status: _______________Contact No.: ______________ E-mail Add.: ___________________
4. Permanent Home Address: ____________________________________________________________
5. Presently living in: ( ) with family ( ) with relatives ( ) with friends ( ) boarding house
( ) Others (please specify) ___________________________________________
6. Person to contact in case of emergency: _______________________________________________
Contact number: ___________________________

FAMILY BACKGROUND
1. Father’s Name: ___________________________________ Age: _______ Nationality: ____________
Occupation/Job: ____________________________________
Educational Attainment: Please check (✔) appropriate box.
( ) College Graduate ( ) College Undergraduate ( )High School Graduate ( ) HS Undergraduate
( ) Graduate of a Vocational Course ( ) Elementary Graduate ( ) Elementary Undergraduate
2. Mother’s Name: ___________________________________ Age: _______ Nationality: ___________
Occupation/Job: ____________________________________
Educational Attainment: Please check (✔) appropriate box.
( ) College Graduate ( ) College Undergraduate ( )High School Graduate ( ) HS Undergraduate
( ) Graduate of a Vocational Course ( ) Elementary Graduate ( ) Elementary Undergraduate
3. Number of Brothers: _____________________ 4. Number of Sisters: ________________________

If married, please answer this portion:

Name of Spouse: ______________________________________ Birthdate: ________________________
Age: _____ Nationality: _________________________________ Religion: _________________________
Educational Attainment: __________________________ Occupation/Job: ________________
Number of children: ________________ Boys: ___________ Girls: _______________

What is the average monthly income of your family? Include the income received by your
parents? Include the income received by your parents and those contributed by your
brothers and sisters and you. Please check (✔) appropriate box.
( ) Php 5,000 and below ( ) Php 5,001 – Php 10,000 ( ) Php10,001-Php 15,000
( ) Php 15,001 and Php 20, 000 ( ) Php20,001 and above
EDUCATIONAL BACKGROUND

Name of School Attended Year Graduated Honors/Rank in Class

1. Elementary

___________________________ _________________ _______________________

2. Junior High School

___________________________ _________________ _______________________

3. Senior High School

___________________________ _________________ _______________________

4. College

___________________________ _________________ _______________________

5. Special courses or training (if any)

Kind Where Inclusive Dates

___________________________ _________________ _______________________

___________________________ _________________ _______________________

Special Interest, Hobbies, Special Abilities:

What were your activities in sports, school paper, clubs, and organizations during high
school? Example: Choir member, Varsity, News Editor, Member-Science Club, Junior Counselor
etc.

__________________________________________________________________________________________

WORK HISTORY AND EXPERIENCE

Employment records (start from your latest job/work)

1. Company Name: __________________________________Address: _________________________

Hours of work: _________________ Position: _______________ Monthly Salary: __________
Inclusive dates Month, Year: _________________