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ADM FR 003 Student Directory Form Final
ADM FR 003 Student Directory Form Final
Family Background
ADM-FR-003 Rev.:1
Effectivity Date: February 12, 2024 Page 1 of 4
STUDENT DIRECTORY FORM
Family’s Monthly Income ( ✔️) Below P 10, 000 ( ) P 10,000-20, 00 ( ) 20, 000 –
above
Language/ Dialect Spoken at home: _TAGALOG / ENGLISH________________________
Educational Background
Elementary
Name of School _BALOGO ELEMENTARY SCHOOL Inclusive Dates
__2008/2014___
Address __ZONE 1, BALOGO, PASACAO, CAMARINES SUR__________________
Awards/Honor ____NONE_____________
Junior High School
Name of School _DR. LORENZO P. ZIGA MEMORIAL HIGH
SCHOOL______________________________ Inclusive Dates __2014/2018_______
Address _ZONE 1, BALOGO, PASACAO, CAMARINES
SUR_______________________ Awards/Honor ___NONE________________
Senior High School
Name of School __DR. LORENZO P. ZIGA MEMORIAL HIGH SCHOOL___
Inclusive Dates_2018/2020_
Address __ZONE 1, BALOGO, PASACAO, CAMARINES
SUR____________________________________________________________
_________________________________________________________
Clubs/Organizations Joined:
_____SPECTRUM________________________________________________
_________________________________________________________
Working Student? ( ) Yes ( ✔️) No
If Yes, Name and Place of Work:
________________________________________________
________________________________________________________
How do you see yourself 5 years from now? _______WORKING FOR MY DREAMS
_________________________________________________________
Health Conditions
Blood Type: ___B______________ Allergies: NONE_______________
Past/ Current Medical Conditions:
________________________________________________
Have you ever been hospitalized? __NO_____ If yes, for what reason?
____________________