MARIANO MARCOS STATE UNIVERSITY Document Code ELP-TEMP-003

External Linkages and Partnerships

Revision No. 1 Page PAGE 2
of
PERSONAL HISTORY STATEMENT
NUMPAGES
(FOR EXCHANGE STUDENT)
2
Effectivity Date March 19, 2024

Personal History Statement

(For Exchange Students)

Personal Data

Name: DE LA CRUZ NAOMI CLAIRE REYES

Last Name First Name Middle Name
Email Address: namclaire12@gmail.com
Contact Details: 09509466984
English Name (if applicable):
Permanent Address (Home Country): Philippines
Religion: Roman Catholic Status: Single
Date of Birth: January 12, 2001 Citizenship: Filipino
Place of Birth: Zone 4, #200 Baras Canaman, Camarines Age: 23
Sur
Physical Description
Sex: Female Height: 152.5 cm Weight: 42 kg
Eyes (Color): Black Hair (color): Black Complexion: Light Brown
Skin
Physical Disability (if any):
Family Data
Name of Father: Jose Basbas
Address: Baras Canaman, Camarines Sur
Contact Details: 09919097557 Occupation: N/A
Name of Mother: Edna De La Cruz
Address: Baras Canaman, Camarines Sur
Contact Details: 09126176925 Occupation: N/A
Contact Person (in case of emergency): _____ My Father _____ My Mother
If not the parents:
Name: Gorge M. Bagaoisan
Contact Details: Occupation:
Relationship:
Educational Background
Level Name of School Started Finished
1 Elementary Canaman Central School 2007 2013
Address: Canaman, Camarines Sur
2 Secondary Universidad de Sta. Isabel 2013 2017
Address: 4400 Elias Angeles, Naga, Camarines Sur

Disclaimer: Reproduction of this form is allowed subject

to compliance to the Documented Information Procedure
established by MMSU.
 MARIANO MARCOS STATE UNIVERSITY Document Code ELP-TEMP-003
External Linkages and Partnerships
Revision No. 1 Page PAGE 2
of
PERSONAL HISTORY STATEMENT
NUMPAGES
(FOR EXCHANGE STUDENT)
2
Effectivity Date March 19, 2024

Universidad de Sta. Isabel 2017 2019

Address: 4400 Elias Angeles, Naga, Camarines Sur
3 Tertiary University of Nueva Caceres 2019 2021
Mariano Marcos State University 2021 2024
Degree Bachelor of Physical Education
Faculty College of Teacher Education
Level IV
Email Address of the School: usecretary@mmsu.edu
School Representative
Name of the Coordinator: Dr. Nariza T. Tamayo
Contact Number: 09109002268
Email: nttamayo@mmsu.edu.ph

I hereby certify that the foregoing answers are true and correct to the best of my
knowledge and belief.

Signed at the College of Teacher Education, Mariano Marcos State University,

Philippines on March 19, 2024.

NAOMI CLAIRE R. DE LA CRUZ

Signature over Printed Name of Applicant

Verified True and Correct:

______________ PROF. FE ERLINDA B. IBALIO ___________________

Signature over Printed Name of Coordinator

Disclaimer: Reproduction of this form is allowed subject

to compliance to the Documented Information Procedure
established by MMSU.