NEW OLD FORMER TRANSFEREE

GUIDANCE OFFICE
STUDENT INFORMATION SHEET

______ESC ______Non
ID NUMBER
ESC

NAME:
(Last Name) (First Name) (Middle Name)
PERSONAL INFORMATION

Gender Birthdate: Month Day Year

Birthplace Email Address

Tel. Nos. Landline Cellphone No.

Home (Permanent) Address No. Street/Subdivision

Barangay Mun/City, Province Zip Code

Blood Type Citizenship Tribal Affiliations Religion

Disability, please specify

Name of Father: __________________________ Name of Mother: __________________________

Contact Number/s: ________________________ Contact Number/s: ________________________
Educational Attainment: ____________________Educational Attainment: ____________________
Occupation: _____________________________ Occupation: _____________________________
Check the following that applies:

OFW: Both Parents Father only Mother Only Broken Family: YES NO

EDUCATIONAL BACKGROUND
Primary Year Last Attended
Intermidiate Year Last Attended
High School Year Last Attended

No. of siblings :

Brothers/Sister Enrolled at Saint Anne Academy:

Name Course & Year Name Course & Year

Name Course & Year Name Course & Year

Credentials Submitted:
( ) Form 138 (ES Card) ( ) SAA Entrance Exams Result
( ) Birth Certificate (PSA) ( ) Transfer Credentials
( ) Permit to Cross-Enroll ( ) Others __________________________________

I certify that the data furnished on this information form as well as the admission requirements
submitted are true and correct. I understand that any concealment/withholding of information in
accomplishing this form or false information/misrepresentation I submitted in this form is enough ground
to disqualify and/or invalidate my admission and/or enrolment at Saint Anne Academy. If admitted, I
promise to uphold the ideals and fully abide by all the rules and regulations of Saint Anne Academy
and of the Department of Education as well as the pertinent Laws of the Republic of the Philippines.

I hereby certify that the above information given are true and correct to the best of my knowledge
and I allow the School and the Department of Education to use my child’s details to create and/or
update his/her learner profile in the Learner Information System and to the School Management
System. The information herein shall be treated as confidential in compliance with the School Data
Privacy and Protocols (Data Privacy Act of 2012).

__________________________________ ________________________________
Parent’s/Guardian’s Original Signature Student’s Signature
Over Printed Name(if around) Date : __________________ Initial of evaluator.

____________