BOHOL ISLAND STATE UNIVERSITY

Bilar Campus
Office of the Registrar

Vision: A premier Science and Technology university for the formation of world class and virtuous human resource for sustainable development in
Bohol and the country.
Mission: BISU is committed to provide quality higher education in the arts and sciences, as well as in the professional and technological fields;
undertake research and development and extension services for the sustainable development of Bohol and the country.
_______________________________________________________________________________________________

Name of Student: _____________________________________________ Student I.D. No._________________

Curricular Program/Major/Year Level: _____________________________

HOUSEHOLD INFORMATION QUESTIONNAIRE (HIQ)

FAMILY PROFILE
1. Profile of family members (Please include all family members/relatives presently living under the same roof and share
in common food).
No. Name Relationship Age Civil Highest Grade of Occupation Class of Gross
(Put Family Head as to Applicant Status Educational Year of Working Worker Monthly
first in the list; (See Attainment Level Family (See Income
include name of codes (Specify Attending Member codes (in
applicant) below) grade, year if below) Pesos)
level or Currently
degree) in School
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.

*Family Head usually provides the chief source of income for the family. He/She is responsible for the organization and care of the family.

Codes for Civil Status (Column 5)

1- Single 2- Married 3- Widowed
Codes for Class of Worker (Column 9)
1- Works for Private Household
2- Works for Private Establishment
3- Works for Government Agency/Corporation
4- Self-employed without any employee
(e.g., sari-sari store owner, dressmaker)
4- Divorced/Separated 5- Unknown
5- Employer in own family-operated farm/business
6- Works with pay on own family-operated farm/business
7- Works without pay on own family-operated farm/business
8- Unemployed (e.g. housewife)

2. A. Annual Family Gross Income 2023: ___________________

2. B. If both parents are unemployed, do you have any relatives other than those in the profile of family members (whether
here or abroad), who contribute in meeting your family expenses? YES_____ NO_____
If YES, please accomplish the table below:
Nature of Financial Relationship of Contributor Frequency of Contribution Average Contribution
Contribution to Applicant (please check) (in pesos)
(e.g., remittances) (e.g., brother who is an OFW)
( ) Monthly ( ) Quarterly
( ) Every ____(no. of mos.) month
( ) Monthly ( ) Quarterly
( ) Every ____(no. of mos.) month
Reminder:
• If your parent or family head is EMPLOYED or HAS his/her OWN BUSINESS, please submit Income Tax Return (ITR)
for the year 2023.
• If your parent or family head is EMPLOYED but has NO Income Tax Return (ITR), please submit Employment
Certificate stating the Monthly Salary or Employment Contract.
• If your parent or family head is an OFW, please submit OFW Contract.
• If your parent or family head is SELF-EMPLOYED and HAS LOW INCOME, please submit Barangay Certificate of Low
Income stating the source and amount of income every month.
• If your parent or family head HAS NO WORK and depending only to remittances or financial assistance, please
submit Barangay Certification stating that parents has no work, and the nature and amount of remittance/financial
assistance received.
(e.g., pension, remittance from family member/relatives, 4Ps)

3. Ownership of the housing unit: (Please check)

____Owned, Fully Paid _____Rented _____Others, please specify____________
____ Owned, Amortized _____Rent Free/Living w/ Relatives
If Rented, how much is the monthly rental? _______________
If Amortized, how much is the monthly amortization? _____________

4. Does your family own hectares of agricultural or non-residential land? YES______ NO______
If YES, please indicate the area in square meters. ______________________

5. Electric Bill of the most recent month (in pesos): __________________

(Note: Please attach clear photocopies of the electric bill.)

I certify that I am the data subject, and the information given above is correct to the best of my knowledge and belief.
I hereby consent Bohol Island State University to store and process my information under the terms of Republic Act No.
10173 also known as the Data Privacy Act of 2012.

_________________________________________
Student’s Signature Over Printed Name