Student Information form

Student Information form
Name: __________________ ________________________ _____________________
Last (family) Name First Name Middle Name
Gender: ________________ Birthdate: _______________________
Religion:__________ Personal C.P. #:______________________________
Home tel. #: ___________ Personal email add:_________________________
Vision (poor/good):________ Hearing (poor/good):___________________
Other Disability/ies: _______________________________________ Health Problems: ________________
Do you prefer to work alone or in group? ______________________________________________________________
Hobbies: __________________________________________________________________________________________
Skills: _____________________________________________________________________________________________
Who are your best friends: ___________________________________________________________________________
Do you have a comptuer at home? ______________ Internet connection? ___________
Person to notify in case of emergency __________________ Contact #:
Are you an honor student: ________ Rank: __________ Scholarship Availed: __________________
Name of Parents:
Mother:_______________ Occupation:___________ Cellphone #: ____________
Father: _______________ Occupation:________ Cellphone #:__________
Name of Guardian: _______________ Occupation:______________ Cellphone #:___________
Parent's email address: _________________________
Draw a sketch from school to your house :