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COLLEGE - Student Information Sheet
COLLEGE - Student Information Sheet
06/09/2021
Date Filed: ____________
1x1
Freshmen Transferee Returning Student Number: _____________________
18NE0089
ID picture
BSED-MATH Year & Section: _________
Course: __________ III Semester: ( ) First (✔) Second 2020-2021
School Year: __________
Instruction: Please COMPLETE this INFORMATION SHEET. Rest assured that all information contained in this form will be
kept CONFIDENTIAL.
A. PERSONAL DATA
Name: TEVES, PETER JOHN F. Nickname: PJ
(Surname) (Given Name) (Middle Name)
Age: 21 Civil Status: (✔)Single ( )Married: ( )Separated Sex: (✔)Male ( ) Female
Date of birth: 12/28/19999 Place of birth: VIRAC, CATANDUANES Birth order among siblings: 2
Religion: CATHOLIC Nationality: FILIPINO Dialects/Language Spoken: FILIPINO,ENGLISH
Contact No: 09268407626 Email Address: [email protected]
Current Address: Nagpandayan Guimba N.E. Contact No: 09268407626
Permanent Address: Nagpandayan Guimba N.E. Contact No: 09268407626
B. FAMILY BACKGROUND
Father Mother
(Mark with if deceased) Mark with if deceased
Name: PEDRO T. TEVES MYRNA F. TEVES
Date of Birth: 08/05/1963 04/18/1965
Place of Birth: SAN MIGUEL, CATANDUANES Nagpandayan Guimba N.E.
Current Address: Nagpandayan Guimba N.E. Nagpandayan Guimba N.E.
Contact Number: N/A 09654452130
Permanent Address: Nagpandayan Guimba N.E. Nagpandayan Guimba N.E.
Contact Number: N/A 09268407626
Highest Educational Attainment: HIGH SCHOOL HIGH SCHOOL
Occupation: FARMER HOUSE KEEPER
Annual Income (optional): P15,000 N/A
Parents:
✔
___________ Married ____________ Father OFW
___________
✔ Living together ____________ Mother OFW
___________ Legally separated ____________ Mother with another partner
___________ Marriage annulled ____________ Father with another partner
1
Persons to notify in case of emergency:
Name Relationship Contact Numbers Address
MYRNA F. TEVES MOTHER 09268407626 NAGPANDAYAN, GUIMBA N.E
C. EDUCATIONAL BACKGROUND
Educational Level School Attended Public Private Course Inclusive Years
Elementary NAGPANDAYAN ELEMENTARY SCHOOL ✔ 2006-2012
High School NAGPANDAYAN HIGH SCHOOL ✔ 2012-2018
College/University
(for transferee or second courser)
D. UNIQUE FEATURES
Interests/Skills/Talents:
Hobbies/Recreational activities: Playing Music Instuments, DJing, Audio/Video Editing
Ambitions/Goals: To be a good Citizen
Guiding Principle in Life/Motto: True success is when you find your peace in mind.
Characteristics that best describes you: Joyful
E. HEALTH CONDITION
Disabilities/Impairments: N.A
2
F. SELF- ASSESSMENT
Below Above
Categories Poor Average Excellent
Average Average
Self-Confidence ✔
Interpersonal Skills ✔
Self-Discipline ✔
Motivation ✔
Sense of Responsibility ✔
Leadership Potential ✔
Emotional Stability ✔
GUIDANCE ACTIVITIES
SERVICES 1ST YEAR 2ND YEAR 3RD YEAR 4TH YEAR 5TH YEAR
INFORMATION
INTAKE/ ROUTINE
INTERVIEW
COUNSELING
(Individual/ Group/ Academic/
Disciplinary Case Referral/ Counselor’s
Discovery)
FOLLOW-UP
CONFERERENCES
(Parent/ Teacher/ Administrator/
School Personnel)
EXTERNAL REFERRAL