FM DOrSU ODI 05 Student Profile Form
FM DOrSU ODI 05 Student Profile Form
FM DOrSU ODI 05 Student Profile Form
STATE UNIVERSITY
Issue Status Rev No. Effective Date Page No.
01 00 07.22.2022 1 of 2
Instructions:
a) Fill out this form completely and correctly.
b) Write legibly. Mark all appropriate boxes/spaces with a check mark(/)
18. Name of Spouse(if married): ________________ Occupation: ________ Number of Children: ______
19. Father’s Name: __________________________ Occupation: _________ Contact No.:____________
20. Mother’s Name: _________________________ Occupation:___________ Contact No.:___________
21. Person to Contact in Case of Emergency: _____________________ Contact No.:________________
Address: ______________________________________________________________________
22. Elementary: _______________________________________ Year Graduated: __________________
23. Senior High School: _____________________ Strand: _________ Year Graduated: ______________
Document Code No.
STATE UNIVERSITY
Issue Status Rev No. Effective Date Page No.
01 00 07.22.2022 2 of 2
For Transferee
V. OTHER INFORMATION
27. Are you a person with disability(PWD)? Yes No If yes, give details (type of disability): _______
28. Are you a single parent? Yes No If yes, give details (number of children):______
29. Are you a working-student? Yes No If yes, give details (employer):______________
PLEDGE
In consideration of my admission to the Davao Oriental State University, I hereby promise and pledge to abide by
and comply with all the rules and regulation laid down by competent authority in the State University and in the
institute in which I am enrolled. By providing information to the Admission Office, I am confirming that all data
supplied are true, complete and correct. I understand that giving false and lacking information will make me
ineligible for admission, and that DOrSU reserves the right to revise any decision made on the basis of the
Information I have provided, should the information be found to be untrue and incorrect.
As a student, I understand and agree that by providing my personal data, I am agreeing to the Data Privacy Policy
and Terms of the Davao Oriental State University(DOrSU) and giving my full consent to the institution and its
affiliates as well as its partners and service providers, if any, to collect, store, access and/or process any personal
data I may provide here in, whether manually or electronically for the period AY_________ until the Academic
Year of my graduation or withdrawal/transfer from the institution, for the purpose of my admission, enrolment,
research and other legitimate records processing under this office concerned. I acknowledge that the collection
and processing of my personal data is necessary for such purposes.
___________________________ __________________________
Student’s Signature Printed Name Date Signed