Pds for students

1. I. PERSONAL INFORMATION (Write in all capital letters.)
NAME: __________________ __________________ __________________ NICKNAME: __________
(Family Name) (Given Name) (Middle Name)
HOME ADDRESS: ______________________ ______________________ _______________________
(Barangay) (Municipality) (Province)
BIRTHDAY: ____________ ______ _______ BIRTHPLACE: ______________ __________________
(Month) (Day) (Year) (Town/City) (Province)
GENDER: __ Male __ Female __ Gay __ Lesbian __ Bisexual AGE: ____
CELLPHONE NUMBER: __________________ E-MAIL ADDRESS: ______________________________
RELIGION: _____________________________ NATIONALITY: ________________________________
FATHER’S NAME: _______________________ OCCUPATION: ___________________ AGE: ______
MOTHER’S NAME: ______________________ OCCUPATION: ___________________ AGE: ______
PARENTS’ CONTACT NUMBER: __________________________ NUMBER OF SIBLINGS: ___________
PERSON TO BE CONTACTED IN CASE OF EMERGENCY: ____________________________________
CONTACT NUMBER: ____________________ RELATIONSHIP: ________________________________
LANGUAGES SPOKEN: __________________________________________________________________
II. EDUCATIONAL BACKGROUND
GRADE SCHOOL GRADUATED: __________________________ YEAR GRADUATED: ____________
GRADE 7: _____________________________________________ GEN. AVERAGE: _______________
GRADE 8: _____________________________________________ GEN. AVERAGE: _______________
III. RELEVANT QUESTIONS
* Are you from a broken family? ___ Yes ___ No
* Which type of family do you have? ___ Nuclear Family ___ Extended Family
* Have you ever incurred a failing grade before? ___ Yes ___ No
* What’s your strength as a student? ____________________________________________________
* What’s your weakness as a student? __________________________________________________
* What subject interests you most? ____________________
* What makes it interesting? ____________________________________________________________
* What are the three qualities of teacher you like best? __________________________________
* Was there a bad experience you had with your former teacher/s? ___ Yes ___ None
* If yes, please elaborate: ______________________________________________________________
* Have you ever been called at the Guidance Office for misbehavior? ___ Yes ___ Never
* Do you think having boyfriend/girlfriend can affect one’s studies? ___ Yes ___ No
* Choose your specialization/skills (Check at least three)
___ Speaking ___ Singing ___ Cartooning ___ Designing
___ Writing ___ Directing/Leader ___ Video Editing ___ Cooking
___ Dancing ___ Acting ___ Photography ___ Hosting
* What is your greatest dream? _________________________________________________________
* How do you rate the quality of education in Manaoag NHS? (Check one)
___ Excellent ___ Very Satisfactory ___ Satisfactory ___ Poor
* Describe your self in one word: _______________________
I hereby certify that the above information is true and accurate.
_________________
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