AQUINAS SCHOOL Guidance & Testing Center 183 F. Blumentritt St. San Juan, MM 724-54-66 to 69; 723-67-56 Telefax:723-67-55 E-mail:
[email protected]
Date of Application ____________________ Application for: _________________________ (Grade/Year Level)
ASG-021
App. No.____
School Year_____-_____
INFORMATION SHEET (Directions; Fill-up all items correctly. Write N/A for an item that does not apply. Please PRINT all entries.)
PERSONAL DATA Student’s Name: _____________________________ ______________________________ __________ (Last) (First) (Middle) Date of Birth:______________
Place of Birth:________________________
Sex:____ Age:_______
Birth Rank:_______________
Nationality:__________________________
Religion:____________
Address:_______________________________________________________________________________ Tel. Number (Residence):_______________________________ Language Spoken: __________________
FAMILY BACKGROUND (Father)
(Mother)
Name:
__________________________
__________________________
Date of Birth:
__________________________
__________________________
Occupation:
__________________________
__________________________
Employment Address:
__________________________
__________________________
Tel. No.
__________________________
__________________________
Educational Attainment:
__________________________
__________________________
Last School Attended:
__________________________
__________________________
Marital Status:
Married
Single Parent
Separated
Annulled
Total No. of Children:______ Guardian’s Name (if not living w/ Parents): Relationship:__________________________________ Employment Address:
Occupation: Tel. No.___________________
Medical Information VISION:
Normal
Defective
WEIGHT:
Normal
Under
Over Special Condition/Handicap:______________________________________________________________________ Hospitalization: Ailment
Date
_______________________________
______________________
_______________________________
______________________
_______________________________
______________________
EDUCATIONAL BACKGROUND Honors/ Name of School and Address
Levels Attended
Years Attended
Awards/ Citations
PRESCHOOL:
ELEMENTARY
HIGH SCHOOL
Academic Strengths: _____________________________________________________________________ Academic Limitations: ____________________________________________________________________
Name and Signature of Informant /Relationship
