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PERSONAL DATA FORM
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Please accomplish the form completeley and accurately. Do not use abbreviations. If a question is not applicable write "NA" on the space provided.
         
APPLICATION FOR SCHOOL YEAR: 20-20
Application Number:
 
     
Date of Application:
 
         

         
Type of Student Freshman Transferees Returnee Foreign Student Cross-enrollee
         
Campus Lipa Batangas  
         
Preferred Schedule Morning Afternoon Evening  
         
Level Applied for:        
         
Pre - Elementary Nursery Kindergarten 1 Kindergarten 2  
         
Elementary Grade 1 Grade 2 Grade 3 Grade 4
  Grade 5 Grade 6    
         
Junior High School Grade 7 Grade 8 Grade 9 Grade 10
         
Senior High School Grade 11 Grade 12
         
College Program:
         
  Semester: Year Level:
         
Graduate School Program:
         
College of Law    
         
Please check the UB sponsored activities you have attended: Student Leadership Room to Room Career Talk/Fair        Other Promotional Activities
         
If others, please specify: When:
         

APPLICANT'S PERSONAL INFORMATION
         
         
Lastname
         
Firstname
         
Middle Name
         
  Age: Civil Status: Date of Birth: Nationality:
 
         
  Gender: Religion: Place of Birth : Working:
  Male Female Yes No
         
Present Address:
   
Permanent Address:
         
Contact Number: Email Address:  
         
Residence: With Parents With Relatives Boarding Others:
         

FAMILY BACKGROUND
         
Parent's Marital Status Church Wedding Living Together Father Remarried  
  Civil Wedding Separated Mother Remarried  
         
Deceased.        

Father's Name:


Age:


Birthplace:

           
Address: Contact Number: Email Address
           
Highest Educational Attainment: Occupation: Employer:
         
Deceased.        

Mother's Name:


Age:


Birthplace:

           
Address: Contact Number: Email Address
           
Highest Educational Attainment: Occupation: Employer:
         
Do you have a stepfather/stepmother? Yes No        
           
Guardian's Name : Age: Relation:
           
Address: Contact Number:    
           
Highest Educational Attainment: Occupation: Employer:
         
Add Delete
Do you have siblings?
Name of Siblings
Age
Sex
Civil Status
Highest Educational Attainment
Occupation/Employer

         
AVERAGE MONTHLY FAMILY INCOME (Please check one only.)
         
  Below Php 10,000.00
Php 31,000 - Php 40,000
Php 61,000 - Php 70, 000
         
  Php 11,000 - Php 20,000
Php 41,000 - Php 50,000
Php 71,000 - above
         
  Php 21,000 - Php 30,000
Php 51,000 - Php 60,000
Please specify:
       
         

EDUCATIONAL BACKGROUND


         
   
LAST SCHOOL ATTENDED
   
         
Levels Attended
Name of School
           Address Years Attended
         
         
Course (if college)  
Honors. Awards and Citations Received:  
         
Type of School: Private Public District: 1 2 3 4 5 6  
         
General Weighted Average:
Outside Batangas Province:
         

What community, school or social organization do you belong to?
         
Catholic Action Student Government Sports Club Theatre Club School Paper
         
      Glee Club Others, Specify:
         
Special Talents / Skills:    
         
Are you a beneficiary of any scholarship program? Yes No    
         
If yes, please state the nature of the grantor:  
         
Name of grantor: Amount granted per semester:
         

GENERAL PERSONALITY MAKE - UP


         
Persevering Irritable Suspicious Lazy Easily Exhausted
         
Optimistic Poor Health Sensitive Submissive Quiet
         
Friendly Nervous Calm Easily Bored Thoughtful
         
Reserved Moody Depressed Sarcastic Unhappy
         
Stubborn Feels Inferior Jealous Patient Quick Tempered
         
Shy Contented Capable Pessimistic Talkative
         
Self Confident Talented Lovable Tactful Cheerful
         
        Others
         
Which whom do you feel at ease and relaxed discussing your problems?
         
Check one or more areas which you would like to discuss with your counselor?    
         
Vocational Educational Emotional Personal Social
         
Family Related Others:      
         
I hereby apply for admission to the University of Batangas. I agree to abide by its rules and regulations. I certify that the forgoing information is true and complete to the best of my knowledge and fully realize that omission or falsification of any information will be considered sufficient reason for rejection of this application or for dismissal, even already admitted.
         
         
     
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