Liceo de Cagayan University

Senior High School - Paseo del Rio Campus

Office of the Prefect of Discipline and Student Affairs
School Year 2020-2021

STUDENT'S INFORMATION SHEET 2 X 2 Photo`

Last Name Given Name Middle Name Suffix (Jr./II)

Month: Day: Year: 2
Grade Level & Section Age Gender Date of Birth

Place of Birth Religion Blood Type

Visaya Ft. Inches kg
Mother Tongue IP (Ethnic Group) Height (in Feet and Inches) Weight (in Kilograms)

Contact Details of the Student LRN:

Complete Home Address:
House # / Street / Sitio / Purok

Barangay Municipality / City Province

Draw both sketches of your home and present addresses at the back of this page, highlighting important landmarks and specifying transportation details.

Complete Present Address:

Street Barangay
Cellphone No: - - Email Address: @
First 4 digits Mid 3 digits Last 4 digits

Telephone No: Facebook Account:

In case of emergency, who is the best person to contact?
Name: Cellphone No: - -
First 4 digits Mid 3 digits Last 4 digits

Relationship with student: Office Number:

Contact Details of the Parents/Guardian

Mother's Maiden Name:
Last Name First Name Middle Name
Occupation: Cellphone No: - - Office No:
First 4 digits Mid 3 digits Last 4 digits
Business / Company Address:

Father's Name:
Last Name First Name Middle Name
Occupation: Cellphone No: - - Office No:
First 4 digits Mid 3 digits Last 4 digits
Business / Company Address:

Name of Guardian: Cellphone No: - -

First 4 digits Mid 3 digits Last 4 digits

Occupation: Office Number:

Business / Company Address:

Email Address of all or any of the parents/guardian:

Other Relevant Information

List down the names of your siblings / relatives / schoolmates studying in Liceo U and living in your neighborhood:
Name Year & Section Name Year & Section
1. 3.
2. 4.

Specimen signatures of: (Please sign thrice to establish signature consistency / identity.)

Father

Mother

Guardian

I hereby certify that all data written herein are true and correct to the best of my knowledge.

_____________________________________________
Signature of Student
 Liceo de Cagayan University
Senior High School - Paseo del Rio Campus
Office of the Prefect of Discipline and Student Affairs
School Year 2017 - 2018

STUDENT'S INFORMATION SHEET 2 X 2 Photo`

Last Name Given Name Middle Name Suffix (Jr./II)

Month: Day: Year: 2
Grade Level & Section Age Gender Date of Birth

Place of Birth Religion Blood Type

5 Ft. 6 Inches 167.64 cm kg
Mother Tongue IP (Ethnic Group) Height (in Feet and Inches) Weight (in Kilograms)

Contact Details of the Student LRN:

Complete Home Address:
House # / Street / Sitio / Purok

Barangay Municipality / City Province

Draw both sketches of your home and present addresses at the back of this page, highlighting important landmarks and specifying transportation details.

Complete Present Address:

Street Barangay
Cellphone No: 0917 - 123 - 4567 Email Address: @ ymail.com
First 4 digits Mid 3 digits Last 4 digits

Telephone No: Facebook Account: www.facebook.com /

In case of emergency, who is the best person to contact?
Name: Cellphone No: 0917 - 123 - 4567
First 4 digits Mid 3 digits Last 4 digits

Relationship with student: Office Number:

Contact Details of the Parents/Guardian

Mother's Maiden Name:
Last Name First Name Middle Name
Occupation: Cellphone No: 0917 - 123 - 4567 Office No:
First 4 digits Mid 3 digits Last 4 digits
Business / Company Address:

Father's Name:
Last Name First Name Middle Name
Occupation: Cellphone No: 0917 - 123 - 4567 Office No:
First 4 digits Mid 3 digits Last 4 digits
Business / Company Address:

Name of Guardian: Cellphone No: 0917 - 123 - 4567

First 4 digits Mid 3 digits Last 4 digits

Occupation: Office Number:

Business / Company Address:

Email Address of all or any of the parents/guardian:

Other Relevant Information

List down the names of your siblings / relatives / schoolmates studying in Liceo U and living in your neighborhood:
Name Year & Section Name Year & Section
1. 3.
2. 4.

Specimen signatures of: (Please sign thrice to establish signature consistency / identity.)

Father

Mother

Guardian

I hereby certify that all data written herein are true and correct to the best of my knowledge.

_____________________________________________
Signature of Student