INSTITUTE OF STUDENT AFFAIRS, CHARACTER EDUCATION, AND CITIZENSHIP
GUIDANCE SERVICES AND CAREER DEVELOPMENT UNIT
GSCDU F. 002
STUDENT INFORMATION UPDATE FORM AGach 1x 1
RECENT Photo
By filling – out this form, I hereby authorize the Ins?tute of Student Affairs, Character Educa?on,
and Ci?zenship to use my personal informa?on for counseling and research purposes.
Academic Year: 2024 – 2025, First Semester Student No: _____________________________
PERSONAL INFORMATION
Name of Student: ____________________________________________________ Age: ___________
(Surname) (First Name) (Middle Name)
Course & Year Level: ___________________ Gender: _______________ Blood Type: ___________
NaGonality: ________________ Civil Status: __________________ No. of children (if any): _______
Religion: ____________________ Contact No: _______________ E-mail Address: _______________
Spouse’s/Common-Law Partner’s Name: ___________________________ Contact No.: ___________
Present Home Address: _________________________________________________________________
_____________________________________________________________________________________
Permanent Home Address: _______________________________________________________________
_____________________________________________________________________________________
Are you employed? ( ) Yes ( ) No Number month(s) / year(s) working: ______________________
If yes, name of employer/company: ________________________________
Address of employer: ___________________________________________________________________
If business owner, nature of business: ______________________________________________________
EMERGENCY CONTACT
Name: _______________________________________ Contact Nos. _____________________________
Email Address: _______________________ RelaGonship to the Student: ______________________
HEALTH INFORMATION
How would you rate your physical health? ( ) Excellent ( ) Good ( ) Fair ( ) Poor
Are you presently under a doctor’s care for any condiGon? ( ) No ( ) Yes, specify ________________
List any medicaGons you are taking: _______________________________________________________
Have you been treated for any psychological reason/s? ( ) No ( ) Yes, specify ____________________
Reason for treatment: _______________________________________________ Date: ____________
Have you had a problem with? ( ) Alcohol/Substance Abuse ( ) EaGng Disorder ( ) Depression
( ) Aggression ( ) Mood Disorder ( ) Others, please specify: ______________________________
Do you engage in physical fitness acGvity? ( ) No ( ) Yes
How o]en: ( ) Not at all ( ) 2-3 Gmes a week ( ) Everyday ( ) 2-3 Gmes a month
By signing, I cerGfy that all the informaGon reported is complete and correct.
_________________________________ ___________________
Signature over Printed Name of Student Date Signed
