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STUDENT INFORMATION SHEET
Passport
Date: April 09, 2025 School Year: 2024-2025 Semester: 2nd Semester Size
Picture
Type of Student: New
Transferee Graduate School
College Level
TO THE STUDENT: Place mark in the appropriate box and make sure to accomplish this from correctly and completely.
Learner's Referrence Number (LRN):
COURSE TO ENROLL:
First Choice Second Choice Third Choice
BS in Veterinary Technology BS in Agribusiness BS in Agriculture
A. PERSONAL INFORMATION
Name: NACION RAYZEL ANN DELA PEÑA Male Female
Last Name First Name Middle Name Suffix
Sexual Orientation: Gender, if non-heterosexual:
Heterosexual
Lesbian Transgender Gay
(Straigth)
Questioning/Queer Bisexual Others, specify:
Heterosexual (LGBTQ+)
Birthdate: 09/01/2025 Age: 18 Birth Order: Eldest Middle Child Youngest
Only Child No. of Siblings:
Civil Status: Single Married, Name of Spouse: No. of children
Legally Separated Annulled Widowed
Address: 02254 SALUTILLO STREET GUIHING HAGONOY DAVAO DEL SUR 8006
( House No. Street Name Barangay City/Municipality Province Country Postal Code)
Religion: Ethnicity/Tribe: 2 DSWD Household No.: 02254
I am a differently abled person (PWD): No Yes, please specify:
Solo Parent: No Yes
Contact RAYZEL ANN DELAPENA
No.: 09667889900 Email:
[email protected] Facebook Name:
NACION
Do you have any health related condition? No Yes, please specify:
IN CASE OF EMERGENCY, CONTACT:
Name: Relationship: Contact No.:
B. ACADEMIC INFORMATION
Year Level Name of School Address Year Graduated AwardsReceived
No data found!
Senior High School Strand: SCIENCE, TECHNOLOGY, ENGINEERING, AND MATHEMATICS (STEM) STRAND - ACADEMIC
I am involved in the school clubs/organizations. No Yes, please specify:
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C. FAMILY INFORMATION
2
Father's Name: Contact #:
Last Name First Name Middle Name Suffix
Educational Attainment: COLLEGE GRADUATE
Mothers's Name: Contact #:
Last Name First Name Middle Name Suffix
Educational Attainment:
Address: 02254 SALUTILLO STREET GUIHING HAGONOY DAVAO DEL SUR 8006
( House No. Street Name Barangay City/Municipality Province Country Postal Code)
Father's Occupation: Mother's Occupation:
Family Monthly income 0-5,000 5,000-10,000 20,000 above
Range:
10,000-15,000 15,000-20,000
D. OTHER RELEVANT INFORMATION
How did you know about DSSC? (Check all that applies)
Career Guidance Radio Advertisement Posters / Tarpaulin Social Media
Through my parents Through my friends Others, Others, specify:
Reason for choosing DSSC: (Check all that applies)
Quality Education Competent Faculty Free Higher Education
Accessibility Excellent Service Good Administration Others,
specify:
Reason for endrolling the course:
Other Courses preferred: [1] BS in Agribusiness [2] BS in Agriculture
Describe yourself
(traits and characteristics):
Hobbies and Interests:
How do you see yourself ten
years from now?
DATA PRIVACY CONSENT FORM
I, RAYZEL ANN D. NACION , voluntarily give my consent to Davao del Sur State College to use, share, and disclose
relevant personal information and sensitive personal information, given and/or disclosed in this form for purposes of
processing of applications, documentation, research, if applicable, and facilitation of future transactions. The personal
information shall not be shared or disclosed with other parties without my consent unless the disclosure is required by,
on in compliance applicable laws and regulations.
RAYZEL ANN D. NACION April 09, 2025
Student's Signature over printed name Date
