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Personal Data Form
Academic Year:2022-2023
All fields are required, but if the information is not
available you can input "-" or "n/a".
By providing the personal data below, the student agrees that the same shall be used by the university, solely for educational purposes. In no case shall the data provided be disclosed except to partner organizations in compliance with contractual obligations or pursuant to law. Finally, it is understood that the personal details provided below may be used to assess student life.
Select student classification
Old
New
Old student number:
Confirm old student number:
Select type of student
Freshman
Transferees
Returnee
Foreign Student
Cross enrollee
Select preferred schedule
Morning
Afternoon
Evening
Select program
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
College
Graduate School
ETEEAP
College of Law
LRN
Select track
Academic
Technical
ARTS DESIGN
Course:
Year Level
1
2
3
4
5
Sem
1
2
Personal Information
Last name
First name
Middle name
Birthdate
Sex
Male
Female
Religion
Civil status
Single
Annulled
Married
Widowed
Nationality
Place of birth
Are you a member of an Indigenous Peoples Group?
No
Yes
If yes, what group?
Are you a person with disability (PWD)?
No
Yes
If yes, what is your disability?
Please specify the year you acquired the status:
Are you on regular medication?
No
Yes
Age
Working
No
Yes
Present address
Permanent address
Mobile no.
Telephone no.
Email
Residence
With parents
With relatives
Boarding
Others
Employer
Employer Address
Occupation
What special assistance does your condition require?
Are you a gifted child?
No
Yes
If yes, what are the details of your medical condition?
Do you require special assistance?
No
Yes
Family Background
Parent's Marital Status
Church Wedding
Civil Wedding
Living Together
Separated
Father Remarried
Mother Remarried
Single Parent
Father Deceased
Father's Last Name
Father's First Name
Father's Middle Name
Age
Birthplace
Address
Contact number
Email address
Highest Educational Attainment
Occupation
Employer
Mother Deceased
Mother's Maiden Last Name
Mother's First Name
Mother's Maiden Middle Name
Age
Birthplace
Address
Contact number
Email address
Highest Educational Attainment
Occupation
Employer
Do you have stepmother/stepfather?
No
Yes
Guardian's name
Relation
Address
Contact number
Email address
Highest Educational Attainment
Occupation
Employer
Average family annual income
Below Php 100, 000
Php 110,000 - Php 200,000
Php 210,000 - Php 300,000
Php 310,000 - Php 400,000
Php 410,000 - Php 500,000
Php 510,000 - Php 600,000
Php 610,000 - Php 700, 000
Php 710,000 - above
Please check if you have sibling(s).
Name of Siblings
Age
Sex
Civil Status
Highest Educational Attainment
Occupation/Employer
Add
Delete
Name of Spouse (if Married)
Applicant's Educational Background
Last Level attended
Nursery
Kindergarten 1
Kindergarten 2
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
College
Graduate School
School Name
Towns
Select
AGONCILLO
ALITAGTAG
BALAYAN
BALETE
BATANGAS CITY
BAUAN
CALACA
CALATAGAN
CUENCA
IBAAN
LAUREL
LEMERY
LIAN
LIPA CITY
LOBO
MABINI
MALVAR
MATAAS NA KAHOY
NASUGBU
OTHERS
PADRE GARCIA
ROSARIO
SAN JOSE
SAN JUAN
SAN LUIS
SAN NICOLAS
SAN PASCUAL
SANTA TERESITA
SANTO TOMAS
TAAL
TALISAY
TAYSAN
TINGLOY
TUY
Year Attended (School Year)
Course (
if college
)
Honors/Awards and Citations Received
School type
Public
Private
Final Grading Average
Community, school or social organization belong?
Catholic Action
Student Government
Sports Club
Theatre Club
School Paper
Glee Club
Others, Specify:
Special Talents / Skills
Beneficiary of any scholarship
Select
Yes
No
If yes, please state the nature of the grantor:
Name of grantor:
Amount granted per semester:
Elementary School
Year graduated
High School
Year graduated
Why did you choose University of Batangas
Aside from studying, do you have any other purpose in staying here in the Philippines? If yes, what is it?
Who referred University of Batangas to you?
What or who is your source or means of funding your tuition and other educational fees?
Have your ever been charged or convicted to for any crime? If yes, for what crime(s)?
What is your Alien Certificate of Registration (ACR) Number?
Please provide your passport details:
Passport number
Date issued
Valid until
Issuing authority
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Reminder
Please make sure to enter the correct details in your application form! Further, make sure that your
birth details
are correctly entered especially your
birth year
. Otherwise, this may result in the
forfeiture
of your
insurance
.