CUMULATIVE RECORDS OF STUDENTS (CuReS)

College : College of Industrial Technology

Course : BS in Industrial Technology (Garments Technology)
Year Level and Section : 1 A
Transferee :
Shifter :
Name : JOHN ANIKIEN TOMBOC ADINA
Student Number : 18-070192
Age : 19 Date of Birth : July 31, 1999
Place of Birth : PEMBO, MAKATI Gender : Male
Citizenship : FILIPINO Civil Status : SINGLE
Indigenous Tribe : None Religion :
Contact Number : 09666716391 Email Address : ANIKIENADINALAXUS@GMAIL.COM
Address : RIGONAN, BRGY. 4 NALUPTA (SUABIT)(POB.), CITY OF BATAC, ILOCOS NORTE
Language(s) spoken at home :
Language(s) most fluent :

BASIC EDUCATIONAL BACKGROUND

Honour(s)
Level School/Address Year Graduated
Received
HILARIO VALDEZ MEMORIAL ELEMENTARY
Elementary 2012
SCHOOL, 4 NALUPTA, CITY OF BATAC
CITY OF BATAC NATIONAL HIGHSCHOOL
Secondary 2016
POBLACION, TABUG, CITY OF BATAC
Easiest Subject(s): Hardest Subject(s):

FAMILY BACKGROUND
FATHER MOTHER
Name ALLAN SALENGA ADINA MYLA MIRANDA TOMBOC
Biological father? Biological mother?
Date of Birth
Place of Birth
Address
Contact Number 09454827450 09973458340
Email Address
Highest Educational Attainment
Occupation BARBER FOODHANDLER
Business Address
Annual Income
Father an OFW? Mother an OFW?

Educational expenses provider

Number of brother(s)/sister(s) studying :
Public School :
Private School :

Family member co-residing with you

Total members of family residing with you :
Total members of family working/employed :

Household sources of income

Date updated : October 24, 2018 || Date generated : October 24, 2018
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Family items
Number of working Number of working
Items Items
units units
AM/FM radio Stereo/Audio system
Karaoke Piano/Organ/Electric keyboard
Installed telephone lines Cell phone
Video player (DVD/VCD/VHS
Television set
player)
Video camcorder Wood/Charcoal/Kerosene stove
LPG stove Electric stove
LPG cooking range with oven Microwave oven
Refrigerator Freezer
Washing machine Air conditioner
Electric water pump and tank Electric water heater
Notebook/Laptop personal
Desktop personal computer
computer
Computer game system (e.g.
Car/Van
playstation)
Owner type jeep Truck
Passenger jeepney Motorcycle
Tricycle

Classification of the house your family is staying

PARENT'S MARITAL STATUS

Number of Brother(s) :
Number of Sister(s) :
Order of birth :
Do you stay in a boarding house? No

UNIQUE FEATURES
Talent(s)/Skill(s) :
Hobbies :
Ambition/Goals :
Principle(s) in Life :

HEALTH
Disabilities/Impairments :
Accidents experienced/effect :
Chronic Illnesses :
Present Concerns/Problems :
Present Fears :

CAPACITIES AND INTERESTS

Individual games : Group games :
Type of books : Music :
Favorite place : Foods :

SOCIAL RELATIONSHIPS
At home

At school

Date updated : October 24, 2018 || Date generated : October 24, 2018
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 DATA PRIVACY CONSENT
I explicitly and unambiguously consent to the collection, processing and storage of my personal data by MMSU
for the purpose(s) described in the MMSU Data Privacy Notice (http://www.mmsu.edu.ph/about/mmsu-data-
privacy-notice).

I hereby further certify that above data given by me is true and correct to the best of my knowledge.

JOHN ANIKIEN TOMBOC ADINA

Signature
Date: October 24, 2018

Date updated : October 24, 2018 || Date generated : October 24, 2018
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TEST RECORDS
Nature/Title of Test Result
Intelligence Test
Achievement Test Subtest:
Aptitude Test
Personality Test
Interest Test
Date Accomplished:_______________
COUNSELOR'S NOTE
PSYCHOLOGICAL CONSULTATIONS
Have you consulted a Psychiatrist before? ( )YES ( )NO
REASON(s)
Have you consulted a Psychologist before? ( )YES ( )NO
REASON(s)
Have you consulted a Counselor before? ( )YES ( )NO
REASON(s)
Counseling Sessions:
COUNSELING SESSION
Date:_______________________________________
( )Referred ( )Called for ( )Walk-in
Reffered by:_________________________________
Reason(s):___________________________________
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Date:_______________________________________
( )Referred ( )Called for ( )Walk-in
Reffered by:_________________________________
Reason(s):___________________________________
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Date:_______________________________________
( )Referred ( )Called for ( )Walk-in
Reffered by:_________________________________
Reason(s):___________________________________
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Date:_______________________________________
( )Referred ( )Called for ( )Walk-in
Reffered by:_________________________________
Reason(s):___________________________________
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Date updated : October 24, 2018 || Date generated : October 24, 2018
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Date Taken
Signature
REMARKS
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