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Name

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Position/ title

Contact no.:________________________ LRN: ___________________________________

Hometown:_________________________________ Civil Status: ______________________________

Birthdate:______________________ Age: ______________________

Sex: _________________________ Language/ Dialect spoken: ___________________

Name of Mother: ____________________________ Occupation:_____________________________

Name of Father: _____________________________ Occupation:_____________________________

Name of Brother/s:___________________________ Name of sister/s:_________________________

Guardian’s name: ______________________________

Award/s received (before): _______________________________________________________________

My best subject is:__________________________ My worst subject is:_______________________

Favorite color: ____________________________ why?:__________________________________

Favorite pet: _______________________________ why?:__________________________________

Favorite food: ______________________________ why?:__________________________________

Favorite book: ______________________________ why?:__________________________________

Favorite movie: _____________________________ why?:__________________________________

Favorite song: _______________________________ why?:_________________________________

Favorite tv series: ____________________________ why?:__________________________________

Hobbies/ field of interest:___________________________________________

My achievements: ______________________________________________________________________

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Dreams/ Ambition in life: ________________________________________________________________

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This year, I would like to learn:____________________________________________________________

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Something new I would like to do this year:__________________________________________________

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My family can help me most this year by: ___________________________________________________

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My teacher can help me most this year by:__________________________________________________

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My child’s strengths are: : _______________________________________________________________

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My child needs help with: _______________________________________________________________

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This year, I would like my child to: _________________________________________________________

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We would like the teacher that: ___________________________________________________________

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Name and Signature