( ATTACHED PHOTOCOPY any of PSA OR NSO or LOCAL BC and recent picture)

Republic of the Philippines

DEPARTMENT OF EDUCATION
Region I
Division of Ilocos Sur
TAGUDIN DISTRICT
GARITAN INTEGRATED SCHOOL

PUPILS PROFILE

LRN:________________________

NAME:_________________________________________________________________________________________________
Surname Given Name Middle Name
ADDRESS:_______________________________________________________________________________________________

BIRTHDAY:________________________________ BIRTHPLACE:___________________________________________________

AGE:___________ RELIGION:_____________________ DIALECT/LANGUANGE SPOKEN:_________________________

WEIGHT: ____________ HEIGHT 1:___________ HEIGHT 2: ___________ BMI:_________

FATHER’S NAME: ____________________________________________Age: _______ BIRTH DATE: ______________________

BIRTH PLACE:__________________ EDUC. ATTAINMENT:_____________________________OCCUPATION: _______________

MOTHER’S NAME:___________________________________________Age: ________ BIRTH DATE:_______________________

MOTHER’S MAIDEN NAME:_____________________________________________

BIRTH PLACE:_________________________ EDUC. ATTAINMENT:_______________________OCCUPATION: _______________

NO. OF CHILDREN: ______ BOY _______ GIRLS

CONTACT NUMBER/S: ________________________________________

# Books No. ______________________

K12 BOOKS ISSUED RETURNED

ENGLISH
MATH
SCIENCE
FILIPINO
EDUKASYON SA PAGPAPAKATAO
EDUKASYONG PANTAHANAN AT PANGKABUHAYAN
ARALING PANLIPUNAN
MUSIKA AT SINING
P.E AT HEALTH
TOTAL

KASUNDUAN: Anumang gamit ng paaralan lalo na ang mga aklat ay dapat pag-ingatan. Anumang bagay na nasira
Ng inyong mga anak ay kinakailangan ayusin o palitan. Ang mga aklat na nasira o nawala habang ito ay nasa
pangangalaga ng inyong mga anak ay kinakailangan ayusin o palitan kapag ito ay nawala. (DepEd Order.#25, s2003)

___________________________________
PARENTS NAME AND SIGNATURE
Date:
______________________
Adviser