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Students Personal Data Sheet Form

The document is a student personal data sheet used by the Guidance Services Unit of the University of Science and Technology of Southern Philippines. It collects personal information from students such as academic history, personal details, family background, living situation, and factors affecting academic performance. The information is kept strictly confidential but may be disclosed if the student's life is threatened or they pose a danger to others. Students are asked to honestly answer questions to help the Guidance Counselor identify how to assist them.

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275 views1 page

Students Personal Data Sheet Form

The document is a student personal data sheet used by the Guidance Services Unit of the University of Science and Technology of Southern Philippines. It collects personal information from students such as academic history, personal details, family background, living situation, and factors affecting academic performance. The information is kept strictly confidential but may be disclosed if the student's life is threatened or they pose a danger to others. Students are asked to honestly answer questions to help the Guidance Counselor identify how to assist them.

Uploaded by

L 1
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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UNIVERSITY OF SCIENCE AND TECHNOLOGY OF SOUTHERN PHILIPPINES

Alubijid Cagayan de Oro Claveria Jasaan Oroquieta Panaon

GUIDANCE SERVICES UNIT


Document Code No

STUDENT’S PERSONAL DATA SHEET (PDS) FM-USTP-OSA-17


Rev. No. Effective Date Page No
00 10.01.21 1 of 1
The Guidance Services Unit (GSU) observes STRICT CONFIDENTIALITY on the personal information shared in this form according to the
ethical principles of confidentiality and in compliance with the Data Privacy Act. However, please take note that the information will be
disclosed on the following circumstances:
1. Threat on the life of the client (e.g. attempt to commit suicide, victim of abuse)
2. The client can cause danger to the lives and health of other people.
Moreover, information may also be given to agencies (e.g. DSWD, Police, Women and Children Protection Unit, Rehabilitation
Unit Hospitals and other health providers) that can facilitate or address client's need and situation

Conforme: ______________________________
Student Signature
A. Academic Information
Academic Year : Course Date of Admission
1st Year: School Year _______ - _______ _________________________________________ ___________________
2nd Year: School Year _______ - _______ _________________________________________ ___________________
3rd Year: School Year _______ - _______ _________________________________________ ___________________
4th Year: School Year _______ - _______ _________________________________________ ___________________
5th Year: School Year _______ - _______ _________________________________________ ___________________
Please check your Academic Status: _____ Old Student _____ Returnee _____ Shiftee _____ New Student _____Transferee

B. Personal Information
Last Name: _______________________ First Name: _____________________________ Middle Name:_____________________
Date of Birth :___________________________________ Age:_____ Gender: _____ Cellphone No:____________________
Email Address:_____________________________________________FB Account Name:______________________________
Home Address:__________________________________________________________________________________________
Present Address:________________________________________________________________________________________
Father’s Name:______________________________Occupation:____________________ Contact No.:___________________
Mother’s Name:_____________________________ Occupation:____________________Contact No.:___________________
Guardian’s Name: ___________________________ Occupation:____________________Contact No.: ___________________
No. of brothers:_____________________________` No. of sisters:________________________________________________
Name of School Last Attended:_____________________________________________________________________________
Address of School Last Attended:_________________________________________________________

C. Other Information: Please answer the following questions honestly:


1. Why did you choose this particular course/program??______________________________________________________________
___________________________________________________________________________________________________________

2. Briefly describe yourself: _____________________________________________________________________________________


3. How would you describe your family? Please check below:
_________ a. a family with harmonious relationship among family members _______d. a family with parents working
_________ b. a family having conflict with some family members abroad
_________ c. a family with separated parents _______e. Others:____________________
4. Where do you live right now? Please check on the space provided
__________ at home _________ boarding house ___________ relatives _________ friends ______ others:__________
5. Describe your living condition. Please check on the space provided
_______a. conducive for studying _______ b. not conducive for studying Why?___________________________________
6. Describe your student life. Please check on the space provided
_____Adjusting _____Struggling ____Enjoying ____ Excelling Academically _____ Has Failing Grades
Needs Help (Pls. indicate what kind of help or assistance needed?) _________________________________________
Others, pls specify: _________________________________________________________
7. What factors affect your studies or performance in the class? Please check on the space provided:
___ a. physical defects or illness ___ f. home problem ___ texting/chatting
___ b. peer influence ___ g. poor attitude ___ computer/online games
___ c. poor study habit ___ h. lack of interest ___ surfing the net (FB..etc.)
___ d. love affair/broken hearted ___ I. too many outside ___ others _______________________
___ e. financial problem interests
8. How will you cope with the factors affecting your studies? _____________________________________________________
______________________________________________________________________________________________________
9. a. When was the last time you visited your Guidance Counselor?________________________________________________
b. Aside from seeking help from a Guidance Counselor, have you undergone treatment from a Psychologist or Psychiatrist?
____ yes ____ no
c. If YES, can you describe or specify the kind of treatment or intervention prescribed to help you cope?: ____________________
_____________________________________________________________________________________________________________

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