GC Form 4
Republic of the Philippines Place 2X2 picture
ISABELA STATE UNIVERSITY
Echague, Isabela here
with white
Guidance & Counseling Center background and
STUDENT CUMULATIVE RECORD name tag
Date of entry: School year 20____ - 20____ ( ) 1st Sem. ( ) 2nd Sem. ( ) Summer Last name, First name Middle initial
Status of Enrollment: ( ) Freshman ( ) Transferee ( ) Returnee Others __________
Track/ Strand: _________________________________
Course to Enroll: First Preference: _____________Second Preference: __________________
PERSONAL DATA
Name: ____________________________________________________________________________________Age: __________
Last name First name Middle initial
Date of Birth: ______________________Place of Birth: ____________________________________________ Sex: M ___ F ___
Birth of Order Among Siblings: 1st ___ 2nd ___ 3rd ___ 4th ___ Others _________ Civil Status: ______ Single ______ Married _____
Permanent Address: _______________________________________________________________________________________
Boarding House Address: ___________________________________________________________________________________
Contact number: ________________________ Email : _________________________________________
Languages / Dialects Spoken: _______________________________________________________________________________
Religion: _________________________________________ Nationality: _____________________________________________
If married, name of Spouse: ___________________________________________________ No. of Children: ________________
HOME AND FAMILY BACKGROUND
FATHER MOTHER
__________________________________________________Name___________________________________________________
______________________________________________Current Address_______________________________________________
_________________________________________________Landline__________________________________________________
_______________________________________________Cellphone No._______________________________________________
___________________________________________Educational Attainment____________________________________________
_______________________________________________Occupation_________________________________________________
______________________________________________Annual Income _______________________________________________
________________________________________________Religion__________________________________________________
(Please name below siblings from eldest to youngest. Include yourself)
Name of Siblings School / Place of Work Age
____________________________________ ______________________________________________ __________
____________________________________ ______________________________________________ __________
____________________________________ ______________________________________________ __________
____________________________________ ______________________________________________ __________
____________________________________ ______________________________________________ __________
____________________________________ ______________________________________________ __________
____________________________________ ______________________________________________ __________
____________________________________ ______________________________________________ __________
Parents: ____Living Together ____Temporarily Separated ____ Father w/ another partner
____Permanently Separated ____Father OFW ____ Mother w/ another partner
____ Marriage Annulled/ Legally Separated ____ Mother OFW
Name of Guardian (if not living with parents): _____________________________________________________________________
Address: __________________________________________________________________________________________________
Landline: __________________________________________ Cellphone: ______________________________________________
Relationship with Guardian: ___________________________________________________________________________________
Person to contact in case of emergency:
Name: ___________________________________________________________Contact No. ______________________________
Address: _________________________________________________________________________________________________
ISUE- OSS- SCR – 007
Effectivity: September 1, 2013
Revision: 0
EDUCATIONAL/ SCHOOL INFORMATION
LEVEL NAME OF SCHOOL SCHOOL ADDRESS DATE ATTENDED
Elementary
Junior High School
Senior High School
College
Vocational
Easiest Subject/s: _________________________________________________________________________________
Most Difficult Subject/s: ____________________________________________________________________________
Subjects w/ Lowest Grades/ What Grades: _____________________________________________________________
Subjects w/ Highest Grades/ What Grades: _____________________________________________________________
0
Awards/ Honors Received: _________________________________________________________G.W.A. ___________
Nature of Schooling: ________ Continuous ________ Interrupted ________ If interrupted how long? _____________
Reason: __________________________________________________________________________________________
___________________________________________________________________________________________.
Membership in Organizations
In School: (from the last school attended)
Name of Organization Position/ Title
___________________________________________________ ______________________________________
___________________________________________________ ______________________________________
___________________________________________________ ______________________________________
Outside School:
Name of Organization Position/ Title
___________________________________________________ ______________________________________
___________________________________________________ ______________________________________
___________________________________________________ ______________________________________
UNIQUE FEATURES
Special Interest: ___________________________________________________________________________________
Special Skills/ Talents: ______________________________________________________________________________
Hobbies/ Recreational Activities: _____________________________________________________________________
Characteristics that describes you best: ________________________________________________________________
Present Concerns/ Problems: ________________________________________________________________________
Present Fears: ____________________________________________________________________________________
HEALTH
Disabilities/ Impairments: ___________________________________________________________________________
Chronic Illness: ____________________________________________________________________________________
Medicines Regularly Taken: __________________________________________________________________________
Accidents Experienced/ Effect: _______________________________________________________________________
ISUE- OSS- SCR – 007
Effectivity: September 1, 2013
Operations Experienced/ Effect: ______________________________________________________________________
Revision: 0
