GC Form 4

Republic of the Philippines

ISABELA STATE UNIVERSITY Place 2X2
Ilagan, Isabela

Guidance & Counseling Center

picture
PERSONAL DATA INVENTORY here
Date of entry: School year 20____
24 - 20____
25 ( ) 1st Sem. ( ) 2nd Sem. ( ) Summer
Status of Enrollment: ( ) Freshman ( ) Transferee ( ) Returnee ( ) Special Student
STEM
Track/ Strand: _____________________________________________________
Course to Enroll: First Preference: __________________________
BS ARCHITECTURE

PERSONAL DATA

Name: ____________________________________________________________________________________Age:
LARA PASCUA LUMBANG __________
18

Date of Birth: ______________________Place

11/16/2005 BRGY.LACQUIOUS,ARAYAT,PAMPANGA
of Birth: ____________________________________________ Sex: M ___ F ___
Birth of Order Among Siblings: 1st ___ 2nd ___ 3rd ___ 4th ___ Others _________ Civil Status: ______ Single ______ Married _____
Permanent Address: _______________________________________________________________________________________
MOLAVE ST.,BRGY.ALINGUIGAN 2ND,CITY OF ILAGAN,ISABELA,PHILIPPINES

Boarding House Address: ___________________________________________________________________________________

Landline: ________________________ Cellphone _______________________________
0953 997 8735 aral
gnabmul
16@ gmai
l.com
Email: __________________________
Languages / Dialects Spoken: _______________________________________________________________________________
TAGALOG,IBANAG

Religion: _________________________________________
ROMAN CATHOLIC Nationality: _____________________________________________
FILIPINO

If married, name of Spouse: ___________________________________________________ No. of Children: ________________

HOME AND FAMILY BACKGROUND

FATHER MOTHER
MARIA LARISSA PASCUA LUMBANG
__________________________________________________Name___________________________________________________
RENATO MERCADO LUMBANG
______________________________________________Current Address_______________________________________________
BRGY.LACQUI OUS, ARAYAT,PAMPANGA BRGY. LACQUIOUS,ARAYAT,
PAMPANGA
_________________________________________________Landline__________________________________________________
_______________________________________________Cellphone
0905 373 9753 No._______________________________________________
0994 738 3500
___________________________________________Educational
COLLEGE GRADUATE Attainment____________________________________________
HIGH SCHOOL GRADUATE
_______________________________________________Occupation_________________________________________________
COMPUTER TECHNICIAN HOUSE W IFE
______________________________________________Annual Income _______________________________________________
15 000 -ABOVE
________________________________________________Religion__________________________________________________
ROMAN CATHOLIC ROMAN CATHOLIC

(Please name below siblings from eldest to youngest. Include yourself)

Name of Siblings School / Place of Work Age

____________________________________
REN ELEAZAR PASCUA LUMBANG ______________________________________________
BRGY.LACQUIOUS KINDERGARTEN __________
4
____________________________________ ______________________________________________ __________
____________________________________ ______________________________________________ __________
____________________________________ ______________________________________________ __________
____________________________________ ______________________________________________ __________
____________________________________ ______________________________________________ __________
____________________________________ ______________________________________________ __________
____________________________________ ______________________________________________ __________
Parents: ____Living Together ____Temporarily Separated ____ Father w/ another partner
____Permanently Separated ____Father OFW ____ Mother w/ another partner
____ Marriage Annulled/ Legally Separated ____ Mother OFW
MARIA CONCESA MAGUDANG PASCUA
Name of Guardian (if not living with parents): _____________________________________________________________________
Address: __________________________________________________________________________________________________
MOLAVE ST.,BRGY.ALINGUIGAN 2ND,CITY OF ILAGAN,ISABELA
Landline: __________________________________________ Cellphone: ______________________________________________
0953 326 3303
Relationship with Guardian: ___________________________________________________________________________________
GRANDMOTHER

Person to contact in case of emergency:

Name: ___________________________________________________________Contact
LAURA MAGUDANG PASCUA-PADILLA 0906 642 0627
No. ______________________________
BRGY.BACULUDDD,CITY OF ILAGAN,ISABELA
Address: _________________________________________________________________________________________________

ISUI- Gui- PDI – 001

Effectivity: August 01, 2022
Revision: 1
 EDUCATIONAL/ SCHOOL INFORMATION
LEVEL NAME OF SCHOOL SCHOOL ADDRESS DATE ATTENDED
BRGY.LACQUIOUS,ARAYAT,PAMPANGA 2012-2014
LACQUIOUS,ELEMENTARY SCHOOL
BRGY.ALINGUIGAN 2ND,CITY OF ILAGAN,
Elementary ALINGUIGAN 2ND ELEMENTARY SCHOOL ISABELA 2014-2016

BRGY.BAGUMBAYAN,CITY
SAINT FERDINAND COLLEGE 2016-2022
OF ILAGAN,ISABELA
Junior High School
BRGY.SAN VICENTE,
ISABELA NATIONAL HIGH SCHOOL CITY OF ILAGAN,ISABELA 2022-2024
Senior High School

College

Vocational

UCSP,MIL,GENERAL CHEMISTRY,CPAR,PHYSICS,PHILOSOPHY
Easiest Subject/s: _________________________________________________________________________________
Most Difficult Subject/s: ____________________________________________________________________________
HOPE,FILIPINO

Subjects w/ Lowest Grades/ What Grades: _____________________________________________________________

PE,DRRR

UCSP,PHYSICS,MIL,CHEMISTRY,PRACTICAL RESEARCH,CPAR
Subjects w/ Highest Grades/ What Grades: _____________________________________________________________

CHAMPION (POSTER MAKING),W ITH HIGH HONORS

Awards/ Honors Received: _________________________________________________________G.W.A. 96
___________

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: ___________________________________________________________________________________
COLLECTING ART MATERIALS,PHOTOGRAPHY

Special Skills/ Talents: ______________________________________________________________________________

PLAYING INSTRUMENTS,FREEHAND DRAW ING

SKETCHING,PAINTING
Hobbies/ Recreational Activities: _____________________________________________________________________
RELIABLE,GENEROUS,CAUTIOUS,CALM
Characteristics that describes you best: ________________________________________________________________
Present Concerns/ Problems: ________________________________________________________________________
Present Fears: ____________________________________________________________________________________

HEALTH
Disabilities/ Impairments: ___________________________________________________________________________
Chronic Illness: ____________________________________________________________________________________
Medicines Regularly Taken: __________________________________________________________________________
Accidents Experienced/ Effect: _______________________________________________________________________
ISUI- Gui- PDI – 001
Effectivity: August 01, 2022
Operations Experienced/ Effect: ______________________________________________________________________
Revision: 1