GC Form 4 - Student Cumulative Record
Republic of the Philippines
ISABELA STATE UNIVERSITY
Cauayan Campus
Guidance and Counseling Center
STUDENT CUMULATIVE RECORD
FILL -OUT ALL IMPORTANT DATA IN BOLD LETTERS
st
Date of Entry:__________S.Y.: 20___-20___ 1 Sem. 2nd Sem. Midyear
Status of Enrollment: Freshman Transferee Returnee Special Student
Course to Enroll: First Preference: _________________ Second Preference: ___________________
PERSONAL DATA
Name: Age:_______
Last Name First Name Middle Name
Birth Date: Order of Birth among Siblings: Number of Siblings:_____
Birth Place Sex: Male Female Gender Identity:(_) Man (_)Woman (_)LGBTQ+
Permanent Address: Cellphone No:
Boarding House Address: Email:
Nationality: Religion: Civil Status: Single
Language/Dialect Spoken: Married
If married, Name of Spouse: No. of children:
Are you the first in your family to attend College? (_) YES (_) NO
HOME AND FAMILY BACKGROUND
FATHER MOTHER
Name
Address
Contact No.
Educational Attainment
Occupation
Greater than or equal equal to 10,957 but less
Greater than or equal equal to P76,669 but less than P131,484
Parents' MONTHLY Greater than or equal to P 219,140 than P21,194
Income Greater than or equal to P131, 484 but
less than P219,140 Greater than or equal equal to P21,194 but less than P43,828 Less than P10,957
(Name below siblings from eldest to youngest.Excluding yourself)
NAME OF SIBLINGS SEX AGE SCHOOL/PLACE OF WORK OCCUPATION
Status of Parents:
Living Together Father Deceased Father OFW Father with another partner
Legally Separated Mother Deceased Mother OFW Mother with another partner
Name of guardian (if not living with parents):
Address: Cell phone number:
Relationship with guardian:
Person to contact in case of emergency:Name:
Address:
Contact No: __________________________
ISUCYN-GCO-SCR-010
Effictivity: January 03, 2018
Revision: 0
EDUCATIONAL INFORMATION
COURSE/ Year Attended/ Honor
LEVEL NAME OF SCHOOL/PROVINCE
DEGREE Garduated Received
Elementary
High School
Senior High
College
Vocational (If any)
Easiest Subject/s: Most Difficult Subject/s:
Subjects w/ Lowest grade Subjects w/ Highest grade
Awards/Honors Received: G.W.A.
Nature of Schooling: Continuous Interrupted If Interrupted how long?
Reason:
If transferee, how many college/university/s have you attended?
If shifted course, reason for shifting?
Membership in Organization: Achievements:
Name of Organization Position/Title Name of Award Date
Description of Self: (Check as many as you can)
Emotional Venturesome Open to change Goal Oriented Suspicious
Shy Self-reliant Self -doubt Accomodating Careful
Assertive Discipline Impatient Independent Feels alone
Sociable Tough-minded Tense Group-player Noncomforming
Unique Features:
Special Skills/Talent
Hobbies/ Recreational Activities
Present Concern/Problems
Present Fears
Health:
Do you have any disability: (_) Physical (_)Mental (_) Intellectual (_) Sensory Impairment (_)NONE
Chronic Illness:
Medicines regularly taken:
Accidents/Experienced/Effect:_________________________________________________________________
Operation experienced/effect:__________________________________________________________________
_______________________________
Name & signature of Student
ISUCYN-GCO-SCR-010
Effictivity: January 03, 2018
Revision: 0
