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General Santos Doctors' Medical School Foundation, Inc.
GUIDANCE OFFICE
Bulaong Subd., Brgy. West General Santos City
 
 
 

STUDENT'S INFORMATION ( Please print your name as written in your PSA Birth Certificate, )

NAME

:
FAMILY NAME GIVEN NAME MIDDLE NAME EXT. NICK NAME

Department

COURSE/STRAND

YEARLEVEL

Admission Status

Gender

 M F

CITIZENSHIP

CIVIL STATUS

 Single Married Separated

BIRTHDATE

AGE

BIRTHPLACE

RELIGION

ETHNIC GROUP/TRIBE

LANGUAGES/DIALECTS SPOKEN AT HOME

COMPLETE PERMANENT ADDRESS

CURRENT ADDRESS

( if not living w/ spouse/parents, write the address of guardian/landlord )

NAME OF GUARDIAN/LANDLORD

RES. TEL NO.

GUARDIAN/LANDLORD TEL. NO.

CELLPHONE NO.

EMAIL ADD

FACEBOOK
 

FAMILY INFORMATION

FATHER'S NAME

AGE

 Living Deceased

CELLPHONE NUMBER

RELIGION

EDUCATIONAL ATTAINMENT

OCCUPATION

COMPANY/BUSINESS

ADDRESS OF COMPANY/BUSINESS

MOTHER'S MAIDEN NAME

AGE

 Living Deceased

CELLPHONE NUMBER

RELIGION

EDUCATIONAL ATTAINMENT

OCCUPATION

COMPANY/BUSINESS

ADDRESS OF COMPANY/BUSINESS

NO. OF SIBLINGS IN THE FAMILY

BIRTH ORDER/RANK

NAME OF SPOUSE (If married)

Age

EDUCATIONAL ATTAINMENT

OCCUPATION

NAME OF CHILDREN IN RANK

AGE

EDUCATIONAL ATTAINMENT

OCCUPATION

  
➕ ✖
 

MARITAL STATUS OF PARENTS

MARITAL STATUS (For married students only)
Living together & are here in the Philipines Living together & are here in the Philipines
Living together but one is working abroad, who? Living together but one is working abroad, where?
Living together but both are working abroad, where? Separated, each doesn't have a family
Separated, each has a family.
Separated, each doesn't have a family Family living with parents/in-laws.
Separted, each has a family Family living with others, other than parents/in-laws, whom?
Living with others, other than parents, with whom?
 
 

FAMILY FINANCIAL STATUS

Below 10,000 monthly 20,001 - 30,000 monthly 40,001 - 50,000 monthly
10,001 - 20,000 monthly 30,001 - 40,000 monthly 50,001 & Above monthly
 

SOURCE OF INCOME

WHO SUPPORTED YOUR STUDIES
 
 

General Santos Doctors' Medical School Foundation, Inc.
GUIDANCE OFFICE
Bulaong Subd., Brgy. West General Santos City
 

THE PERSON IN THE FAMILY WHOM YOU ARE VERY CLOSE WITH

HOW WOULD YOU DESCRIBE YOUR RELATIONSHIP WITH YOUR:
 

Father

Mother

Sister/s

Brother/s

Spouse (if married)

Child/Children
 

EDUCATIONAL INFORMATION

 

Name & Address of School

Year Graduated

Honors/Awards Received

ELEMENTARY

JUNIOR HIGH SCHOOL

SENIOR HIGH SCHOOL
 
 

FOR TRANSFEREES, LIST DOWN COLLEGES/UNIVERSITIES YOU HAVE PREVIOUSLY ATTENDED:

 

Name of School

Address

Course

Sem/School Year

  
➕ ✖

GRADE 12 GPA (For Incoming First Year)

NCAE/NAT Result

SCHOLARSHIP/S RECEIVED (If any)

SUBJECTS :

Best Liked:

Found Easy:

Least Liked:

Found Difficult:

HOBBIES/INTEREST/TALENTS/ABILITIES/SKILLS

AMBITIONS/PLANS

The course that you've enrolled is a :

Free Choice Forced Choice Your desired course

Finish each of the following sentences in any way you want.

 

1.   If only I could
 

2.   My mom
 

3.   Higher Education
 

4.   My dad
 

5.   My dream
 

6.   The thing that bothers me about myself is
 

7.   My family
 

8.   I would truly be happy if
 
 
General Santos Doctors' Medical School Foundation, Inc.
GUIDANCE OFFICE
Bulaong Subd., Brgy. West General Santos City
 
 

HEALTH/PHYSIOLOGICAL/PSYCHOLOGICAL CONDITIONS

Please check the condition/s that applies/apply to you

 
Epilepsy  
Visual Impairment (specify)  
Hearing Impairment (specify)  
Speech Impairment (specify)  
Depression & Anxiety ; (if yes how long)  
Under Medication (if yes, please specify)  
Surgery (specify)  
Heart Disease  
Scoliosis  
Others (specify)  
 
 

OTHER INFORMATION

How did you know about the General Santos Doctor's Medical School Foundation, Inc. (GSDMSFI)?

Brochure Career Talks Radio Facebook Family/Relatives Friends Others
 
 

TERMS OF REFERENCE

I hereby attest to the completeness and accuracy of all information supplied in this form. I understand that withholding of information or giving false information may nullify my application for admissions or may jeopardize my continued stay after admission has been granted.

The GSDMSFI will use the information that you provide to us and information we collect about you to administer your application and will serve permanent data upon enrollment. In addition, we may use your information to analyze and improve our admissions process, use your contact details, demographic information and other details to contact you with news, marketing or promotional information regarding GSDMSFI and studies/surveys to be conducted by GSDMSFI via phone calls, mail, email, SMS or any type of electronic facility; and for other GSDMSFI processes and functions. We also might use your information to conduct general research. We may use your information and share it internally with other GSDMSFI offices and units.

 

I agree with terms of references
 
 

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For questions and comments, email us at

gsdmsf@pinnacleasia.com