San Beda College Alabang
Alabang Hills Village, Muntinlupa City
DATA PRIVACY OFFICE
Placid Hall Annex, 8236-7222 Local 4052
dataprivacy@sanbeda-alabang.edu.ph
DATA PRIVACY NOTICE
Peace.
This Privacy Notice describes the practice of SBCA regarding the processing, collection,
use, disclosure and disposal of data collected from you in the usual course of business
of the College. This Privacy Notice is being provided in compliance with the Data
Privacy Act of 2012 and its Implementing Rules and Regulations. “SBCA” or “our” refers
to San Beda College Alabang and to all the divisions, departments and offices under its
name.
By accomplishing the proceeding or attached school form, you agree to share your
personal data to SBCA and gives consent to its processing which will be used in the
pursuit of our legitimate interests as an educational institution. After official use, the data
will be expunged from our files or archived.
By providing this information and signing this consent form, you agree to our Privacy
Policy which is in accordance with the provisions of the law.
_____________________________
Student’s Name & Signature
_________________
Date
If student is under 21 years of age, please provide signature of parent/guardian:
______________________________
Sign over Printed Name of Parent
_________________
Date
San Beda College Alabang
8 Don Manolo Blvd., Alabang Hills Village, Alabang, Muntinlupa City 1770
Tel No. 236-7222 | 236-7200 | 236-7210 local 1690 |Direct line: 809-0752
Counseling and Career Development Services
INTEGRATED BASIC EDUCATION DEPARTMENT
STUDENT PERSONAL INFORMATION SHEET
Academic Year: 2020-2021
GRADE LEVEL:
Kindly attach
recent 1x1
picture
STATUS:
(LVL)
I. PERSONAL INFORMATION
LAST NAME
Gender:
Nationality:
Complete Address:
FIRST NAME
Birthdate:
Religion:
(MM)
(D)
(YR)
MIDDLE NAME
Age:
Email Address:
Nickname
Contact No.
II. FAMILY BACKGROUND
A. Parents/Guardian
Father
Mother
Guardian
Complete Name
Complete Address
Age
Citizenship
Religion
Educational Attainment
School Attended
Occupation
Business Address
Tel. No.
Cellphone No.
Email Address
B. Siblings (from eldest to youngest)
Complete Name
Age
Level in School/ Occupation
School/ Business Address
C. Other members of the household (e.g. relatives, employees etc.)
Name
Age
Relationship to the student/ Occupation
D. Marital Status of Parents:
(Please
listlist
provided)
(Pleaseselect
selectononthe
the
(Please
select
onprovided)
the list provided)
E. Significant Home Condition:
(Please (Please
select onselect
the list
onprovided)
the list provided)
For items with an asterisk (*), please provide more explanation here: __________________________________
______________________________________________________________________________________________
III.
EDUCATIONAL HISTORY (from most recent date)
School Attended
SBCA-ACAD-FORMS-G-IBED-05
Business Address
Grade Level/s
Awards Received
Has the child been involved to any disciplinary case?
YES
NO
If yes, please specify: _______________________________________________________________________
Sanction given (if any): _____________________________________________________________________
IV.
HEALTH / PHYSICAL DEVELOPMENT
a. Any congenital disease?
YES
NO If yes, please explain nature: _________________________________
b. Any major operation/prolonged hospitalization?
YES
NO If yes, please explain nature: _______________
____________________________________________________________________________________________
c. Any allergies?
YES NO If yes, please specify: ________________________________________________
V.
PSYCHOLOGICAL RECORD
Please accomplish data below if the child has been brought for consultation with a specialist such as a developmental
pediatrician, psychologist, neurologist, occupational therapist, etc.
Kind of Specialist
Condition/Diagnosis
Consultation
Date
Intervention
Provided
Present Status/
Condition of the Child
IMPORTANT: Kindly submit relevant data on the diagnosis and intervention given. It will help the school
in its follow-up or in providing intervention as needed.
VI.
OTHER RELEVANT INFORMATION
My child’s usual disposition at home (Please check items that apply to your child)
shares problems w/ father
enjoys bonding time w/ father
refuses to join family affairs
shares problems w/mother
enjoys bonding time w/ mother
prefers to be left alone
shares problems w/ sibling/s
enjoys bonding time w/ sibling/s
often fights w/ a family member
Others, please specify: ___________________________________________________________________________
Describe your
your child’s
child'sstrengths,
strengths,weaknesses,
weaknesses,
interests,
talents,
hobbies,
activities
Describe
interests,
talents,
hobbies,
activities
etc. etc.
______________________________________________________________________________________________
______________________________________________________________________________________________
Narrate any
in in
your
child’s
life.life.
any significant
significantevent
eventthat
thatoccurred
occurred
your
child's
______________________________________________________________________________________________
______________________________________________________________________________________________
Relate
how
think
guidance
counselorcould
couldhelp
help your
your child
child at
How do
youyou
think
thethe
guidance
counselor
at this
thistime.
time?
______________________________________________________________________________________________
______________________________________________________________________________________________
Please
check
thethe
box
if youif understand
and agree
with the
following
terms:
Please
check
circles
you understand
and agree
with
the following
terms:
I allow
thethe
guidance
counselor
to conduct
routine
interview,
exit interview
counseling
session
I allow
guidance
counselor
to conduct
a routine
interview
or exitand/or
interview
with my
child with my
I allow
thethe
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conduct
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interview
and/or
counseling
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child
I allow
guidance
counselor
conduct
a routine
interview
myinformation
child
using
online
using
the
online
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the
school.
I understand
that
all
arethe
strictly
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online
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school.
with
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information
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that it is my
platforms approved
by responsibility
the school. to ascertain a private place/space free from distraction when my child will
that an
willinterview
be gathered
are strictly
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it is my responsibility
to ascertain
a
have
or counseling
session.
I also understand
that that
confidentiality
maybe overruled
in the presence
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I Iallow
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IBED-CCDS
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harm andand
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IBED-CCDS
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imposed
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imposed
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school.
 I hereby allow the IBED-CCDS of San Beda College Alabang to collect, use and share my personal
for
its
pursuits
of
legitimate
interests
as anCollege
educational
allow
the
IBED-CCDS
of
to collect and use my personal data
I data
hereby
certify
the
truthfulness
ofSan
theBeda
information
thisinstitution.
document.
I hereby
certify
the
truthfulness
of the
information
in thisinAlabang
document.
I hereby certify the truthfulness of the information in this document.
for its pursuits of legitimate interests as an educational institution.
______________________________
Signature over Printed Name
SIGNATURE OVER PRINTED NAME
SBCA-ACAD-FORMS-G-IBED-05