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PHS Revised 1998 PERSONAL HISTORY STATEMENT To be accomplished completely and submitted by the applicant foreign student in six 6 original copies to the college or university he/she is seeking admission into PERSONAL DATA PHYSICAL DESCRIPTION Sex 2. 2 Height 2. 3 Weight Eyes 2. 5 Hair 2. 6 Complexion Built 2. 8 Other Distinguishing Feature Physical Handicap or Disability if any FAMILY DATA Name Last Name First Name Middle Name Name in Native Language Character If Married Woman State Maiden s Name Man Name of Spouse Address Permanent Abroad Philippines Age 1. 6 Date of Birth 1. 7 Place of Birth Citizenship 1. 9 Religion Name of Father Address EDUCATIONAL BACKGROUND Name of School Date of Attendance Course Finished Elementary High School College Post Graduate GENERAL QUALIFICATION Language Grade of Proficiency Oral or Written Hobbies 5. 3 Sports COURSE APPLIED FOR Semester Trimester First Second Third School Year I CERTIFY THAT THE FOREGOING ANSWER ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEGDE AND BELIEF* Signed at Date Signature of Applicant Signed photograph of applicant to be affixed here A true copy /babylee fn phsfrm disk nbq1 Left Thumb mark Right Thumb mark. 2 Height 2. 3 Weight Eyes 2. 5 Hair 2. 6 Complexion Built 2. 8 Other Distinguishing Feature Physical Handicap or Disability if any FAMILY DATA Name Last Name First Name Middle Name Name in Native Language Character If Married Woman State Maiden s Name Man Name of Spouse Address Permanent Abroad Philippines Age 1. 6 Date of Birth 1. 7 Place of Birth Citizenship 1. 9 Religion Name of Father Address EDUCATIONAL BACKGROUND Name of School Date of Attendance Course Finished Elementary High School College Post Graduate GENERAL QUALIFICATION Language Grade of Proficiency Oral or Written Hobbies 5. 6 Date of Birth 1. 7 Place of Birth Citizenship 1. 9 Religion Name of Father Address EDUCATIONAL BACKGROUND Name of School Date of Attendance Course Finished Elementary High School College Post Graduate GENERAL QUALIFICATION Language Grade of Proficiency Oral or Written Hobbies 5. 3 Sports COURSE APPLIED FOR Semester Trimester First Second Third School Year I CERTIFY THAT THE FOREGOING ANSWER ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEGDE AND BELIEF* Signed at Date Signature of Applicant Signed photograph of applicant to be affixed here A true copy /babylee fn phsfrm disk nbq1 Left Thumb mark Right Thumb mark. 2 Height 2. 3 Weight Eyes 2. 5 Hair 2. 6 Complexion Built 2. 8 Other Distinguishing Feature Physical Handicap or Disability if any FAMILY DATA Name Last Name First Name Middle Name Name in Native Language Character If Married Woman State Maiden s Name Man Name of Spouse Address Permanent Abroad Philippines Age 1. 6 Date of Birth 1. 7 Place of Birth Citizenship 1. 9 Religion Name of Father Address EDUCATIONAL BACKGROUND Name of School Date of Attendance Course Finished Elementary High School College Post Graduate GENERAL QUALIFICATION Language Grade of Proficiency Oral or Written Hobbies 5. 3 Sports COURSE APPLIED FOR Semester Trimester First Second Third School Year I CERTIFY THAT THE FOREGOING ANSWER ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEGDE AND BELIEF* Signed at Date Signature of Applicant Signed photograph of applicant to be affixed here A true copy /babylee fn phsfrm disk nbq1 Left Thumb mark Right Thumb mark.

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