PERSONAL HISTORY STATEMENT
PHS (Revised 1998)
(To be accomplished completely and submitted by the applicant international student in six (6) original copies to the college or university he/she is
seeking admission to.)
1.0 PERSONAL DATA
1.1 Name: ________________________________________________________________________________
(As it appears on your passport) (Last or Family Name) (First or Given Name) (Middle Name)
1.2 Name in Native Language Character: ________________________________________________________
1.3 If married woman, state maiden name: _______________________________________________________
If married man, state name of spouse: ________________________________________________________
1.4 Address: Outside the Philippines: ___________________________________________________________
_______________________________________________________________________________________
Address in the Philippines: _________________________________________________________________
_______________________________________________________________________________________
1.5 Age : ______1.6 Date of Birth: _______-_______-_______ 1.7 Place of Birth: ________________________
1.8 Citizenship: ____________________________ 1.9 Religion: ______________________________________
2.0 PHYSICAL DESCRIPTION
2.1 Sex: [ ] Male [ ] Female 2.2 Height: ________cm 2.3 Weight: ________ lbs
2.4 Eyes: ________________ 2.5 Hair: _______________ 2.6 Complexion: _________________________
2.7 Built: _________________ 2.8 Other distinguishing features: _____________________________________
2.9 Physical Handicap or Disability (if any): ________________________________________________________
3.0 FAMILY DATA
3.1 Name of Father: _________________________________________________________________________
(Last or Family Name) (First or Given Name) (Middle Name)
3.2 Name of Mother: _________________________________________________________________________
(Last or Family Name) (First or Given Name) (Middle Name)
3.3 Address: __________________________________________________ Tel. No.: ______________________
4.0 EDUCATIONAL BACKGROUND
Name of School Date of Attendance Course Finished
4.1 Elementary ________________________________ _______________ ____________________________
4.2 High School ________________________________ _______________ ___________________________
4.3 College ________________________________ _______________ ____________________________
$.4 Post Graduate ______________________________ _______________ ____________________________
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5.0 GENERAL QUALIFICATION
5.1 Language Grade Proficiency (Oral or Written)
___________________________ ________________________________________
___________________________ ________________________________________
___________________________ ________________________________________
___________________________ ________________________________________
5.2 Hobbies: _________________________________________________________________________________
5.3 Sports : __________________________________________________________________________________
6.0 COURSE APPLIED FOR: _______________________________________________________
Semester [ ] First [ ] Second School Year: _________________________________
I CERTIFY THAT THE FOREGOING ANSWERS ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE
AND BELIEF.
Signed at _____________________________________ Date _____________________________
____________________________________________
(Signature of Applicant)
Please glue your 2x2
photo here with your
signature at its back.
Do not staple.
Affix your left thumbmark Affix your right thumbmark
Inside the box inside the box
A true copy:
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