Performer's Profile Form

Type of Performance: (Include the name of Cultural Group you are interested in joining.)

Performing Arts Music Dance Theater Visual Arts Literary Arts

Pursuant to Republic Act No. 10173 also known as the Data Privacy Act of 2012, the Batangas State University, the National Engineering University, recognizes the fundamental human right of privacy, of communication while ensuring the protection of personal data and/or stakeholders and ensure that all the information collected from them are all processed in accordance with the principles of transparency, legitimate purpose and proportionality mandated under the said Data Privacy Act.

I. PERSONAL INFORMATION

2" x 2" ID Picture

First Name: *

Middle Name:

Last Name: *

Address:

Present Address:

Date of Birth:

Age:

Gender:

Place of Birth:

Email:

Contact Number:

Father's Name:

Mother's Name:

Guardian (if not living with Parents):

Contact Number (Parent/Guardian):

II. EDUCATIONAL INFORMATION

Campus:

Extension Campus/College:

SR Code:

Year Level:

Program:

Number of Units:

First Semester Second Semester

III. PARTICIPATION IN THE FIELD OF INTEREST / ACHIEVEMENTS

Date	Event	Level (Local, Regional, National, International)	Rank (Place)	Action
				-

IV. AFFILIATION TO ORGANIZATIONS

Position	Name of Organization	Inclusive Years	Action
			-

I hereby certify that all information in this form is true and correct. Any misrepresentation of facts will render this invalid and immediately disqualifies my membership to the cultural group.

Signature of Performer/Member

Date:

*Required Attachments: Certified True Copy of Certificates and Recognitions

Type of Performance: (Include the name of Cultural Group you are interested in joining.)

Consent of Data Subject

I. PERSONAL INFORMATION

II. EDUCATIONAL INFORMATION

III. PARTICIPATION IN THE FIELD OF INTEREST / ACHIEVEMENTS

IV. AFFILIATION TO ORGANIZATIONS