PDS - Fe Marie Susuban

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BUKIDNON STATE UNIVERSITY

Malaybalay City, Bukidnon 8700


Tel (088) 813-5661 to 5663; TeleFax (088) 813-2717, www.buksu.edu.ph

PERSONAL DATA SHEET


Date: _____________
January 15, 2021

PERSONAL INFORMATION

________________________
Susuban ______________________________
Fe Marie _____________________
Gulapo
Family Name First Name Middle Name
Birthdate (MM/DD/YY):_______________________
04/19/97 Birthplace: __________________________
Gender: _______________
Female Age: _________________
23
Civil Status: ________
Single Name of Spouse (If married): _________________________________
Father’s Name: ______________________________________
Fernando L. Susuban
Mother’s Maiden Name: _____________________________
Mary Jane J. Gulapo
Address: _________________________________________________________________________
Camp Phillips,Manolo Fortich, Bukidnon
Contact Number/s: ___________________________________
09676643771 Fax: ________________________
Email Address: _____________________________________
[email protected]

EDUCATION
Primary: __________________________________________
Camp 14 Elementary School Year: ______________________
Secondary: ________________________________________
Alae National High School Year: ______________________
Undergraduate:
College/University: _______________________________________________________________
Xavier University-Ateneo de Cagayan
Degree Obtained: __________________________________
Bachelor of Arts in Philosophy Year: ______________________
Honors/Distinction (if any):_________________________ Year: ______________________
Postgraduate:
College/University: _______________________________________________________________
Degree Obtained: ______________________________ Year: _______________________
Other Courses: ___________________________________________________________________
Licensure Exam Passed: ________________________ Date Registered: ___________________

Full Time Student Working

PRESENT OCCUPATION
Occupation: ______________________________________________________________________
Address: _________________________________________________________________________
Name of Employer/Business: ______________________________________________________
Contact No. of Employer/Business: _________________________________________________

Present Occupation:

Private Academe Government Judiciary

In case of emergency, please contact:


Name: ___________________________________________________________________________
Mary Jane G. Susuban
Contact Number: ___________________________________
09358444317

By signing my name below, I certify that I have read, understood, and truthfully provided the above information.
I also certify that I understood, agreed and promised to comply with the policies of Bukidnon State University and
the College of Law. I certify that I will abide by their rules and regulations particularly on fees and terms of
payment.

Name and Signature: _________________________________ Date: _____________________


January 15, 2021

This form is
Document Code: Revision No.: Issue No.: Issue Date: Page 1 of 1
COL-F- 003 001 002 May 16, 2018

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