Republic of the Philippines

D E PA RT M E N T O F E D U C AT I O N
R E G I O N III
SCHOOLS DIVISION OFFICE OF BATAAN

Guidance and Counseling Office

STUDENT INDIVIDUAL INVENTORY

Dear Students: Kindly fill-out this form. The following information will aid the Guidance Office develop a program to
address your needs. Rest assured that information provided will be treated with confidentiality. Thank you.
PERSONAL DATA
LRN No. _____________________________________ Date Filled ________________________________
Name ________________________________________ Nickname _________________________________
Age __________ Date of Birth_______________________ Place of Birth ________________________
Sex __________ Birth order among siblings ____________
Complete Address __________________________________________________________________________
Landline _____________________ Cellphone __________________ Email ________________________
Languages/Dialects Spoken at Home ___________________________________________________________
Languages/Dialects Most Fluent In _____________________________________________________________
Religion from Birth ___________________________________ Current Religion ______________________
FAMILY DATA
Father Mother
(Mark + if deceased) (Mark + if deceased)
Name ________________________________________ __________________________________________
Date of Birth __________________________________ __________________________________________
Place of Birth __________________________________ __________________________________________
Address ______________________________________ __________________________________________
Landline ______________________________________ __________________________________________
Cellphone _____________________________________ __________________________________________
Highest Educational Attainment___________________________ __________________________________________
Occupation ____________________________________ __________________________________________
Business Address _______________________________ __________________________________________
Business Landline ______________________________ __________________________________________
Annual Income _________________________________ __________________________________________
Language/s Spoken ______________________________ __________________________________________
Religion Raised with _____________________________ __________________________________________
Current Religion ________________________________ __________________________________________
Number of Brothers & Sisters ______________________ __________________________________________
(Please name below siblings from eldest to youngest. Include yourself.)
Name of Siblings School/Place of Work Age
_________________________________ __________________________________ __________________
_________________________________ __________________________________ __________________
_________________________________ __________________________________ __________________
_________________________________ __________________________________ __________________
_________________________________ __________________________________ __________________
_________________________________ __________________________________ __________________
_________________________________ __________________________________ __________________
_________________________________ __________________________________ __________________
 Republic of the Philippines
D E PA RT M E N T O F E D U C AT I O N
R E G I O N III
SCHOOLS DIVISION OFFICE OF BATAAN

Parents (Please Check)

_________ Living together __________ Temporarily separated
_________ Permanently separated __________ Father OFW
_________ Marriage Annulled/Legally Separated __________ Mother OFW
_________ Father with another partner __________ Mother with another partner
Guardian (if not living with parents) ___________________________________________________________________________
Address __________________________________________________________________________________
Landline ___________________________________________ Cellphone ___________________________
Relationship with guardian ___________________________________________________________________
EDUCATIONAL DATA
Grade/Year Level School Attended Inclusive Years of Attendance

Membership in Organizations
In School:
Name of Organization Position/Title
______________________________________________________ __________________________________________
______________________________________________________ __________________________________________
______________________________________________________ __________________________________________
Attendance Record
Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade
12
Days of School
Days Present
Days Absent
No. of times
late
Test Records
Nature of Test/Title of Test Result /Grade Date

____________________________________
Signature of Counselor over printed name
DepEd Vision: DepEd Mission:
We dream of Filipinos who passionately love their country and whose
competencies and values enable them to realize their full potential and 1. Students learn in a child-friendly, gender-sensitive, safe and
contribute meaningfully to building the nation. motivating environment.
As a learner-centered public institution, the Department of Education 2. Teachers facilitate learning and constantly nurture every learner.
continuously improve itself to better serve its stakeholders. 3. Administrators and staff, as stewards of the institution, ensure an
To protect and promote the right of every Filipino to quality, equitable, enabling and supportive environment for learning to happen.
culture-based education where:
 Republic of the Philippines
D E PA RT M E N T O F E D U C AT I O N
R E G I O N III
SCHOOLS DIVISION OFFICE OF BATAAN

4. Family, community and other stakeholders are actively engaged

and share responsibility for developing life-long learners.
MAKA-DIYOS MAKATAO MAKABAYAN MAKAKALIKASAN