Documente Academic
Documente Profesional
Documente Cultură
Department of Education
Province of Cebu
San Fernando NATIONAL HIGH SCHOOL
South Poblacion, San Fernando, Cebu
Guidance Form 1
INDIVIDUAL INVENTORY RECORD
I. PERSONAL DATA
Name : _________________________________________________________________ Sex : _____ Age : ______
(Last Name) (First Name) (Middle Name)
Date of Birth : _________________________ Place of Birth : _________________ Religion : _________________
Home Address : ___________________________ Citizenship : ___________________ Contact Nos. : _____________
(If you are not living with your parents, pls. fill this up)
GUARDIAN
Name
Date of Birth
Age
Occupation
Educational Attainment
Home Address
Marital Condition of Parents :
( ) married and living together ( ) separated ( ) solo parent ( ) one parent is deceased ( ) both parents are deceased
Source of Income/Livelihood: ___________________________________
Living With : ( ) parents ( ) grandparents ( ) relatives ( ) friends ( ) others (pls. specify)______________
Type of Discipline : ( ) lax ( ) strict ( ) democratic
Ambient of Growth : ( ) city ( ) province
Birth Rank : _________________________________________________
Problems met/experienced with:
Father
Mother
Brother/s
Sister/s
Others (specify)
III. SCHOLASTIC RECORD
NAME OF SCHOOL HONORS/AWARDS RECEIVED
Elementary
High School
College
Vocational
ENGLISH
FILIPINO
A.P.
E.P.
M.A.P.E.H.
E.P.
MATHEMATICS
SCIENCE
GEN. AVE.
REMARKS
V. MEDICAL HISTORY
Height : _________ Weight : __________ Visual Acuity : ______________________ Hearing : _____________
Do you get sick often? ( ) yes ( ) no frequency _________________________________________
Illnesses since childhood :
______________________________________________________________________________________
Physical disabilities/handicaps : _________________________________________________________________________________
Do you have a permanent/family doctor? ___________________ How often do you visit the doctor? ______________________
Additional Health Information (pls. specify): ________________________________________________________________________
___________________________________________________________________________________________________________