Malabag National High School: I.D Picture 1x1

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Republic of the Philippines

Department of Education
Division of Cavite
DISTRICT OF SILANG
MALABAG NATIONAL HIGH SCHOOL

INDIVIDUAL INVENTORY RECORD


I.D Picture
1x1

Dear Student,

The purpose of this this form is to bring together all essential information that may enable us to help
you meet the specific needs and further plans. Being a member of this school we would like to know about
yourself as we can work with and understand you better.
Your accurate and honest response is expected.

I. PERSONAL DATA
Name: _____________ _____________ _____________ Sex:_____ Age:___ Nickname:______
Last Name First Name Middle Name
Date of Birth: ___ /___ /____ Place of Birth: ________________________ Nationality:___________
mm/ dd / yyyy
Religion:_________________Civil Status:_____________ Contact No: ________________________
Guardian:__________________________ Address: _______________________________________
Number of Children in the Family:____________ No. of Boys: ___________ No. of Girls: _________
Sibling Position: ________ Living with (please check) Parents: ___ Grandparents: ____Other: _____

II. FAMILY DATA


A.
FATHER MOTHER
Name
Birthday
Place of Birth
Nationality
Educational Attainment
Occupation
Address
Contact Number

B. FAMILY MONTHLY INCOME (Please check)


( ) Php 51, 000.00 and above ( ) Php 21, 000.00 - Php 25, 000.00
( ) Php 46, 000.00 - Php 50, 000.00 ( ) Php 16, 000.00 - Php 20, 000.00
( ) Php 41, 000.00 - Php 45, 000.00 ( ) Php 11, 000.00 - Php 15, 000.00
( ) Php 36, 000.00 - Php 40, 000.00 ( ) Php 6, 000.00 - Php 10, 000.00
( ) Php 31, 000.00 - Php 35, 000.00 ( ) Php 5, 000.00 and below
( ) Php 26, 000.00 - Php 30, 000.00

C. PARENTS MARITAL STATUS (Please check)


( ) Married in Church and living together
( ) Married in Civil and living together
( ) Father Remarried
( ) Mother Remarried
( ) Widow
( ) Widower
( ) Married in Church but separated
( ) Married in Civil but separated
( ) Others (Please specify)
____________________________________________________
III. EDUCATIONAL BACKGROUND

School Attended School Year Honors/ Awards


Pre-School
Nursery
Kinder
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10

If Transferees, Write the reason for transfer: ____________________________________________

Club/Organization in School Position Curriculum Year School Year

Favorite Areas / Activities- Checklist

( ) Art ( ) Mathematics ( ) Business ( ) Singing


( ) Dancing ( ) Agriculture ( ) Speaking ( ) Painting
( ) Music ( ) Science ( ) Sports ( ) History
( ) Drawing ( ) Drama ( ) Writing

Memorable Events in life: _________________________________________________________________

______________________________________________________________________________________

Ambition: ______________________________________________________________________________

______________________________________________________________________________________

Occupation Wanted: _____________________________________________________________________

STANDARDIZED TEST TAKEN

Name of Test Date Taken Score Taken Percentile Rank

I hereby certify that the above information is true and correct to the best of my knowledge and belief.

________________________
Signature

________________________
Date

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