MALLIG NATIONAL HIGH SCHOOL-ANNEX

Mallig, Isabela

GUIDANCE OFFICE

PERSONAL DATA INVENTORY

DIRECTION: Please complete this inventory as accurately and honestly as you

can. The purpose of collecting this information is to be of assistance to you
in making choices and decisions. All information which you provide about
yourself will be treated confidentially.

NAME: _________________________________ Date: __________________

Birth date: _____________________ Birth Place: _________________

Address: ______________________________ Tel/cell Phone No.___________

Year & Section: _______________________ Sex: ___________________

Boarding house: _____________________________________________

Name of Landlord/landlady: __________________________________

Previous School Attended: ___________________________________

Outstanding Activities, Honors, awards (if any):_______________________

Mother’s Name: __________________________________________

Age: __________________ Occupation: _____________________

Father’s Name: __________________________________________

Age: __________________ Occupation: _____________________

Parent’s married: ______________________ Separated: ___________________

Parent’s not married: ____________________________

Mother/Father Remarried: ____________________________

Name of step-parent or guardian (if any):______________________________

Address: _____________________________ Age: _______________

Occupation: ___________________________

Sample Guidance Forms- 1

Name of brothers/ sisters studying here at Mallig National High School-Aannex

(Indicate year and section)

Name Year & Section

_______________________ _______________________
_______________________ _______________________
_______________________ _______________________
_______________________ ____________________

Indicate your Sibling Position: _______________________________________

SCHOLASTIC DATA:

A) Elementary school graduated ___________________________________

Date Graduated: ____________________ General Average: ____________

TEST RECORD:

Date Kind of Test Score Rank

_____________ ___________________ ____________ ___________

_____________ ___________________ ____________ ___________

_____________ ___________________ ____________ ___________

_____________ ___________________ ____________ ___________

VOCATIONAL PLANS:

List the occupation which you would like to make a living

______________________________ _____________________________

______________________________ _____________________________

School subject you like best:

______________________________ _____________________________

______________________________ _____________________________

School subject you like least:

______________________________ _____________________________

______________________________ _____________________________

Sample Guidance Forms- 2

CO-CURRICULAR ACTIVITIES:

Indicate the interest group to which you wish to belong.

(Please check)

_________ Sports Club

_________ Home Arts Club ______ Social Studies Club
_________ Religious Club ______ English Club
_________ Civic Awareness/Service Club ______ Filipino Club
_________ Math/ Science ______Others

EMOTIONAL REACTIONS:

______ Shy ______ Submissive _____ Confident

______ Friendly ______ Studious _____ Jealous
______ Nervous ______ Cheerful _____ Aggressive
______ Patient ______ Irritable _____ Unhappy
______ Stubborn ______ Lazy Fatigue

CHECK PROBLEM AREA IN WHICH YOU ENCOUNTER MUCH DIFFICULTIES

_______ Teacher Student Relationship

_______ Financial Difficulty
_______ Boy-Girl relationship
_______ Study habits
_______ Parent-child relationship
_______ Adjustment to school
_______ Boarding House
_______ Health Problem (Specify)
_______ Career choice

What is the highest level of education you expect to finish

(Check your choice)

_______ Technical/College
_______ Doctoral Degree
_______ Master’s Degree
_______ No intention to finish Degree

Briefly state your reason(s) why you enrolled here at Mallig National High
School-Annex

Sample Guidance Forms- 3

Questions:

1. Do you experience any problem or difficulty now?

_________________________________________________________________

2. If yes, describe your problem briefly:

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

________________________________________________________________.

3. Would you like to talk over your difficulty to the guidance

counselor? ___________________________________________

4. Whom do you like to talk with? __________________________

Sample Guidance Forms- 4

 Mallig ational High School-Annex
Mallig, Isabela

GUIDANCE OFFICE

FAMILY BACKGROUND FORM

Name:

Surname Given Name Middle Name

Birthday: ___________________________________
Birthplace: _________________________________
Address: ____________________________________

A) Paste your family picture including all the members and describe each.

B)
1. My father is ___________________ who works in _______________

And my mother is _________________ who works in _____________

They a) _____ live together

b) _____ are separated
c) _____ deceased (For M)
d) _____ remarried (For M)
e) _____ working abroad (Father, Mother or both)

2. I wish my dad is
_________________________________________________________________

Sample Guidance Forms- 5

 3. I wish my mom is
_________________________________________________________________

4. I wish our family is

_________________________________________________________________

C)
1. My happiest moment with my family is when
_________________________________________________________________

2. Our saddest moment as a family is when

_________________________________________________________________
_________________________________________________________________

3. If luck will turn to my favor, I wish Dad and Mom will be

_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

4. My greatest fear for our family is

_________________________________________________________________

D). Represent your family by drawing your favorite family activity

Sample Guidance Forms- 6

 Mallig National High School-Annex
Mallig, Isabela

GUIDANCE OFFICE

PRE- COUNSELING FORM

Name: __________________________________________________________________
Surname First Name M.I.

Address: ____________________________________
Year $ section: _____________________________
Referred by: ________________________________
Chief Reason/s for referral:
___________________________________________________________
___________________________________________________________
__________________________________________________________.

Time Started: _______________________________

Date of Counseling: _________________________

Student’s Problem:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

Summary of the interview:

_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

Steps taken to assist the student:

_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

Date of next scheduled interview: _____________________________

Time ended: _____________________________

____________________________
Guidance Coordinator

Sample Guidance Forms- 7

 Mallig National High School-Annex
Mallig, Isabela

GUIDANCE OFFICE

FOLLOW-UP CUONSELING FORM

Name: _________________________________________________________________
Surname Given name M.I.

Year $ Section: ________________ Date last counseled:_________________

Time started: __________________ Follow-up No. _______________________
Student’s Problem:
_________________________________________________________________

A) BACKGROUND:

_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_______________________________________________________.

B) ASSESSMENT OF PROGRESS OF STUDENT:

_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
____________________.

C) STEPS TAKEN TO ASSIST THE STUDENT:

_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
____________________________________________________________.

DATE OF NEXT SCHEDULED INTERVIEW: _______________________________

DATE: _________________________

_______________________
Guidance Coordinator

Sample Guidance Forms- 8

 Mallig National High School-Annex
Mallig, Isabela

GUIDANCE OFFICE
HOME VISITATION REPORT FORM

Name of Parent/Guardian: ________________________________________

Name of Child/Student: __________________________________________
Year $ Section: __________________________ Date: ________________

PURPOSE OF HOME VISITATION:

_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
______________________________________________________________.

SUMMARY:

_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_______________________.

ACTION TAKEN:

_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
______________________________.

RECOMMENDATION/S:

_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

_______________________
Guidance Coordinator

Sample Guidance Forms- 9

 Mallig National High School-Annex
Mallig, Isabela

GUIDANCE OFFICE FEEDBACK SLIP

Date:_______________

ADVISER: _____________________________

Kindly give us your comments concerning the attendance, class standing

and behavior of ________________________________________,
a student in your class _________________________.

We will appreciate it very much if you will hand this paper back
at the office the soonest time possible.

________________________
Guidance Coordinator

Comments:

1. Attendance _____________________________
2. Class Standing __________________________
3. Behavior in class _______________________

_______________________
Adviser’s Signature

Received by: ___________________

Date Received: _________________

Sample Guidance Forms- 10

 Mallig National High School-Annex
Mallig, Isabela

GUIDANCE OFFICE

REFERRAL SLIP

___________________
Date

Name of Student: ________________________________

Year $ Section: _________________________________
Purpose of Referral: ____________________________
State the nature of problem: __________________________________________

_____ Psychological Testing

_____ Career/ Vocation Counseling
_____ Orientation Service Assistance
_____ Information Service Assistance
_____ Educational Placement assistance
_____ Others

_____________________
Name

_____________________
Designation

Sample Guidance Forms- 11

 Mallig National High School-Annex
Mallig, Isabela

GUIDANCE OFFICE

NOTICE ON COUNSELING CASES

________________
Date

Dear Parents,

Please be informed that your child was referred to the Guidance Office
for guidance/counseling due to ____________________________.

May I therefore, request that you come to the Guidance Office on

________________ so that we could further discuss your child’s concern.

Thank you.

Very truly yours,

___________________
Guidance Coordinator

Sample Guidance Forms- 12

 Mallig National High School-Annex
Mallig, Isabela

GUIDANCE OFFICE

CALL SLIP

Miss/ Mr. __________________,

Greetings!

You are requested to come to the Guidance Office

on _________________ at _____________ a.m./p.m.

______ Counseling
______ Follow- up
______ Testing

Please do not fail to come. Thank you.

Yours truly,

________________________
Guidance Counselor

Mallig National High School-Annex

Mallig, Isabela

GUIDANCE OFFICE

CALL SLIP

Miss/ Mr. _______________,

Greetings!

You are requested to come to the Guidance Office

On _______________
At _______________a.m. / p.m. for:

______Counseling _____ Follow-Up

_____Testing

Please do not fail to come. Thank you.

Yours truly,

______________________
Guidance Counsel

Sample Guidance Forms- 13

 Mallig National High School-Annex
Mallig, Isabela

GUIDANCE OFFICE

COUNSELING REPORT

CONFIDENTIAL

Name: ____________________________________ Date: _________________

Age: _________ Year & Section: _________________ Sex: ____________
Sibling Position: ___________________ Religion: ___________________

PRESENT CONDITION:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
___________________________________

CONCERN/ PROBLEM
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
________________________________

ATTITUDE/S TOWARDS PROBLEM

_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
___________________________________

RECOMMENDATION/INTERVENTION
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_________________________

Notes:
_____________________________________________________________________________
_____________________________________________________________________________
___________________________________________________________.

Sample Guidance Forms- 14

 Mallig National High School-Annex
Mallig, Isabela

Name of Activity: ________________________Venue: ___________Date:____________

Year &section: _________

Directions: Please read each statement in the questionnaire and check the number
that corresponds to your answer.

Scale: 5- Very strongly agree 4- Strongly agree 3-

Agree
2- Moderately Disagree 1- Strongly disagree

Items 5 4 3 2 1
1.The objectives of the activity were clear and specific.
2.There was evidence of adequate planning before this activity
was undertaken
3.The school policies, rules & regulations were manifested in
the behaviors of the students.
4.The venue’s conduciveness contributed in the realization of
the objectives of the activity.
5.The facilities were convenient.
6.The activities were appropriate, relevant and helpful in my
growth & development.
7.Quality of participation of the students.
8.Provision was made for acquainting students with
administrative and service personnel.
Note: item 8 is intended for orientation activity only.

Please write your comments and suggestions below.

A) Good points
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
___________________________.
B) Weak points
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
___________________________.

C) What would you suggest/recommend to improve the activity?

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________________________________.

Sample Guidance Forms- 15

 La Salette of Ramon
Ramon, Isabela

Seminar on: _______________________Date:______________Venue:_________________

Direction: kindly give your honest assessment about the seminar on the bases
of the factors enumerated below. Put a check on the column that
corresponds to your assessment.

5- Excellent 3-Good 1-Poor

4-Very good 2-Fair

Items Rating

1 2 3 4 5
1.Attainment of the objectives of the seminar

2.Effectiveness of the speaker/s

3.Timeliness of the topic

4.Time schedule management

5.Quality of participation of the participants

6.Venue of the seminar

Please answer the following questions.

1. What follow-up activities would you like to recommend?
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
__________________.

2. Are there any comments which you would like to make?

_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_____________________.

Sample Guidance Forms- 16