Iir Revised Sy 2020 2021

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ELIZABETH SETON SCHOOL

Center for Student Well-being


INDIVIDUAL INVENTORY RECORD

Grade/Year & Section: Grade 10 Student Number: 201210064 1x1 recent


ID picture
House Name (HS only): Saint Lorenzo Ruiz School Year: 2020 - 2021 here
Year/Level Started in ESS: Grade 1 Academic Strand (SHS only):

The learner’s personal information is used exclusively by the Center of Student Well-being to help identify
needs and concerns that can be addressed by the center. The information you are asked to provide will
be part of the learner’s cumulative record. All information will be kept strictly confidential. Please be honest
and sincere in answering this form to enable us to better understand your child.

I. STUDENT’S PERSONAL INFORMATION

Name: Albino Angel Medina Nickname: Angel


(Last) (First) (Middle)
Address: #15 Pioneer St. Moonwalk Subd. Las Pinas City
Birthdate: March 5, 2005 Place of Birth: Las Pinas City Birth Order: first-born
Nationality: Filipiino Religion: Catholic Telephone No.: 82960618
Mobile No.: 09397450432 Email Address: [email protected]

II. FAMILY BACKGROUND


Father Mother
(as reflected on the learner’s (as reflected on the learner’s Guardian
birth certificate) birth certificate)
Gary T. Albino Elisa M. Albino
Name
Master's Degree College
Educational Attainment
Architect House Wife
Occupation
09283392858 09995669562
Contact Number
[email protected] [email protected]
Email Address

Name of Sibling/s If alumni, indicate what batch in


Birthdate Level / Occupation
(Eldest – Youngest) ESS / College Degree and School
Ishmael M. Albino May 29, 2010 Grade 5

Althea M. Albino Feb. 14, 2012 Grade 3

Athena M. Albino June 18, 2019

OTHER PERSON/S STAYING AT HOME


Name Relationship Contact Number
Resan P. Azucena Housemaid 09102866520

Child lives with: ✔ Both Parents Father Mother Guardian Relative


Supervision of School Work: ✔ Father ✔ Mother Tutor Others
Language/s or Dialect/s Spoken at Home:
ELIZABETH SETON SCHOOL
Center for Student Well-being
INDIVIDUAL INVENTORY RECORD

III. PERSONAL CHARACTERISTICS


(Your child’s adviser may see your comments on this portion)

1. What strengths, interests and preferences does your child have?


Has respect, trustworthy, loyal, and friendly, good at making decisions, being very organized

Strengths

Singing, Playing musical instruments, Watching movies and series, Listening to music, Reading books,
Social Media, Hanging out with friends, travelling
Interests

She plays the Piano and the Ukelele, She likes to watch any movie genre, she mostly listens to pop
songs, her favorte books are the Harry Potter series, her favorite social medias are Instagram and
Preferences Tiktok.

2. What does your child need to improve on in terms of the following…


N/A
Academics

N/A
Behavior

To become a successful businesswoman


Career Plans
*JHS/SHS learners only

3. Do you have special concerns about your child? If yes, kindly specify how the guidance counselor/ level
mentor can help him/her.
N/A

4. Has your child consulted with a medical professional / outside specialist for any challenges or concerns he/she
might have? If yes, kindly indicate assessment and recommendations.
N/A

5. Please list two (2) goals that you would like to set with your child for this year.
5. - To be a Merit Card Holder or Medalist
6. - To finish and graduate Junior High School

CONFORME
o
✔ I certify that the information I have provided in this form is true and correct to the best of my knowledge. I
am also allowing ESS to use the data in this inventory for routine interviews, mentoring/counseling,
academic coordination and for research purposes while adhering to the Data Privacy Act of 2012.*

Father’s Signature over Printed Name Guardian’s Signature over Printed Name

Mother’s Signature over Printed Name Date

*In lieu of your digital signature, checking the box and inputting your name in the spaces above signify that you agree to the
aforementioned Conforme statement.

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