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    Individual Inventory Form

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    ALLAN PALATTAO
    This document contains an individual inventory form collecting personal, family, educational, health, and psychosocial information about a student. It collects details about the student's name, address, family, parents' information, socioeconomic status, educational background, health profile, hobbies, talents, goals, problems, and relationship with others. The form is signed by both the student and a school guidance designate.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Individual Inventory Form

    Uploaded by

    ALLAN PALATTAO
    49 views2 pages
    This document contains an individual inventory form collecting personal, family, educational, health, and psychosocial information about a student. It collects details about the student's name, address, family, parents' information, socioeconomic status, educational background, health profile, hobbies, talents, goals, problems, and relationship with others. The form is signed by both the student and a school guidance designate.

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    Individual Inventory Form

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    This document contains an individual inventory form collecting personal, family, educational, health, and psychosocial information about a student. It collects details about the student's name, address, family, parents' information, socioeconomic status, educational background, health profile, hobbies, talents, goals, problems, and relationship with others. The form is signed by both the student and a school guidance designate.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    49 views2 pages

    Individual Inventory Form

    Uploaded by

    ALLAN PALATTAO
    This document contains an individual inventory form collecting personal, family, educational, health, and psychosocial information about a student. It collects details about the student's name, address, family, parents' information, socioeconomic status, educational background, health profile, hobbies, talents, goals, problems, and relationship with others. The form is signed by both the student and a school guidance designate.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    Guidance Form 1

    Republic of the Philippines


    Department of Education
    Region 02 (Cagayan Valley)
    SCHOOLS DIVISION OF ISABELA
    501947 DUROC INTEGRATED SCHOOL

    INDIVIDUAL INVENTORY
    Personal Data & Family Background
    Name:___________________________________________ Nickname:__________________ Age: ______
    Address:_______________________________________________________________________________
    Nationality:___________________ Religion: __________________ Sex: __________
    Date of Birth:_____________________ Place of Birth: ____________________ Birth Order among siblings: ____________
    Number of Children in the family: _____________ Languages/Dialects Spoken: _____________________________

    Parents Information
    Father Mother
    Information
    __Living __Deceased __Living __Deceased
    Name
    Age
    Date of Birth
    Place of Birth
    Address
    Nationality
    Religion
    Contact number
    Highest Educational Attainment
    Occupation
    Languages/Dialects spoken
    Parents Marital Status
    __Married __Living Together __Widow __Annulled __Separated __Others (Specify)____________
    Living with whom?
    __Both parents __Mother __Father __Others (Specify)_____________
    Guardian (if not living with Parents): ________________________________ Address: _____________________________________
    Relationship with Guardian: ____________________________ Contact number: ___________________________________

    Socio-Economic Status
    Monthly Household Income of family (check)
    Below P1,000 P5,001-P8,000
    P1,000-P2,000 P8,001-P15,000
    P2,501-P5,000 OVER P15,000
    Which of the following describe the student’s house?
    ___Concrete ___Semi Concrete ___Wooden ___ Bamboo/Nipa Hut
    Information about family dwelling
    a. The Family ___owns house and lot ___rents house ___others, please specify:_______________
    b. Type of toilet ___flush ___pit ___water sealed
    c. Sources of water ___faucet/tap water ___deep well ___others, please specify:__________
    Appliance/s or gadgets owned ___1. TV ___2. Computers ___3. Refrigerator ___ 4. Washing machine__5. Others (pls specify)______
    Vehicle/s owned ___1. Tricycle/motorcycle ___2. Car ___3. Jeep 4. Truck ___5. Others (specify)_______________
    Land owned ___1. Residential ___2. Farm/field ___3. Commercial/industrial ___4. Kaingin ____5. None

    Educational Background
    Schools Attended:
    Early Childhood Education:_____________________________ Year: _____________
    Elementary: _________________________________________ Year: ____________
    Easiest subject/s:_____________________________ Most difficult subject/s:__________________
    Subject/s with lowest grades____________________ Subjects with highest grades ___________________
    Extracurricular activities liked or participated in:_________________________________________________
    Significant school experiences:_______________________________________________________________
    Has the student ever dropped out of school? Yes_____ No_____
    If Yes, for how long? _____________________ What reason/s?__________________________________
    Is the student receiving any type of financial assistance to attend school? Yes_____ No_____
    If Yes, from what source/s (specify)____________________________________________________________
    Vocational Information
    Do you plan to pursue Senior High school? _____ What Track/Strand do you prefer? __________
    Do you plan to go to college? Why?___________________________________________________________
    What life occupation do you like?
    *First choice: ________________________
    *Second choice :________________________
    *Third Choice: ________________________

    Health Profile
    Height: _______ Weight: _______ Normal Vision: ( )YES ( )NO Normal Hearing: ( )YES ( )NO
    Ailments (please check the item/s which is/are applicable to you)
    ____1. Anemia ____4. Diabetes ____7. others (specify)___________________
    ____2. Asthma ____5. Hypertension
    ____3. Heart Problem ____6. Allergies
    Disability (please check the item/s which is/are applicable to you)
    ____1. Speech impairment ____4. Left-handed ____7. others (specify)___________________
    ____2. Visual impairment ____5. Harelip
    ____3. Hearing impairment ____6. Physical disability (specify)______________________
    Have you been hospitalized? ___________________ Have you undergone operation? _______________________

    Psycho-Social
    Hobbies: __________________________ Talents/Skills ______________________
    Ambitions/Goals:_______________________________ Characteristics that describe you best: ______________________

    Problems/Concerns: (please check the item/s which is/are applicable to you)


    ____1. Financial concerns ___9. Overcoming shyness
    ____2. Issues on alcohol & other drugs ___10. Depression (extreme sadness
    ____3. Study habits/academic concerns Relationship with:
    ____4. Self-confidence ___11. Parents
    ____5. Social skills ___ 12. Teachers
    ____6. Time Management ___ 13. Girls
    ____7. Peer Pressure ___ 14. Boys
    ____8. Family Relations ___ 15. Friends
    ____9. Abuses, trauma, (physical, sexual, verbal, etc.) ___16. Neglect (by parents)

    Is your home or family happy? (please check one) Yes___ No____. Why?
    __________________________________________________________________________________________

    Present Fears: _______________________________________________________________________________

    ___________________________
    Student’s Name & Signature

    School Guidance Designate (Secondary. Dept)

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