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STS Form 1 (Revised 2010)

Republic of the Philippines Department of Education Region III Division of Bulacan

FELIZARDO C. LIPANA NATIONAL HIGH SCHOOL


Sta. Rita, Guiguinto, Bulacan

EDUCATIONAL PROFILE
Year & Section:
LEARNING AREAS No. Name Filipino Final 1st 2nd 3rd 4th English Final 1st 2nd 3rd 4th Mathematics Final 1st 2nd 3rd 4th Science Final 1st 2nd 3rd 4th MAKABAYAN Final 1st 2nd 3rd 4th

School Year:
No. of Failing Marks Final 1st 2nd 3rd 4th % of Failure 1st 2nd 3rd 4th Final Learning Faltering 1st 2nd

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Accomplished by: Class Adviser

Legend: N Normal (No Failing Marks) S Sporadic (between 25% to 50%) T Temporary (not more than 25%) C Chronic (more than 50%)

ear:
Learning Faltering 3rd 4th Final

een 25% to 50%)

1 2 3 4 5 6 7 8
Nationality Ethnic Affiliation Religion Date of Birth Birth Registered Y/N Distance of school from home Means of Transportation Student lives with Who helps student do homework Recipient of financial assistance Y/N Source House/Lot Ownership Type of House Type of Toilet Source of Water Supply Family Dwelling Source of Power Supply Materials/Appl iances Available at Home Monthly Household Income Parental Status Student's Name Age Address Place of Birth

Year & Section:

STS Form 2 A (Revised 2010)

9 10 11 12 13 14 15 16 17 18 19 20 21 22
No.

FAMILY BACKGROUND PROFILE (A)


School Year:

Accomplished by: __________________________________ Class Adviser

Is family a member of Communit y Dev. Org.? Y/N

STS Form 2 B (Revised 2010)

FAMILY BACKGROUND PROFILE (B)


Year & Section:
Parent's Name Student's Name Mother Father Mother Father Parent's Address Living/Decease d Religion Language / Dialect Spoken

School Year:
Nationality Occupation Education

No.

Mother Father Mother Father Mother Father Mother Father Mother Father Mother

2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

Accomplished by: Class Adviser

r:
Education Father

STS Form 3 (Revised 2010)

HEALTH AND NUTRITION PROFILE


Year & Section:
Nutritional Status Weight Status Height Status Common Diseases/Illnesses Incurred within the Year First Grading
No. of Days Absent

School Year:

Name

Above Below Above Below Normal Normal Normal Normal Normal Normal

Illness

Illness

No. of Days Absent

Illness

No. of Days Absent

Illness

No. of Days Absent

Nature

No. of Days Absent

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

Diphtheria

Sex (M/F) Wt. Ht. (kg) (cm)

Second Grading

Third Grading

Fourth Grading

Major Accidents

Immunizations

No.

BCG

23

Accomplished by: Class Adviser

l Year:

Tetanus Polio Measles Whooping cough Hepa B

Immunizations

STS Form 4 (Revised 2010)

ABSENTEEISM AND DROP OUT PROFILE


Year & Section:
Absenteeism Status No. Name No. of Days Absent No. of Days Present
Ever Dropped Out? Y/N

School Year:
Student's Drop Out History
ce

How Long Months Years Reason(s) Family member who dropped out

Reason(s)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

% At o te f nd an

Accomplished by: Class Adviser

School Year:

Remarks

FAMILY BACKGROUND CODE SHEET


Pupil's Nationality no code No formal education Non-formal education Pre-school education Elementary education, grade Elementary education, grade Elementary education, grade Elementary education, grade Elementary education, grade Elementary education, grade Secondary education, year 1 Secondary education, year 2 Secondary education, year 3 Secondary education, year 4 College Post graduate 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 None Who helps student Mother with his/her Father homework Siblings Others Concrete Semi-concrete Other No toilet Flush Pit Water sealed Other Faucet or tap water Deep well Others 0 1 2 3 4 1 2 3 0 1 2 3 4 1 2 3

Pupil's Ethnic Affiliation code no Birth Registration Yes No 1 2 0 1 0 1 1 2 3 4

No Pupil's Drop Our History Yes Family Member's Drop Out History No Yes Both parents Mother Father Others

Education (use for all family members)

1 2 3 4 5 6

Type of House

Type of Toilet

Pupil Lives With

Parental Age (father, mother) (number) no code Parental Mortality (father, mother) Alive Deceased Roman Catholic Protestant Islam I.N.C. Others Married Live-in Widow(er) Annulled Separated Others 1 2 1 2 3 4 5 1 2 3 4 5 6

Parental Religious Affiliation

Farmer 1 Wage worker (non-daily, own account) 2 3 Daily worker (e.g., street vendor, daily laborer) 4 Occupation Contractual of Temporary Worker (primary and Regular employee (private) 5 secondary) Government employee 6 Fisherman 7 Housewife 8 Others 9 Below PhP1000 Between PhP1,000 Between PhP2,501 Income (monthly) Between PhP5,001 Between PhP8,001 Over PhP15,000 Land and house ownership None Own house and lot Rents house 1 2 3 4 5 6 0 1 2

Source of Water Supply

Resources at Home

PhP2,500 PhP5,000 PhP8,000 PhP15,000

None 0 TV 1 Radio 2 Newspaper (daily) 3 Books 4 Magazine 5 Combination of any 2 6 Others 7 Electricity Kerosene lamp Petro-heat Others No short term Yes, (less than 6 months or seasonal) 1 2 3 4 0 1

Parental Marital Status

Power Source

Migration History (family, mother, father)

Land and house ownership

Others

Migration History (family, mother, father)

Yes, short term (less than 6 months or Yes, long term seasonal) (more than 6 months)

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