Republic of the Philippines

EULOGIO “Amang” RODRIGUEZ INSTITUTE OF SCIENCE and TECHNOLOGY

Nagtahan, Sampaloc, Manila

COLLEGE OF ENGINEERING

INDIVIDUAL STUDENT INVENTORY

1. Name: _______________________________________ __ Age: ____ Sex: ___ Civil Status: ______

(Surname) (First Name) (M.I.)
2. City Address: _______________________________________________________________________
3. Provincial Address: __________________________________________________________________
4. Date of Birth: _____________________ Place of Birth: ______________ Nationality: ___________
5. Dialect/s Spoken: __________________________________________ Religion: ________________
6. Education:

Name of School Course Finished Inclusive Date

Elementary: _________________________________ ________________ ______________

Secondary: _________________________________ ________________ ______________
Vocational: _________________________________ ________________ ______________
Program: __________________________ ________________ ______________
Major: __________________________

College: __________________________________ ________________ ______________

Major: __________________________________

7. Family Background

A. Father Mother Spouse

Name: ____________________ ____________________ ____________________

Place of Origin: ____________________ ____________________ ____________________
Occupation: ____________________ ____________________ ____________________
Monthly Income: ____________________ ____________________ ____________________

Siblings Age School/Company

____________________________________ _____ __________________________________

____________________________________ _____ __________________________________
____________________________________ _____ __________________________________
____________________________________ _____ __________________________________
____________________________________ _____ __________________________________
 B. Family Income/Financial Status (Please Check)
___ Poor ___ Below Average ___ Average ___ Above Average

C. Home Living Conditions (Please Check)

___ Unbearable ___ Bearable ___Pleasant ___ Happy

8. Estimated Monthly Expenses

Food: Php _______________ Electricity/Water: Php _______________
Clothing: Php _______________ Education: Php _______________
House Rental: Php _______________ Others: Php _______________

9. Physical Health
Height: __________ Weight: ____________
Physical Condition (Please Check):
___ Unhealthy ___ Weak but not sick
___ Marginally Healthy ___ Healthy
Are you physically handicapped? If yes, what is your handicap? _______________________________
Can you easily relax after a strenuous activity? ___ Yes ___ No
Do you have worries, anxieties, or strong prejudices? If yes, what are they?
______________________________________________________________________________
Are you happy most of the time? ___ Yes ___ No

10. Interests and Traits

Condition of Leisure Time:

___ Limited ___ Adequate ___ Adequate and well-applied ___ None
What are your present habits and interests? __________________________________________
______________________________________________________________________________
To what type or group of people do you enjoy working with during social activities?
___ Group of the same age ___ Group of older people
___ Group of the same sex ___ Group of younger people
___ Group of the opposite sex ___ Mixed group of old and young people
Do you participate in sports activities? If yes, in what sports? _____________________________
What activities do you enjoy most?
___ Playing/Listening to Music ___ Reading ___ Others (pls. specify)
___ Physical Activities ___ Painting