SAN MIGUEL DISTRICT

STA. CRUZ ELEM. SCHOOL

ZONE__________
FAMILY SURVEY MAPPING
2019
Name of Father____________________________________________________Date of Birth_______________Age______Occupation_______________________
Highest Educational Attainment___________________________________________________
Name of Mother:__________________________________________________Date of Birth_______________Age_______Occupation:____________________
Highest Educational Attainment:______________________________________________
Parents’ Address:__________________________________________________Contact No:____________________________________
Monthly Income:___________ Annual Income:__________
4P’s Recipient: Yes______No_______
With water supply / / With Sanitary Toilet / /

Children ages 2-18

Age Male Female IN SCHOOL Grade OUT OF SCHOOL
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18

_________________________________________________________________________________________________________________________________________________
SAN MIGUEL DISTRICT
STA. CRUZ ELEM. SCHOOL

ZONE__________
FAMILY SURVEY MAPPING (2019)

Name of Father______________________________________________________Date of Birth_________________Age______Occupation______________________

Highest Educational Attainment___________________________________________________
Name of Mother:______________________________________________________Date of Birth________________Age______Occupation:____________________
Highest Educational Attainment___________________________________________________
Parents’ Address:______________________________________________________Contact No:_________________________________________
Monthly Income:___________ Annual Income:__________
4P’s Recipient: Yes_________No_________
With water supply / / With Sanitary Toilet / /
Children ages 2-18
Age Male Female IN SCHOOL Grade OUT OF SCHOOL
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18