SOCIODEMOGRAPHIC PROFILE

Name of Child: ____________________________ _________________________ __________________

Family Name First Name Middle Name
Address: ____________________________ ____________________________ ____________________
Barangay Municipality Province

Child handedness (Check appropriate Box): Right Left Both not yet established

Is the child presently studying? (Check appropriate Box) Yes No

If Yes, write name of child’s school / learning center / day care: _________________________________

Father’s Name: _______________________________ Fathers Age: ____________________________

Father’s Occupation: ___________________________ Father’s Educational Attainment: ___________

Mother’s Name: _______________________________ Mother’s Age: ___________________________

Mother’s Occupation: __________________________ Mother’s Educational Attainment: ___________

Child’s Number of Siblings: ______________________ Child’s Birth Order (1st, 2nd, 3rd, etc.): _______

No. of Brother/s: ______________________________ No. of Sister/s: __________________________