Professional Documents
Culture Documents
I. FAMILY DATA
a) Name of Husband _______Alberto G. Mendoza_______________________ Age : ___60___
b) Name of Wife ___________Teodocia E. Mendoza______________________ Age : ___60__
c) Address __sitio ibabao ambulong batangas city______________________________
d) Educational Attainment (highest)
Husband_______highschoo___________ Wife ___________3 rd college_____________
e) Length of Residency (on above address)_______________________________________
f) Family Size ____________5_____________ g) Religion ________catholic ____
h) Place of Origin _____________________________ i) No. of Children_____5 ___
Highest Educational
Name Age Sex Status Occupation
Attainment
Alberto G. Mendoza 60 M Marrie Highschool ofw
d
Teodocia E. Mendoza 60 F Marrie 3rd yr college ofw
d
Albert heissen E. Mendoza 29 M Marrie 2nd yr college ofw
d
Albert Angelo E. Mendoza 21 M single 3rd yr college and none
going
Allysa Mae E. Mendoza 20 F F 2nd yr college and none
single going
d) Toilet facilities:
( / ) owned ( ) shared ( ) public
Type: ( ) pit latrine ( ) bored hole latrine ( ) aqua privies ( ) flush system
Garbage disposal:
( / ) burning ( ) flying saucer( ) MMA Collection
( / ) open dumping ( ) garbage collector Others/specify _____________________
e) Food preferences:
( / ) fish ( ) vegetable ( ) combination
( / ) pork ( ) beef ( ) others: specify______________________
How is food stored?
( ) covered ( ) uncovered ( / ) refrigerated
Are you using iodized salt? ( ) Yes ( ) No
For how long? ( / ) Weeks ( ) Months ( ) Years
f) Gardening:
( ) fruitbearing ( / ) herbal ( ) ornamental plants
g) Animal or pet:
( / ) dog ( / ) cat ( ) chicken ( ) fish ( ) bird ( ) others:
specify:__________________