ST.

ANTHONY’S COLLEGE
San Jose, Antique
LEADERSHIP DEVELOPMENT 4
FAMILY PROFILE

Sitio, Barangay & Purok, Municipality: ___________________________________________________________

RESPONDENT’S NAME: ______________________________________________________________________

( ) Father ( ) Mother ( ) Daughter ( ) Son ( ) Others – to be specified: ____________________

EDUCATIONAL ATTAINMENT:

( ) ELEMENTARY ( ) HIGH SCHOOL ( ) COLLEGE ( ) Others – Specify: __________________________

OCCUPATION (Obra): ____________________________SOURCE or sources OF INCOME: ________________

_____________________________________________________________________________________________

RELIGION: ________________________ORGANIZATION’S AFFILIATED WITH: _______________________

CHILDREN SEX AGE EDUCATIONAL ATTAINMENT/OCCUPATION

1. _____________________ ________ _________ ____________________________________________

2. _____________________ ________ _________ ____________________________________________

3. _____________________ ________ _________ ____________________________________________

4. _____________________ ________ _________ ____________________________________________

5. _____________________ ________ _________ ____________________________________________

(Use separate page if space is not enough)

HOUSEHOLD SOURCE OF INCOME/OCCUPATION:

OCCUPATION INCOME PER MONTH (estimated)

Father ___________________________ ________________________________

Mother ___________________________ ________________________________

Children ___________________________ ________________________________

___________________________ ________________________________

TENURE STATUS OF HOUSE UNIT AND LOT FUEL FOR COOKING

(Pagpanag iya kang gina ulian nga balay)
󠅕Owned 󠅕Charcoal
󠅕Rented 󠅕Firewood
󠅕Shared (lumon) 󠅕Liquefied petroleum gas (lpg)
󠅕Rent-free, with consent of owner 󠅕Other (specify): ____________
󠅕Rent-free, without consent of the owner (squatters)

ESTIMATED TOTAL FAMILY EXPENSES PER MONTH ₱ ________________________________

MAIN SOURCE OF WATER SUPPLY KIND OF TOILET FACILITY

󠅕Owned – use faucet, community water system
󠅕Shared – use faucet, community water system
󠅕Owned – use tubed/piped deep well (Jetmatic pump)
󠅕Shared – use tubes/piped deep well
󠅕Dug well (Awang)
󠅕Spring (tubudan), river, rain, etc.
󠅕Owned – Water Sealed with septic tank
󠅕Shared – Water Sealed with septic tank
󠅕Open Pit
󠅕None (wara CR)
󠅕Others (please specify): _____________
 ST. ANTHONY’S COLLEGE
San Jose, Antique
LEADERSHIP DEVELOPMENT 4
FAMILY PROFILE

PERCEPTION OF WELFARE LEVEL

How would you rate financial situation of the household with regards to satisfying basic household needs (food,
clothing, school, etc.)?

󠅕More than sufficient (Sobra sa kinahanglanon)

󠅕Sufficient (Sakto lang)
󠅕Barely sufficient (Daw kulang)
󠅕Insufficient (Kulang gid)

PERCEIVED ISSUES AND PROBLEMS IN THE COMMUNITY:

How many are

Agency/ies that
affected / Pira ka
could help
panimalay ang
ISSUES / MGA PROBLEMA NGA NATALUPANGDAN UKON (sarang
apektado
EKSPERYENSYA SA SITIO / PUROK / BARANGAY maparapitan
(estimate in terms
nga ahensya nga
of number of
makabulig)
households)

Social / basic Services

(Education, Water
system, roads,
electricity, health
services, etc.)

Political (Pagdumara
sa Barangay ukon
Banwa)

Economic
(Parangabuhian)

Cultural & Spiritual

Environment

Others (please
specify):
___________________

(Use separate paper if space is not enough. . .)

NAME & SECTION OF INTERVIEWER: ________________________________________________________

Date filled up: ________________________________