PUPIL’S INVENTORY/ Survey Form

I. Pupil’s Data:
Name: __________________________________ Date Enrolled: _________________________
Age of Pupil: _____________________________ Date of Birth: __________________________
Place of Birth: __________________________ Address:_______________________________
Contact Number:
II. Father’s Name: ________________________________ Occupation: _______________________
Educational Attainment: ___________________________________________________________
Mother’s Maiden Name: _________________________ Occupation: _______________________
Educational Attainment: ___________________________________________________________
Other members of the family: _______________________________________________________
_______________________________________________________________________________
________________________________________________________________________________

III. Pupil’s Characteristics:

Naglalaro ba siya sa labas? ______________________________ Saan: ________________________
Kanino?___________________________________________________________________________
Sino ang sumusubaybay sa kanya sa paglalaro?___________________________________________
Anong laro ang kanyang pinaglalaruan? _________________________________________________
Mayroon ba siyang gawain sa bahay? ___________________________________________________
Matulungin ba ito?__________________________________________________________________
Madalas ba siyang humingi ng tulong sa iba? _____________________________________________
Madalas ba siyang mapaiyak o magalit? _________________________________________________
Paano nya ito ipinakikita? _____________________________________________________________
Ano ang kanyang kinatatakutan? _______________________________________________________
Masasabi ba ninyo ang dahilan? ________________________________________________________
Sino ang nagdidisiplina sa bahay sa bata? ________________________________________________
Paano? ____________________________________________________________________________

IV. Emotional Characteristics:

Mapagmahal ba ang batang ito? _________________________________________________________
Nagpapakita ba siya ng pangkaraniwang interes sa inyo o kaya sa ibang tao? _____________________
Agad ba siyang naaabala kung may bagong pangyayari? ______________________________________
Siya ba ay sobrang likot o galaw ng katawan o parang walang gana? ____________________________

V. Social Problems:
Sinu-sino ang madalas niyang kasama? _____________________________________________________
Naglalaro ba siya ng mag-isa? ____________________________________________________________
Sana’y ba siyang makipaglaro sa ibang tao? __________________________________________________
Kung siya’y nakikipag-away sa kanyang kalaro, ano ang kanyang ginagawa?_________________________
______________________________________________________________________________________
Mahusay ba siyang makipagkaibigan? _______________________________________________________

VI. General Information:

Ano ang maipagmamalaki ninyo sa batang ito? ______________________________________________
Iba pang bagay na maipagmamalaki ninyo sa batang ito? ______________________________________
Mayroon ba kayong problema sa bahay tungkol sa batang ito na maaring makatulong ang paaralan?
________________________________________________________________________________________
Ano namang paraan ng pagdidisiplina ang nais ninyong gawin para sa inyong anak?
Kung walang takdang-aralin? _______________________________________________________
Kung hindi naka-uniporme?_________________________________________________________
Kung gumagawa ng kaguluhan? _____________________________________________________
Kung nahuhuli sa klase? ___________________________________________________________
Kung may hindi nasunod na alituntunin sa paaralan? ____________________________________

__________________________________________
Pangalan at Lagda ng Magulang
 ANECDOTAL RECORD

Name: _________________________________________________________________ Age : _____________

Sex:___________
( Surname) (First name) ( Middle Name)
Address:
________________________________________________________________________________________
Birthday: __________________________________________________ Birth Place: _____________________
Nationality: ________________________________________________ Religion: ______________________
Father’s Name ________________________________Educational Attainment: ______________________
Mother’s Name________________________________Educational Attainment: ______________________
Cellphone Number: _____________________________________Position in the Family __________________
Language / Dialect understood by the child:
____________________________________________________________________
Check the child’s interest:
( ) Music ( ) stories ( ) Pets
( ) Books ( ) toys ( ) other ( please specify: ______________
MEDICAL RECORD :
Name of Child’s Doctor: ______________________________________________________________
Address:________________________________________________________________________________________
________
Please check the medical treatment which your child has undergone:
( ) serious accident ( ) handicaps
( ) serious illness ( ) allergies
( ) operation ( ) others please specify
Whom should we call in case of emergencies? _______________________________________________________
Address: _____________________________________________ Cellphone no. ______________________

PARENT’S QUESTIONNAIRE:

State 2 reasons why you want to enroll your child in this school?
1. ___________________________________________________________________________________________
2. ___________________________________________________________________________________________

PARENT’S AGREEMENT:
The details of developing a child to his/her fullest potential as a person physically, intellectually, socially,
spiritually and aesthetically is a joint venture of the school and home. As a parent’s role, the school experts every
parent to:
1. Become partners in implementing the school program
2. Comply with the school rules and regulations
3. Allow their child to participate in school activities.
4. Strictly adhere punctuality in attendance everyday.
5. To actively participate in all PTA activities and projects.

I, _______________________________________________parent/guardian
of____________________________is willing to abide in the aforementioned Parent-School Agreement.

_____________________________________________
Parent/ Guardian Signature
 LEARNER’S INDIVIDUAL PLAN
PART I
Full Name Age:
LRN Gender
Address Citizen
Birthdate Religion
Birthplace Health Background:
Father’s Name
Mother’s Name
Guardian

PART II
Nutritional Status PRE POST FOUR FUNDAMENTALS ( 4FS)
Addition Subtraction Multiplication Division
Pre test
Post test

Reading Level ENGLISH FILIPINO SUBJECTS Pre Post SUBJECTS Pre Post
Pre Post Pre Post English ESP
Non-Reader Math Mother Tongue
Syllabic Science A.P.
Slow Filipino MAPEH
Average
Fast

PART III

SUBJECT Specific Intervention/ MONITORING STATUS

Needs Strategies
Monitoring Insufficient Some Progress Mastery
Date Progress

Prepared by: