PUPILS PROFILE

and
ANECDOTAL RECORD

Name: _____________________________________________________ Date of Birth: ___________________

Age: ______ Gender: ____________ Nationality: ________________ Religion: _______________________
Grade Level: __________ Landline/Telephone #: ______________ Cellphone #: ___________________
Address: ____________________________________________________________________________________
Purok Barangay Municipality Province
Name of Father: __________________________ Age: ____ Occupation: ___________ Mobile #: ______________
Name of Mother: __________________________ Age: ____ Occupation: __________ Mobile #: ______________
(Maiden Name)

Name of Guardian: ________________________ Age: ____ Occupation: __________ Mobile #: ______________

No. of Children in the Family: ____________ No. of Boys: ______________ No. of Girls: ______________
Are your Biological Parents, i.e., mother and father still living together? ( ) YES; ( ) NO
What can you say to your own parents and family? ___________________________________________
_____________________________________________________________________________________________

Rate yourself by checking the corresponding box/space that best illustrates your personality qualities:
( ) Very Healthy ( ) Healthy ( ) Not so Healthy ( ) Sickly
If not so healthy and sickly, jot down the kind of illness affecting you? ___________________________________
( ) Very Friendly ( ) Friendly ( ) Not so friendly ( ) Do not like having friends
( ) Very Shy ( ) Shy ( ) Self Confident
What you would like to be when you grow up? (Ambition in Life) _______________________________________
Skills/Talent (eg. Singing, Drawing, etc.) _______________________________________________________________
Name of preparatory school where you graduated: __________________________ School Year: ___________
Schools Attended (Preparatory School):
Name of School School Year Preparatory School Age Teacher
Level
Toddler
Nursery
Kinder I
Kinder II

Psychological Test:
Test Date Taken Raw Score Percentile Rank Classification

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CRITICAL INCIDENT RECORD:
KINDERGARTEN
Date Problem Action Taken Remarks

GRADE I
Date Problem Action Taken Remarks

GRADE II
Date Problem Action Taken Remarks

GRADE III
Date Problem Action Taken Remarks

GRADE IV
Date Problem Action Taken Remarks

GRADE V
Date Problem Action Taken Remarks

GRADE VI
Date Problem Action Taken Remarks

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