Republic of the Philippines

Department of Education
REGION VI
SCHOOLS DIVISION OF CADIZ CITY
CADIZ EAST ELEMENTARY SCHOOL I

PUPIL’S PROFILE
1X1 Photo

I. PERSONAL DATA

Name: ________EARL THEODORE M. BORNALES__________ Age: __8__ Sex: Male __/__ Female ____

Date of Birth: _____DECEMBER 12, 2012____________ Place of Birth: _CADIZ CITY_________________

Address: ____CADIZ HEIGHTS PHASE 3, BRGY. TINAMPA-AN, CADIZ CITY___________

Contact Number: ___09070469397_____________ Religion: _____ROMAN CATHOLIC________________

II. EUDACTIONAL BACKGROUND

Previous School Attended: __ CADIZ EAST ELEMENTARY SCHOOL I_________ Year Finished: ___________________

Honors/ Awards Received: __________________________________________________________________

Subject/s Liked Best: ___MATH____________________________________________________

III. FAMILY BACKGROUND

A. FATHER MOTHER

Name: ____ERLITO O. BORNALES JR.___ Name: ____MARIA VERA M. BORNALES______

Age: __33__ Religion: ____ ROMAN CATHOLIC ___ Age: __32__ Religion: ___ ROMAN CATHOLIC ___

Address:CADIZ HEIGHTS PHASE 3 Address: CADIZ HEIGHTS PHASE 3

BRGY. TINAMPA-AN, CADIZ CITY BRGY. TINAMPA-AN, CADIZ CITY

Contact Number: _____09070469397________ Contact Number: ___09502131925_________

Occupation: _____TEACHER__________ Occupation: _____ TEACHER ______________

B. EDUCATIONAL STATUS:

____ Elem. Level ____ Elem. Graduate ____ Elem. Level ____ Elem. Graduate

____ HS Level ____ HS Graduate ____ HS Level ____ HS Graduate

____ College Level __/__ College Graduate ____ College Level ___/_ College Graduate

____ Masteral ____ Doctorate ____ Masteral ____ Doctorate

C. PARENTS’ MARITAL STATUS

__/_ living together ____ living together but one/both working abroad ____ separated

____ separated without having each a family ____ separated with other families ____ deceased
Living with whom: ____ with my parents ____ one of my parents ____ relatives ____ dormitory/boarding house

D. Number of Brothers: __3_ Number of Sisters: _0_ No. of sibling attending school: _1_

Rank/ Birth Order: __1__ Only Child: ____ Eldest: _/___ Middle: ____ Youngest: ____

D. Name of Guardian (If not living with parents):

_______________________________________________________

Address: ______________________________ Contact Number: _______________ Occupation:

__________________

IV. SOCIO-ECONIMIC STATUS

House: __/_ Owned ____Rented __/__ Electric Light __/__ Study Table ____House Tutors

___/_ School Bag ___/_ Shoes __/__ TV/Cable __/__ Umbrella/ Raincoat ___/_

Cellphone

V. HEALTH INFORMATION

What is the general condition of your health? __/__ Good ____ Fair ____ Poor
Do you have any physical deficiency/deformities? ____ Yes __/__No
(If Yes, in what form?)
____ Eye impairment ____ Kidney ailments ____ Asthma/ Lung ailments
____ Throat ailments ____ Heart ailments ____ Epilepsy/ Seizure disorder
____ Hearing impairments ____ Bone ailments ____ Joints/ Muscle impairments
____ Stomach ailments ____ Allergy (please specify) _______________
Others (please specify): ____________________________________________________________________

VI. LEISURES AND INTEREST

What do you do during your free time? ___Computer Games____________________________________

Hobbies, special talents or skills you have? ____Sing,Dance__________________________________

Inclination/ Interest: ____ Sports ____ Performing Arts ____ Class Leadership
__/_ Literacy ____ Creative Arts ____ Religious Groupings ____ Declamation/
Oration
_/__ Singing __/_ Dancing ____ Acting/ Dramatics____ Playing Musical Inst
Others:
_____________________________________________________________________________________

VII. PERSONAL CHARACTERISTICS

Encircle the number(s) corresponding to the words which describe you:

1. Perseverance/ determined 4. Capable

2. Friendly 5. Tolerant
3. Stubborn 6. Shy
7. Jealous 19. Reserved
8. Conscientious/ careful 20. Selfish
9. Irritable 21. Submissive
10. Poor Health 22. Optimistic
11. Tires easily 23. Daydreaming
12. Confident 24. Excitable
13. Industrious 25. Anxious
14. Cooperative 26. Nervous
15. Religious 27. Unhappy
16. Calm 28. Sensitive
17. Trusting 29. Patient
18. Pessimistic/ doubtful 30. Unsure
Personal Ambition:

__________________________________________________________________________

________________________________________________________________________________________
_

EARL THEODORE M. BORNALES

Student’s Name and Signature

Address: Cor. Abelarde-Cabahug St., Brgy. Zone 4, Cadiz City, Negros Occidental 6121
Telephone No.: (034) 493-11-81
Email Address: 117546@deped.gov.ph