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First Year Student Inventory Form

This document is an individual inventory form for students of Pangasinan State University. It collects personal information such as name, contact details, family background, education history, health, interests and hobbies. It also includes intake interview questions for students to write their first thoughts on topics like family, friends, dreams and fears. The form is to be filled out completely and correctly by new students and submitted along with a photo for assessment by a counselor.

Uploaded by

Kezaiah jean Mendoza
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Download as PDF, TXT or read online on Scribd
433 views2 pages

First Year Student Inventory Form

This document is an individual inventory form for students of Pangasinan State University. It collects personal information such as name, contact details, family background, education history, health, interests and hobbies. It also includes intake interview questions for students to write their first thoughts on topics like family, friends, dreams and fears. The form is to be filled out completely and correctly by new students and submitted along with a photo for assessment by a counselor.

Uploaded by

Kezaiah jean Mendoza
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

FM-AA-AGT-0

Rev. 01
16-July-2018

INDIVIDUAL INVENTORY FORM


PANGASINAN STATE UNIVERSITY
_________________ Campus

FIRST YEAR TRANSFEREE


PLEASE READ BEFORE FILLING UP!
1. Fill up this form COMPLETELY AND CORRECTLY
2. Submit this form together with 2X2 ID picture with plain background and nametag
I. PERSONAL INFORMATION
Last Name

First Name

Middle Name

Course and Year


2X2
Date of Birth Place of Birth ID PHOTO
Gender Age Civil Status

Religion Citizenship

Residential Email Ad
Address
Permanent Tel. No. Cellphone No. .
Address

Home with Parents Private House Dormitory/ Boarding House


Place where you are staying
(Please check all applicable to you)
Staying with friends Apartment Other: Please specify, .

II. EDUCATIONAL BACKGROUND


Private/ Dates of Honors /Special
LEVEL SCHOOL GRADUATED SCHOOL ADDRESS
Public Attendance Awards Received
Preschool
Elementary
High school
Vocational (if any)
College (if any)
High School GPA:
III. FAMILY BACKGROUND
FATHER MOTHER
(indicate  after the name if deceased) (indicate  after the name if deceased)
Name
Educational Attainment
Occupation
Age

Guardian’s Name
Educational Attainment Occupation

Living together Temporarily Separated Permanently Separated


Parents’ Marital Relationship:
(Please check all applicable to
Father OFW Mother OFW Marriage Annulled/Legally Separated
you)
Father w/ Another Partner Mother w/ Another Partner Others, specify________________

No. of children in the family including


Birth order (ex. 1st child, 2nd child...)
yourself
Who finances your Parents Relatives Siblings Guardian
schooling :
(Please check all applicable to
you) Scholarship Grant Self-support Others, specify________________

Weekly allowance Parents’ total monthly income


IV. HEALTH
A. Academic B. Psychological
Do you have problems with : (If Yes, please specify) Previous Consultations: (If Yes, please specify)
Your vision No Yes, Psychiatrist No Yes,
Your speech No Yes, Psychologist No Yes,
Your hearing No Yes, Counselor No Yes,
Your general health No Yes,
FM-AA-AGT-0
Rev. 01
16-July-2018

V. INTERESTS AND HOBBIES


A. Academic B. Extra-Curricular
What is /are your favorite subject/s? What are your hobbies? Write them in the order of your preferences.

1. 3.

What is/are the subjects you like least? 2. 4.

VI. INTAKE INTERVIEW QUESTIONS


(Read each item carefully and finish them by writing the first things or idea that comes to your mind)
1. My father
2. My mother
3. My family
4. My sibling/s
5. My childhood
6. My friends
7. My school
8. My dream
9. My weakness
10. I am afraid

STUDENT’S SIGNATURE : DATE :

VII. TO BE FILLED OUT BY COUNSELOR


COUNSELOR’S OBSERVATION :

COUNSELOR’S RECOMMENDATION :

ATTENDING COUNSELOR’S
SIGNATURE OVER PRINTED NAME : DATE :

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