Republic of the Philippines

DEPARTMENT OF EDUCATION
Region I
2X2
SCHOOLS DIVISION OFFICE OF PANGASINAN II LATEST
PICTURE
300363 - TAYUG NATIONAL HIGH SCHOOL (with NAMETAG)

LEARNER'S PROFILE
Guidance Office
DATA PRIVACY
I have read CONSENT
this form and understand its contents. I voluntarily give my consent for the collection, use, processing, storage and retention of my personal data
or information to this institution for the reason for referral described in this document. I also understand that my consent does not prevent the existence of
other criteria for lawful processing of personal data and does not waive any of my rights under RA 10173 – Data Privacy Act of 2012 and other applicable
laws.

_____________________________
Signature Over Printed Name

Grade & Section(JHS)/Strand (SHS): ________________________________________ LRN No.:_____________________

Name/Pangalan: _________________________________________________________Nickname:____________________
Family Name/Apelyido Given Name/Ibinigay na Pangalan Middle Name Extension name (e.g Jr. III)
Date of Birth: ______________ Place of Birth:______________________ Sex:________ Age:_________
Petsa ng Kapanganakan Lugar ng Kapanganakan Kasarian Edad
Address: _______________________________________________________________________________________________
No./Bilang ng Street Barangay Bayan/Municipality Probinsiya Bansa/Country
Contact Number:____________________ E-mail Address:_____________________ Religion:_________
Numero ng Telepono Relihiyon

I. FAMILY BACKGROUND:
Name Date of Birth Educational Attainment Work
Pangalan Araw ng Kapanganakan Kursong Natapos Hanapbuhay
Father
Mother
Guardian
Stepdad
Stepmom

Name of siblings Date of Birth Civil Status Educational Attainment Work

Kursong Natapos o Kinukuha pa
Pangalan ng mga kapatid Araw ng Kapanganakan May asawa/wala lamang Hanapbuhay kung meron

Please check ( √ ) the current status about your family/Lagyan ng tsek ( √ ) ang kasalukuyang kondisyon o sitwasyon sa bahay
1. Parent's Status: ________ Married and Living Together ________ Complicated _______ Separated
Estado ng Magulang: Kasal at nagsasama sa bahay Kumplikado Hiwalay
2. I am living with my
Nakatira ako kasama ang aking:
____Father & Mother ____Father ____Mother ____Step Dad ____Stepmom
Ama at Ina Ama Ina Pangalawang Ama Pangalawang Ina
____Grandparents ____GrandFather ____GrandMother Others:_______ Contact No._______
Lolo at Lola Lolo Lola Banggitin ang iba pang sagot:
3. Birth Child Order
Sa aming magkakapatid, ako ang:
___1st Child ___Middle Child ___Last Child Others:________________________________
Panganay Gitnang Anak Panghuling Anak Banggitin ang iba pang sagot:
4. My family is having a problem with:
Ang aking pamilya ay humaharap sa/ sa mga problemang: (maaaring higit pa sa isa ang sagot)
__health problem __financial __parents are always fighting __frequent sibling fights
pangkalusugan o sakit pinansiyal madalas na pag-aaway ng mga magulang madalas na pag-aaway ng mga magkakapatid
__ gambling parents __alcoholic parents __lack of time from parents Others:_______________________
nagsusugal ang mga magulang palaging naglalasing ang ama o ina kulang sa oras na naibibigay ng mga magulang Banggitin ang iba pang sagot:
5. These are my work/responsibilities at home:
Ang mga sumusunod ay responsibilidad na aking ginagampanan:
___household chores __taking care of younger siblings/cousins/relatives __helps with farm work
gawaing-bahay nangangalaga sa nakababatang kapatid, pinsan, o pamangkin tumutulong sa mga gawaing-bukid
___in charge of the sari-sari store Others:______________________________________
nagtitinda o nagbabantay sa tindahan Banggitin ang iba pang sagot:
6. Dialect being used at home: ________________________________________________________________________
Ang diyalekto o wika na ginagamit namin sa bahay ay:
7. 4Ps Recipient? Yes:______ No:______ 4Ps HH#.:_____________
Ang aking pamilya ay kabilang sa 4Ps Oo Hindi

II. EDUCATIONAL BACKGROUND:

NAME OF SCHOOL INCLUSIVE DATES SECTION & ADVISER
GRADE 6
GRADE 7
GRADE 8
GRADE 9
GRADE 10
GRADE 11
GRADE 12
1. Any problems encountered: (May problema ka bang hinaharap tungkol sa mga sumusunod?)
School/subject? __________________________________________________________________
Advisers/Teachers? __________________________________________________________________
Classmates/Schoolmates? __________________________________________________________________
Others (pls specify) ___________________________________________________________________
2. My favorite subject is: __________________________________________________________________
Ang paborito kong subject ay
3. I am having a hard time in the following subject: ______________________________________________
Nahihirapan ako sa mga “subjects” na
4. My teachers are __________________________________________________________________
Ang aking mga guro ay
5. I am excited to go to school because ___________________________________________________
Gustung-gusto kong pumasok sa paaralan dahil
6. I don't want to go to school because ___________________________________________________
Ayaw kong pumasok sa paaralan dahil

Please put a check mark (√) on the recent condition/situation of your studies:
(Lagyan ng tsek ( √ ) ang kasalukuyang kondisyon o sitwasyon sa pag-aaral)
1. I have enough time at home to study: ____Yes ____No
May sapat na oras ako sa bahay para sa pag-aaral Oo Hindi
2. At home, I am assisted in my studies, assignment and project by my:
 Sa bahay, ako ay tinutulungan at tinuturuan sa aking mga aralin, takdang-aralin at proyekto ng aking
___Parents ___father ___mother___grandparents ___relatives ___siblings ___none
magulang ama ina lolo/lola kamag-anak kapatid wala
3. Hindrances in my studies are:
 Ang mga bagay na nakakaistorbo o nakakasagabal sa aking pag-aaral ay:
__watching TV __going computer shop __playing mobile games __peers
panonood ng TV pagpunta sa computer shop paglalaro ng mobile games barkada
__household chores __others:________________________________
gawaing bahay Iba pang sagot:
III. HEALTH BACKGROUND:
Please fill-up the following information needed in each number:
Punan ng detalyeng kailangan sa bawat bilang
1. I was hospitalized because of ____________________________ when I was ______ years of age.
Ako ay na-hospital dahil sa noong ako ay gulang.
2. I suffered from the following diseases: ___________________________________________________
Ang mga sakit na aking naranasan ay
3. Please check: _______ I am sickly/often got sick ____not sickly
Lagyan ng tsek: ako ay sakitin o madalas magkasakit hindi ako sakitin
4. I have allergic reactions with ___________________________________________________________________
Ako ay may allergy sa
5. Which of the following have you ever tried/use: Drugs__ Alcohol__Cigarette/Vape___Gambling: ___Others:____
Alin sa mga sumusunod ang nasubukan mo ng gamitin: droga alak sigarilyo vape iba pa
IV. INTEREST/HOBBIES:
1. I love to __dance __sing ___act __draw/paint __read __poetry __write
Ako ay mahilig sumayaw kumanta umarte gumuhit/magpinta magbasa tumula sumulat
2. I love playing __basketball __volleyball __badminton __chess
__throws __runs __ jumps __others:_________
3. I dream to become a __________________________________________________________
Pangarap kong maging
Do you have circle of friends/ barkada?Yes___No____ Do you belong to a fraternity/sorority group?_______
May barkada ka ba Oo Hindi Kabilang ka ba sa fraternity o sorority
Name of Group?_____________________ How do you define your friends?__________________________
Anong pangalan ng grupo ninyo? Anong masasabi mo sa mga kaibigan mo?
Are you in a relationship(bf/gf)?Yes___No____ Are you a member of LGBTQ?Yes___No____
Ikaw ba ay may bf/gf oo hindi Ikaw ba ay miyembro ng LGBTQ Oo Hindi
Do you experience any form of violence/ abuse?Yes___No____ If YES, what kind?______________________
Nakaranas ka ba ng pananakit o pang-aabuso Oo Hindi Kung oo, anong klase ito
Do you experience bullying in our school or outside? Yes___No____ If YES, what kind?______________________
Nakaranas ka ba ng pambubulas sa loob o labas ng paaralan?
Anything you want to discuss/ share personally with your school Guidance Counselor?______________________
May nais ka bang ibahagi sa ating Guidance Counselor?