STI Guidance and Counseling Office

CONFIDENTIAL Individual Inventory Form

RECENT 1X1
Tertiary (Semester):
STI _______________ PHOTO
 1st  2nd  Summer
Senior High (Quarter):
SY ____ - ____
 1st  2nd  3rd  4th  Summer

Surname First Name M.I. Student No. Year Level Program and Section

Nickname Nationality Gender Status Religion Birthday

______ /______ / ______
Contact Information
Cellular phone number/s E-mail address 1 E-mail address 2 Home number
_______________________________ ______________________ __________________ _____________
Present Address: _______________________________________________________________________________
Permanent Address: ____________________________________________________________________________
Provincial Address: _____________________________________________________________________________

For married students only

Name of Spouse: __________________________________________________________________ Age: ______
Working: If working: Occupation Contact number
 Yes  No _________________________________________ __________________________
Family Background

Father Mother
Name
Age and Birthday
Nationality
Religion
Educational Attainment
Occupation
Contact Number
Company
Monthly Income

 Married
Status of Parent/s:  Single Parent  Divorced/Annulled  Remarried
 Living together Separated  Widowed/Widower
Name of Guardian/s: ___________________________________________________________________________
Address of Parent/s or Guardian/s: ________________________________________________________________
Contact Number of Guardian/s: __________________________________________________________________

Sibling Order:
Name Age Gender Program/Occupation School/Company

In case of emergency, please contact: ______________________________ Contact #: ______________________

Copyright 2017 STI EDUCATION SERVICES GROUP, INC. All rights reserved.
STRICTLY CONFIDENTIAL. Should only be accessed by the Guidance Counselor/Associate.
▪▪▪
STUDENT DEVELOPMENT AND WELFARE
FT-SDW-096-00 | INDIVIDUAL INVENTORY FORM | PAGE 1 OF 2
 STI Guidance and Counseling Office
Individual Inventory Form
Educational Background
Name of School Year Attended
Grade School ________________________________________________________________ _____ - _____
High School ________________________________________________________________ _____ - _____
College ________________________________________________________________ _____ - _____
Vocational ________________________________________________________________ _____ - _____
Others ________________________________________________________________ _____ - _____
Extra-curricular activities from previous schools: ______________________________________________________
Awards/Citations received: _______________________________________________________________________
Most liked subject/s in school: ____________________________________________________________________
Least liked subject/s in school: ____________________________________________________________________
Your 3 major strengths as a student: _______________________________________________________________
Work Experience (Start from the most recent to the previous experience/s if any.)
Company Position Duration Job Description

Interests and Recreational Activities

Sports:
Hobbies:
Talents:
Other Activities:
Socio-civic:
School Organizations:
Health
 Have you ever been hospitalized?  Yes (state when/reason) ____________________  No
 Have you ever had an operation?  Yes (state when/reason)____________________  No
 Do you currently suffer from any  Yes (state illness) __________________________  No
illness/condition?
 Do you take any prescription drugs?  Yes (drug name/purpose) ___________________  No
 Have you submitted a medical  Yes (Attached) ____________________________  No
certificate/assessment report?
Common illness in the family: _____________________________________________________________________
When did you last see a doctor? _________________ Reason for the visit: ____________________________
Life Circumstances
Indicate any LOSS that you have experienced (ex. death of a family member, close friend):

Check any of the PROBLEMS below that currently concerns you:

 Fear  Communication  Shyness  Loneliness  Stress  Anger
 Self-confidence  Academic Performance  Career  Financial  Others: ____________
 Relationship/s with:  Father  Mother  Siblings  Teachers  Others:_________________
* Counselor’s/Associate’s notes: _________________________________
____________________________________________________________
Student’s signature over printed name
Assessed by: _________________________________________________
Guidance Counselor/Associate’s Name and Signature

Copyright 2017 STI EDUCATION SERVICES GROUP, INC. All rights reserved.
STRICTLY CONFIDENTIAL. Should only be accessed by the Guidance Counselor/Associate.
▪▪▪
STUDENT DEVELOPMENT AND WELFARE
FT-SDW-096-00 | INDIVIDUAL INVENTORY FORM | PAGE 2 OF 2