TABACO NATIONAL HIGH SCHOOL

Guidance and Counseling Unit

Tabaco, Albay

STUDENT’S PROFILE FORM

PERSONAL INFORMATION

Name ____________________________________ Age _______Sex___ Birth Date_____________

Grade Level/ Section _________________________________________ Track/ Strand______________
Home Address___________________________________________________________________
Mobile Address __________________________Email Ad ____________________ Civil Status ________
What subject/s you like most? _________________ Why? __________________________________
What subject you like least? __________________ Why? _____________________________________
Please mark (X) if you are staying in:
( ) own house ( ) relative’s house ( ) boarding house ( ) with non-relatives
Contact Person in case of Emergency ___________________________ Mobile No. _______________
School Last Attended __________________________________ Address ________________________

FAMILY BACKGROUND

Father _________________________________ Mother ______________________________________

Age _____ Mobile ________________________ Age _______ Mobile ___________________________
Occupation _____________________________ Occupation __________________________________
Place of Work ___________________________ Place of Work ________________________________
Marital Status of Parents (please mark X)
( ) married living together ( ) married but separated ( ) Living together but not married
( ) Single Parent ( ) Widow/ Widower
Family Structure (please mark X)
( ) Living with parent ( ) living with Grandparents ( ) living alone
( ) living with relative ( ) living with siblings ( ) Others
Birth Order (please mark X)
( ) eldest ( ) second ( ) middle ( ) youngest ( ) only child
Monthly Family Income (please mark X)
( ) P5,000 lower ( ) P5,000- 10,000 ( ) P10,000 – P15,000 ( ) P15,000- P20,000
( ) P20,000 -P25,000 ( ) P25,000- higher
MEDICAL HISTORY (please mark X)
Past Illness (Mga Naging Sakit sa nakaraang 6 na buwan)
( ) Primary Complex ( ) Asthma ( ) Rheumatic Fever ( ) Chicken Pox ( ) Kidney Disease
( ) diabetes ( ) Pneumonia ( ) dengue ( ) skin problem ( ) typhoid fever
( ) hepatitis ( ) Anemia/ Leukemia ( ) Covid positive
Do you have history of hospitalization for serious illness, operation, fracture or injury? Yes ____ No___
Are you taking medicine regularly? Yes ____ No , If yes name of medicine___________________
ROAD MAP TO THE RESIDENCE
KARAGDAGANG IMPORMASYON

Pakisagot ng buong katapatan ang mga kinakailangang datos at ito ang magiging basehan para sa
interbensyon na maaring ibigay ng paaralan. Anumang impormasyong makakalap ay mananatiling
kompidensyal. Lagyan ng tsek ang angkop na kahon.

A. Mga pag-aaring gadyet na kasalukuyang nakakatulong sa pag-aaral: (I-tsek ang lahat na

nagagamit)
O Android cellphone O keypad cellphone O laptop O desktop O printer
O Internet/ wifi O flashdrive O transistor radio O television
B. Mga taong nakakatulong sa pagsagot/gawa ng mga gawaing pampaaralan.
O magulang O kapatid O kamag-anak O kaibigan
O tutor O iba pa maliban sa nabanggit ___________________________
C. Kakayahan sa pagbasa
O nakakabasa ng mga salita pero hindi naunawaan ang binasa
O nakakabasa na may pag-unawa sa binabasa
O Hirap magbasa ng mga salita
O hindi nakakabasa
D. Usapang pangkalusugan: nakakaranas ng
O pagkabalisa (anxiety) O depresyon O mahinang paningin O mahinang pandinig
O may kasalukuyang karamdaman, pakilagay__________________________________
E. Educational Assistance: benepisyaryo ng
O 4P’s O CIBI O iba pa maliban sa mga nabanggit