Republic of the Philippines

DEPARTMENT OF EDUCATION
Negros Island Region
Division of Negros Occidental
SIPALAY CITY NATIONAL HIGH SCHOOL (Attach Most Recent
(SENIOR HIGH SCHOOL) Photo Here)
SIPALAY CITY.NEGROS OCCIDENTAL
GUIDANCE DEPARTMENT

INDIVIDUAL INVENTORY FORM

S.Y. 2022 – 2023 Grade/Section: COOKERY 11

Class Adviser: VILMA P. SERRANO
S.Y. 20 ___ - 20 ___ Grade/Section: _____________________________
S.Y. 20 ___ - 20 ___ Grade/Section: _____________________________
S.Y. 20 ___ - 20 ___ Grade/Section: _____________________________

I. PERSONAL DATA
LRN: _____________________________ Date Filled: _________________
Name of Student: ___________________________________________________ Nickname: ___________________
Sex: ____ Yr. & Section: _______________________ S.Y. ________ Adviser: ________________________________
Age: ____ Date of Birth: _______________________ Place of Birth: _______________________________________
Home Address: _________________________________________________________________________________
Citizenship: __________________ Religion: ___________________________
Tel./Mobile No. (Student): _______________________ Tel./Mobile No.(Parent): _____________________________
E-mail: ________________________________________ FB Account: ______________________________________
Elementary School Graduated from (for 1 st Year only) __________________________________________________
Name of School last attended (for 2nd and 4th Year only) _________________________________________________
School Address: _________________________________________________________________________________
Easiest Subjects: _________________________________________________________________________________
Most Difficult Subjects: ___________________________________________________________________________
Subjects with Lowest Grades/ What Grades: __________________________________________________________
Subjects with Highest Grades/ What Grades: __________________________________________________________
Plan after High School: ____________________________________________________________________________
Awards/ Honors Received: _________________________________________________________________________
Are you a 4P’s recipient? __Yes ___No (Please Check)
Health (Disabilities/Impairments): _________________________

Membership in Organizations
In School:
Name of Organization Position/ Title
___________________________________ _____________________________________
___________________________________ _____________________________________
___________________________________ _____________________________________

Outside School:
Name of Organization Position/ Title
___________________________________ _____________________________________
___________________________________ _____________________________________
___________________________________ _____________________________________

Unique Features
Friends: In School: ______________________________________________________________________________
Outside School: _____________________________________________________________________________
Hobbies / Recreational Activities: __________________________________________________________________
Ambition / Goals: _______________________________________________________________________________
Guiding Principle in Life / Motto: ___________________________________________________________________
Characteristics that describes you best: ______________________________________________________________
______________________________________________________________________________________________
Present Concerns / Problems: ______________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Present Fears: ___________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
 II. FAMILY BACKGROUND
Please fill in the blanks and check the appropriate data.

Name of Father: ______________________________ Maiden Name of Mother: _____________________________

Educational Attainment Educational Attainment

___ College Graduate ___ College Graduate
___ College Undergraduate ___ College Undergraduate
___ High School Graduate ___ High School Graduate
___ Elementary Graduate ___ Elementary Graduate
___ Others please specify ___ Others please specify

Occupation _______________________________ Occupation _________________________________

Employer ________________________________ Employer __________________________________
Tel./Mobile No. ___________________________ Tel./Mobile No. _____________________________
Address __________________________________ Address ____________________________________

Monthly Income: (check only one) Monthly Income: (check only one)
___ P 5,000 – below ___ P 5,000 – below
___ P 6,000 – 10,000 ___ P 6,000 – 10,000
___ P 10,000 – 20,000 ___ P 10,000 – 20,000
___ P 21,000 – 30,000 ___ P 21,000 – 30,000
___ P 30,000 and above ___ P 30,000 and above

Number of children in the family: ____ Your rank in the family: ___________________

II. FAMILY STATUS

1. Parents/ Family Status: ___ Married ___ Single Parent ___ Separated ___ Widow

2. Are you living with both parents? ___ Yes ___ No

Reasons:
a. Parents are living together under one roof? ___ Yes ___ No
b. Parent/Parents is/are deceased? ___ Yes ___ No
(Please Specify) ___ Father ___ Mother ___ Both
c. Parent/Parents has/have another family? ___ Yes ___ No
(Please Specify) ___ Father ___ Mother ___ Both
d. Parent/Parents is/are working abroad? ___ Yes ___ No
(Please Specify) ___ Father ___ Mother ___Both
e. Only living with relatives or guardian? ___ Yes ___ No

(For No. 2 – e only)

Guardians Name: __________________________________ Relationship: ______________
Address:___________________________________________________________________
Contact No.:________________________________________________________________

Remarks/ Other Pertinent Data gathered/ Observed: ________________________________________________

___________________________________________________________________________________________

III. Draw a sketch of the direction to your house. If your address is difficult to locate, start from an identified known landmark in your
area to your house.