Republic of the Philippines

Department of Education
REGION III
TARLAC CITY SCHOOLS DIVISION
BANTOG ELEMENTARY SCHOOL
BANTOG, TARLAC CITY

INDIVIDUAL INVENTORY FORM

Important: This is the Individual Inventory Form. It will be used by the Guidance Counselor as a means to assist you in
every way possible. Please supply the information required below honestly and thoroughly as you can. Rest assured that
information gathered here shall be utilized with utmost confidentiality and professionalism.
PERSONAL PROFILE
Name: _____________________________________________________________
Sex:_____________
1X1
Grade/Year Section: _______________________________Birthdate: ___ / ___ / _______ (mm/dd/yr)
PICTURE of
Address:____________________________________________________________________________
the Student
Birthplace: _________________________________Contact Number: __________________________
Person to be conducted in case of accident: _______________________________________________
Relationship: ____________________Address:_____________________________________________
_______________________________________________Contact Number: ____________________________________
FAMILY BACKGROUND
Profile of Parents Father Mother
Name: _____________________________ ___________________________________
Age: _____________________________ ___________________________________
Contact Number: ____________________________ ___________________________________
Address: _____________________________ ___________________________________
Occupation: _____________________________ ___________________________________
Siblings Name(s) Age School/Work Address
___________________________________ _____ _____________________________
___________________________________ _____ _____________________________
___________________________________ _____ _____________________________
Marital Status of Parents
_____ Living Together _____ Separated without other family _____ Separated with other families
Who are you living with? (In the absence of your parents): _________________________ Relationship: ____________
Address: ________________________________Contact No.: _________________Occupation: _____________________
Economic Status: How much does your parents earn in a year?)
_____ P25,000.00 – P50,000.00 ________ P50,000.00 – P75,000.00 ________ P75,000.00 and above
Sources (and other sources) of Income:__________________________________________________________________
ACADEMIC BACKGROUND
Level Name of School School Address Year General Average
Attended
Secondary Education
(If transferee)
Preferred
College/University(in
the future)
Favorite Subject(s):

_____ English _____ Social Studies ____Technical Vocational Education _____ Sciences
_____ Mathematics _____ Filipino _____ Values ____ MAPEH ___ Computer Education

Least Liked Subject(s):

_____ English _____ Social Studies ____Technical Vocational Education _____ Sciences
_____ Mathematics _____ Filipino ____ MAPEH ____ Computer Education. _____ Values E

Honors/Awards/Recognition Received:
_______________________________ _____________________________ _____________________________
SOCIAL BACKGROUND (Membership in School Clubs/Organization (in and outside the school):
Name of Organization Position(s) Held
_________________________________________ ___________________________
_________________________________________ ___________________________
Who are your friends in school (please name a few of the ones closest to you)?
Names Grade/Year & Section
_______________________________________ ________________________________
_______________________________________ ________________________________
HEALTH INFORMATION
Do you have problems with (Please Check)
Vision Speech Hearing General Health
[ ] [ ] _____________ [ ] [ ] _____________ [ ] [ ] _____________ [ ] [ ] ______________
YES NO (If Yes, please specify) YES NO (If Yes, please specify) YES NO (If Yes, please specify) YES NO (If Yes, please specify)
OTHER INFORMATION
What is/are your motto(s) in life? ______________________________________________________________________
Have you consulted/been sent to see the Guidance Counselor before? _____ Yes _____ No
What was/were the reason(s)?_________________________________________________________________________
How may your Guidance Counselor help you (today and in the future)
_____ Family matters _____ Academic concerns _____ Financial matters
_____ Relationship problems _____ Career concerns (for College) _____ Health Concerns
_____ Concerns with teachers _____ Self
If your Guidance Counselor should conduct a seminar, which topic(s) do you prefer?
_____ Family matters _____ Academic concerns _____ Financial matters
_____ Relationship problems _____ Career concerns (for College) _____ Health Concerns
_____ Concerns with teachers _____ Self

Others (Please Specify):

_______________________________________________________________________________
 PARENT CONSENT
COUNSELING is a confidential process designed to help you address your concerns, come to a greater
understanding of yourself, and learn effective personal and interpersonal coping strategies. It involves a
relationship between you and a trained counselor who has the desire and willingness to help you accomplish your
individual goals. Counseling involves sharing sensitive, personal, and private information that may at times be
distressing. During the course of counseling, there may be periods of increased anxiety or confusion. The outcome
of counseling is often positive; however, the level of satisfaction for any individual is not predictable. Your
counselor is available to support you throughout the counseling process.

CONFIDENTIALITY: All interactions with Counseling Services, including scheduling of or attendance at

appointments, content of your sessions, progress in counseling, and your records are confidential. No record of
counseling is contained in any academic, educational, or job placement file. You may request in writing to
release specific information about your counseling to persons you designate.
EXCEPTIONS TO CONFIDENTIALITY:
• The counseling staff works as a team. Your counselor may consult with other counseling staff to provide the
best possible care. These consultations are for professional and training purposes.
• If there is evidence of clear and imminent danger of harm to self and/or others, a counselor is legally required
to report this information to the authorities responsible for ensuring safety.
• Philippine law requires that staff of Counseling Services who learn of, or strongly suspect, physical or sexual
abuse or neglect of any person under 18 years of age must report this information to county child protection
services.
• A court order, issued by a judge, may require the Counseling Services staff to release information contained in
records and/or require a counselor to testify in a court hearing.
There is no fee for counseling services. If you are referred off campus to health, mental health, or substance abuse
professionals you are responsible for their charges.
I have read and discussed the above information with my child’s school guidance counselor. I understand the
risks and benefits of guidance and counseling services, the nature and limits of confidentiality, and what is
expected of me as a parent and student of the school guidance and counseling services.
__________ ____
Signature of the Parent over Printed Name Signature of the Student over Printed Name

____
Date