Republic of the Philippines

Department of Education
Region III
Division of San Jose City
TAYABO HIGH SCHOOL

STUDENT’S ANECDOTAL RECORD

I.PERSONAL INFORMATION

Name of Student: _________________________________________________________________________

(Surname) (First name) (Middle name)
Present Address: __________________________________________________________________________
Date of Birth: _____________________ Age: _________________ Sex: Male _______ Female __________
Number of Siblings: __________ Sibling Position: ___________
Special Skills/Talents: ______________________________________________________________________
Students living with: Both parents _______ Mother ________ Father _________ Uncle/Auntie __________
Grand Parents __________ Others (Specify) ___________________
Parents Status: Married _______ Single Parent _______ Separated _______ Widow/Widower ___________
Broken Family __________ Others (Specify) __________________

PARENTS PROFILE

Name of Father: ________________________ Name of Mother: __________________________

Age: ___________ Age: ____________
Educational Attainment: _________________ Educational Attainment: ____________________
______________________________________ _________________________________________
Name of Guardian: ______________________ Relationship to the student: _________________
Contact number of Parents or Guardian: ________________________________________

II. ACADEMIC INFORMATION

Academic Information: Are you transferee? Yes _________ No__________

Name of School last attended: ________________________________________________________________
School Year Last Attended: __________ Grade & Section Last Attended: ___________________________
Name of Class Adviser last Attended: ___________________________________________________________
Grade Level Status: Promoted ( ) Irregular ( ) Retained ( ) Dropped out ( )
Back subject/s (please indicate if there is any) ___________________________________________________

III. OTHER QUERRIES

1. Have you ever been listed (Student At Risk of Dropping Out - SARDO)? No ____, if YES, when? __________
2. Who is financing your studies? ____________________________________________________________
3. Are you a beneficiary of 4Ps? No ______, if YES, since when? ______________________________
4. Are you a scholarship beneficiary? No ______, if YES, what is that particular scholarship?
___________________________________________________.
5. Do you have severe illness or any health problems? None _______, if YES please give brief history
__________________________________________________________________________________________
_________________________________________________________________________________________.

IV. SIGNIFICANT EVENTS/EXPERIENCES IN LIFE

__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
_________________________________________________________________________________________.

V. EXTRA CURRICULAR ACTIVITIES

Activity Type of Activity Date Level Awards/ Remarks

(school, Honors
community, Received
religious, others)
School Division Regional National others

VI. CHALLENGES IN BEHAVIOUR

Records/Case(Violence/ Number Date Action Taken Behavioral Status/ Remarks

offense/ misbehaviour, others) of times Condition (delinguent,
repeated provisionary, others)

VII. ADVISER

Name Grade Level Section School Year Signature