For Wheelchair:

Name of Client: ___________________________________________

Address: _________________________________________________

Age : ____________________________________________________

Birthday: _________________________________________________

Educational Attainment: _____________________________________

Occupation : _______________________________________________

Income : ___________________________________________________

Iba pa nga gikikitaan han padre de pamilya ? ______________________________________________

Income : ___________________________________________________________________________

Hira hin-o an naukoy kaupod an napa interview?

NGARAN RELASYON MO HAN EDA NATAPOS PAG TRABAHO KITA/INCOME

MIYEMBRO D ESKWELA
1
2
3
4
5
6
Ano an nahatabo an PWD? Diin nahatabo?

___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________

Kakan-o nahatabo? __________________________________________________________________________________

Ano man an binuhat han pamilya ngadto han PWD katapos hadto na panhitabo?

______________________________________________________________________________________________________

An kapamilya o mga urupod, ano an mga naihatag na bulig ngadto an PWD?

_________________________________________________________________________________________________________________
For Wheelchair:
Name of Client: ___________________________________________
Address: _________________________________________________
Age : ____________________________________________________
Birthday: _________________________________________________
Educational Attainment: _____________________________________
Occupation : _______________________________________________
Income : ___________________________________________________
Iba pa nga gikikitaan han padre de pamilya ? ______________________________________________
Income : ___________________________________________________________________________
Hira hin-o an naukoy kaupod an napa interview?

NGARAN RELASYON MO HAN EDAD NATAPOS PAG TRABAHO KITA/INCOME

MIYEMBRO ESKWELA
1
2
3
4
5
6
Ano an nahatabo an PWD? Diin nahatabo?
_______________________________________________________________________________________________________
Kakan-o nahatabo? __________________________________________________________________________________
Ano man an binuhat han pamilya ngadto han PWD katapos hadto na panhitabo?
______________________________________________________________________________________________________
An kapamilya o mga urupod, ano an mga naihatag na bulig ngadto an PWD?
_______________________________________________________________________________________________________