Department of Education

Region III-Central Luzon

Schools Division of Pampanga STUDENT’S
(NAME OF SCHOOL) PICTURE
(School Address Here) HERE
Guidance and Counseling Office
INDIVIDUAL INVENTORY RECORD FORM
Form No.1

I. PERSONAL INFORMATION
Name: _____________________________________________________________________________________________________
(Last Name) (First Name) (Middle Name)
Grade Level and Section: _______________________ Nickname:________________________ Gender: _____________
Date of Birth: _________________________ Age: ____________ Place of Birth:______________________________
Nationality: ______________ Civil Status: ___________ Religion: ____________ Contact Number:_____________
Permanent Address: _________________________________________________________________________________________
House#/Purok/Zone/ Barangay Municipality Province
II. EDUCATIONAL BACKGROUND
GRADE SCHOOL ATTENDED SCHOOL ADDRESS PUBLIC/ SCHOOL HONORS RECEIVED/
LEVEL PRIVATE YEAR SPECIAL AWARDS
6
7
8
9
10
11
12
Nature of Schooling: [ ] Continuous [ ] Interrupted, Why? _____________________________________

III. HOME AND FAMILY BACKGROUND

FATHER MOTHER GUARDIAN (if not Parent)
Name
Current Address
Contact Number
Occupation/Business Address
Highest Educational Attainment
Note: Mark with Ɨ if deceased
List names of brothers and sisters from eldest to youngest including yourself.
Name Age Civil Status Highest Educational Attainment Occupation/Business Address

My parents are:
( ) Living together ( ) Single Parent ( ) Separated
___ legally married ___ father ___ legally separated ___ annulled
___ not married ___ mother ___ not legally separated ___ not annulled

Who finances your schooling? ( ) Parents ( ) Brother/Sister ( ) Scholarship

( ) Relatives ( ) Self-supporting/working student
IV. HEALTH
Physical
Do you have problems with (Please check)
YES NO If Yes, please specify YES NO If Yes, please specify
Your Vision ( ) ( ) _________________ Your speech ( ) ( ) _________________
Your hearing ( ) ( ) _________________ Your general health ( ) ( ) _________________

V. INTEREST AND HOBBIES

1. What is/are your favorite subject/s?_____________________________________________________________________
2. What is/are the subjects/s you like least? _________________________________________________________________
3. What are your hobbies? Write them in the order of your preferences.
a._______________________________________ b._______________________________________
c._______________________________________ d._______________________________________
4. Which of the following organizations have you participated in? (Please check)
( ) Athletics ( ) Religious Organizations ( ) Dance Troupe ( ) Scouting ( ) Others, please specify____________

School
School ID:
Logo
e-mail address: