Guidance Form 1

Republic of the Philippines

Department of Education
REGION III – CENTRAL LUZON
SCHOOLS DIVISION OFFICE OF NUEVA ECIJA
LAUR CENTRAL SCHOOL
GEN. TINIO ST. LAUR, NUEVA ECIJA 3129

LAUR CENTRAL SCHOOL

_________________________________________
(School)
General Tinio Street,Brgy I,Laur,Nueva Ecija
(Address of School)

PUPIL’S CUMULATIVE RECORD AND PROFILE

I – PERSONAL DATA

Name: ALINAH D. GONZALES Age: 9

Birth Date: January 03,2013 Place of Birth: Laur Nueva Ecija
Address: 11 Roxas Street,Brgy. IV, Laur,Nueva Ecija Nationality: Filipino Religion: Roman Catholic

II – FAMILY DATA
A. Father / Guardian B. Mother
Jose D. Gonzales Name Maria May D. Gonzales
June 19,1975 Date of Birth May 20,1981
Cabanatuan City Place of Birth Laur, Nueva Ecija
College Graduate Educational Attainment College Graduate
Driver Occupation Teacher
Roman Catholic Religion Roman Catholic
Date of Death (if deceased)
Cause

C. Children in the Family: Boys: _______0________ Girls: _____1_______ Total: _________1_______

D. Home and Family Problems ( please Grade Level

Remarks
check) I II III IV V VI
Broken Home
Very Strict Parents
Very Lax Parents
Very Crowded Homes
Indigent
School Far from Home
Others
Teacher-Adviser’s Initial

E. Economic Status: Well to do _____√_____ Average ___________ Poor ___________

F. Language Used at Home: Bicol _________ Tagalog ___√________ English __________ Others
______________

III – Health Status: Normal ________√______________________ Handicap ___________________________

P - poor F – Fair G – Good Ex - Excellent

Grade Level Remarks
1. Health Examination ( please check) (P, F, G, Ex)
I II III IV V VI
Hearing √ √ √ Ex
Vision √ √ √ Ex
Speech √ √ √ Ex
Skin and Scalp √ √ √ Ex
General Health √ √ √ Ex
Height √ √ √ Ex
Weight √ √ √ Ex
Blood Pressure √ √ √ Ex
Eyes and Ears √ √ √ Ex
Teeth and Gums √ √ √ Ex
Throat and Tonsils √ √ √ Ex
Respiratory System √ √ √ Ex
Nutrition √ √ √ Ex
Teacher-Adviser’s Initial

2. Diseases / Sickness since Birth

Typhoid Fever _____X_____________ Chicken Fox ______X______________ Dysentery _________X_________
Whooping Cough __________________ Influenza ____________X________ Mumps __________X________
Asthma___________X_______ Measles ____X________________

Action Taken _______________________________________

Examine by: _______________________________________
3. Immunization and Immunity Test
Kind Date Given Result
NONE

4. Operation Undergone _______________________NONE___________________________________________________

5. Physical Defects _____NONE____________________________________________________________________

IV SCHOLASTIC ACHIEVEMENT
Grade Subjects Done General Teacher-
A. School Attended Level Subjects Done Well Poorly Average Adviser’s
Initial
Laur Central School I 88

Laur Central School II

Laur Central School III

Laur Central School IV

V
VI

B. Standard Test Record Grade Date Scores Interpretation

 Knox Tube Test
Printer Personality Inventory
Philippine Personality
Otis Lannon Mental Ability
Others

V APPRAISAL OF PUPIL BEHAVIOR

O VS S NS NI ( to be rated after the semester)
Grade Level
A. Personal Qualities Remarks
I II III IV V VI
1. Honesty √ √ √ √ VS
2. Courtesy √ √ √ √ VS
3. Helpfulness and Cooperation √ √ √ √ VS
4. Resourcefulness and Creativity √ √ √ √ VS
5. Consideration for others √ √ √ √ VS
6. Sportsmanship √ √ √ √ VS
7. Obedience √ √ √ √ VS
8. Self – Reliance √ √ √ √ VS
9. Industry √ √ √ √ VS
10. Cleanliness and Orderliness √ √ √ √ VS
11. Promptness and Punctuality √ √ √ √ VS
12. Sense of Responsibility √ √ √ √ VS
13. Love of God √ √ √ √ VS
14. Patriotism / Love of Country √ √ √ √ VS
Teacher-Adviser’s Initial

Grade Level
B. School Problems Remarks
I II III IV V VI
1. Underachiever
2. Slow Learner
3. No Interest
4. Potential Drop-outs
5. Frequently Absent
6. Frequently Late
7. Others
Teacher-Adviser’s Initial

C. Home Visits
E – Excellent G – Good F – Fair N – Need Improvement
Grade Waste Home
Date of Visit Dwelling Facilities Surroundings Recommendation Teacher
Level Disposal Project
I
II
III
IV
V
VI
D. Significant Notes on Personal and Social Traits
Teacher-
Grade Teacher Comments Adviser’s
Initial
I LUZ G.CARDENAS
II DOMINICIANA P. OBLIGADO
III MARITA N. DELA CRUZ
IV YOLANDA PANGILINAN
V