GUIDANCE AND COUNSELING SERVICE INDIVIDUAL INVENTORY RECORD

I. PUPIL’S PERSONAL DATA:

Name: ___________________________________________ Nickname: ______________ Sex: _______ Nationality: _________

(Surname) (Given) (Middle)

Place of Birth: _____________________________________________ Date of Birth: _________ __ Religion: __________________

Guardian: _________ _________ ____ ______ Relationship: ______________ Address: ______________________________

II. FAMILY DATA:

1. Father’s Name: ___________________________ Educ’l Attainment: ____________________ Occupation: __________________

Place of Birth: ___________________________ Date of Birth: ________________________ Religion: ___________ _________
Nationality: ______________________________ Living or Dead: ______________________ Cause of Death: _______________
2. Mother’s Name: __________________________ Educ’l. Attainment: ___________________ Occupation: __________________
Place of Birth: __________________ _____ Date of Birth: ____________________ Religion: ____________________
Nationality: ___________________ ___________ Living or Dead: ______________________ Cause of Death: _______________
3. No. of Children: Boys: __________ Girls: ____________ Total No. of Children: ___________
4. Language: ___________ Dialect(s) used at home: _________ Family Economic Status: _______________ _______
5. Address: __________________________________________________ House: Owned: ________________ Rented: ___________

III. EDUCATIONAL DATA:

1. School Attended School Year Grade & Sec. Rating Honor Earned Teacher

2. Failed or dropped out in any Grade? Yes ________ No ________

Grade School Year Cause (s)

___________________ ______________________ __________________________
___________________ ______________________ __________________________
___________________ ______________________ __________________________

3. Special ability or talents Gr. I: _______________ Gr II: _______________ Gr III: ______________

Gr. IV: ______________ Gr. V: _______________ Gr. VI: ______________

4. Disciplinary measure(s) taken against the child, if any:

Grade Date Reason Consequence Comment
________________ __________________ _____________________ __________________ __________________
________________ __________________ _____________________ __________________ __________________
________________ __________________ _____________________ __________________ __________________
________________ __________________ _____________________ __________________ __________________
________________ __________________ _____________________ __________________ __________________

IV. AVOCATIONAL AND VOCATIONAL DATA:

1. Child’s Hobbies Gr. I: ______________ Gr II: ______________ Gr III: ______________
Gr. IV: ______________ Gr. V: ______________ Gr. VI: ______________

2. Ambition: Grade I Grade II Grade III Grade IV Grade V Grade VI

Child’s Ambition:
Father’s Ambition for Child:
Mother’s Ambition for Child:

3. Material’s Read: