STUDENT INDIVIDUAL INVENTORY FORM

We would like to thank you for choosing our school as your partner in
your child’s education. This will be your child’s initial inventory record
with us. We would like to request you to please honestly fill-out this
form. The information and comments that you would share with us 2X2 PICTURE
could be utilized to assist your child and discover other factors that CONFIDENTIAL
may contribute to the formation of your child’s individuality. (Student)

Rest assured that all information gathered from this form shall be dealt
with utmost confidentiality.
Thank you very much.
Date: ____________________
LRN: _______________________ Grade Level: __________ Section: ________________
Name of Student: _____________________________________________________________
Surname Given Name Middle Name

Age: _____ Date of Birth: ____________________ Place of Birth: _________________

Child’s Birth Order: ___ eldest ___ middle child ___ youngest ___ only child

Home address: _______________________________________________________________

Contact Numbers: ____________________ Mobile No. _____________________ Landline

Check which of the following are applicable:

___ Parents living together ___ Father re-married ___ Widow

___ Parents separated ___ Mother re-married
___ Parent Working Abroad ___ Single Parent

The child is living with whom now?

___ Parents ___ Grandparents
___ Father only
___ Mother only ___ others (pls. specify) ________________

CHILDREN IN THE FAMILY STARTING WITH THE ELDEST (include the applying child)
Name Age Birthday Civil Status School/Office

PARENTS’ RECORD
Information on FATHER Information on MOTHER
Name
Age
Date of Birth
Citizenship
Religion
Educational Attainment Degree Level Degree Level
(Please check the level
and write the degree) __ High School ____________ __ High School ____________
__ Vocational ____________ __ Vocational ____________
__ College ____________ __ College ____________
__ Grad. Stud. ____________ __ Grad. Stud. ____________

Last School Attended

Guidance Office Form 1

 STUDENT INDIVIDUAL INVENTORY FORM

Present Occupation
Position in the Firm
Name of Firm
Address of Firm
Contact No.
Email Address
Hobbies/Interests
Traits/Characteristics

STUDENT’S HEALTH INFORMATION

_____ Height _____ Weight

Has your child had any of the following illnesses? Pls. check those that have affected your child
for the past 5 years up to the present:

___ asthma ___ hearing defects ___ nervousness

___ convulsion or fits ___ heart diseases ___ pneumonia
___ diabetes ___ hernia ___ smallpox
___ epilepsy ___ influenza ___ stammering
___ eye defects (pls. specify) ___ mumps ___ typhoid fever
___ dengue ___ tuberculosis ___ frequent headaches
___ fainting spells ___ measles

Does your child have other special needs and concerns (e.g. ADD, ADHD, LD, etc.)? Please
specify.
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

Does your child have allergies (e.g. food, medicine, etc.)? Please specify
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

Was your child involved in any serious accident? If so, please specify.
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

STUDENT EDUCATIONAL INFORMATION

Last School Attended: __________________________________________________________

Best-liked Subjects: ____________________________________________________________

Least-liked Subjects: ___________________________________________________________

Grade Range/General Average on Report Card: _____________________________________

Awards Received: _____________________________________________________________

School Activities/Club: __________________________________________________________

Activities Outside the school: _____________________________________________________

Guidance Office Form 2

 STUDENT INDIVIDUAL INVENTORY FORM

PERSONALITY INFORMATION

Check those which you feel best describe your child’s general personality make-up:

___ aggressive ___ honest ___ pessimistic

___ anxious ___ independent ___ quick
___ calm ___ irritable ___ quiet
___ cheerful ___ jealous ___ sarcastic
___ confident ___ lacks motivation ___ sensitive
___ conscientious ___ lazy ___ shy
___ courteous ___ lovable ___ smart
___ depressed ___ moody ___ stubborn
___ dull ___ neat ___ submissive
___ easily confused ___ nervous ___ talented
___ easily excited ___ optimistic ___ talkative
___ easily tired ___ passive ___ thoughtful
___ feels inferior ___ patient ___ withdrawn
___ friendly ___ persevering

Others, please specify: _________________________________________________________

SOCIAL RELATIONSHIPS

Please check any of the items that apply to your child.

At Home:
___ discusses problems with the father ___ asserts himself/herself
___ discusses problems with the mother ___ demanding
___ enjoys the company of siblings ___ goes only with familiar people
___ enjoys family outings/affairs ___ prefers to be left alone
___ friendly with household help ___ often fights with people in the house
___ generous with his/her things ___ difficult to deal with

Others, please specify: _________________________________________________________

In School:
___ would rather be a follower ___ is looked as a leader
___ friendly with the people in school ___ afraid of teachers/other students
___ enjoys the company of classmates ___ would rather be alone
___ interested in class activities ___ goes only with familiar people
___ asserts himself/herself ___ always in trouble with classmates

Others, please specify: _________________________________________________________

CAPACITY AND INTEREST

Please check any of the items that best describe your child:
___ impatient ___ eager to do activities
___ poor in comprehension ___ finishes tasks easily
___ slow learner ___ learns quickly
___ has a short memory ___ orderly
___ has academic difficulties ___ inquisitive
___ creative ___ imaginative

Others, please specify: _________________________________________________________

Guidance Office Form 3

 STUDENT INDIVIDUAL INVENTORY FORM

Please write some of your child’s interests/favorites in the following areas:

1. Individual Games: ___________________________________________________________

2. Group Games: ______________________________________________________________

3. Types of Book: ______________________________________________________________

4. Kinds of Food: ______________________________________________________________

5. Place he/she usually enjoys: ___________________________________________________

OTHER PERTINENT INFORMATION

Relate significant events/unforgettable experiences that happened in your child’s life.

____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

List down any difficulties, conflicts, obstacles, or worries that you think disturb your child.
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

In what way could the guidance advocate help him/her at this time? Please write other information,
which you think is vital information to your child’s development.
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

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List down three topics you are interested to learn from in a parenting seminar.
1. ____________________________________________________________________
2. ____________________________________________________________________
3. ____________________________________________________________________

Are you willing to be a speaker for any seminar? ___ Yes ___ No ___ Maybe

What topics would you like to share?

1. ____________________________________________________________________
2. ____________________________________________________________________
3. ____________________________________________________________________

What would be the best day for you to attend the parenting seminars? ____________________

______________________________ ______________________________
Father’s Signature over Printed Name Mother’s Signature over Printed Name

Guidance Office Form 4