A.

Identifying Data

LRN : 109115110030
Name : Shaiphalie G. Diaz
Sex : Female
Age : 11
Birthdate : November 24,2005
Birthplace : Calamba Laguna
Nationality : Filipino
Dialect : Tagalog
Religion : Roman Catholic
Guardian : Father & Mother
Address : Purok 1 Poblacion San Francisco, Quezon

B. Family Background
Father
(Cellphone # : 09499685771
Name : Lorenzo J. Diaz
Birthdate : October 2, 1972
Birthplace : Bayambang Pangasinan
Age : 44
Religion : Roman Catholic
Occupation : Fisherman and Pedicab Driver
Educational Attainment : 4th year High School

Mother
(Cellphone # : 09485658643
Name : Rose M. Guevarra
Birthdate : May 1, 1981
Birthplace : San Andres Quezon
Age : 36
Religion : Roman Catholic
Occupation : Fish Vendor
Educational Attainment : 2nd year High School
Are you living with your parent? Yes
Are your parent living together? Yes

C. Social Inventory
Food/s : Cake Color: Red
Game/s: Cooking fever Hobbies/Activities: Playing
Ambition: Teacher Hopes: To be Professional Teacher
Movie/s: Comedy Fears: Snake
Attitudes: Kind

D. Organization

Name Position Date

Shaiphalie PIO September
G. English 25
Diaz Club 2017

Pupils Signature Parent/Guardian Signature

Date Accomplished: September 26, 2017

Teacher: Mrs. Maricel C. Andes