Holy Rosary Academy of Sipalay, Inc

Debuyan St. Brgy 2, Sipalay City, Negros occidental

Guidance Services

Date: _______________
CONFIDENTIAL

INDIVIDUAL STUDENT INVENTORY RECORD

Name:_______________________________________________________________________________________
(Last Name) (First Name) (Middle Name)
Yr. & Sec.: _________________Age: _______Date of Birth: ______________________
Place of Birth: ___________________________________________________________
Address: _______________________________________________________
Contact Number:____________________________

If you are a boarder: Address:

_________________________________________________________________________
Contact Number_________________________________Land Lady:
_______________________________________
Relationship to land lady: ______________________________________

Check any of the following:

Which is applicable? With whom are you living now?

( ) parents living together ( ) parents

( ) mother deceased ( ) grand parents
( ) father deceased ( ) father only
( ) parents separated ( ) mother only
( ) father remarried ( ) others: ____________

FAMILY RECORD

Information on Father Information on Mother

Name: ______________________________ _____________________________
Age: ______________________________ _____________________________
Date of Birth: ______________________________ _____________________________
Citizenship: ______________________________ _____________________________
Religion: ______________________________ _____________________________
Hobbies: ______________________________ _____________________________
Present Occupation:
______________________________ _____________________________
Contact Num.: ______________________________ _____________________________
Educational Attainment:
______________________________ _____________________________
School Attended:
______________________________ _____________________________

Children in the family stating with the eldest (include yourself)

NAME AGE SCHOOL ATTENDED STATUS OCCUPATION

__________________________ ________ ______________________________ _______________ ________________
__________________________ ________ ______________________________ _______________ ________________
__________________________ ________ ______________________________ _______________ ________________
__________________________ ________ ______________________________ _______________ ________________
__________________________ ________ ______________________________ _______________ ________________
__________________________ ________ ______________________________ _______________ ________________
__________________________ ________ ______________________________ _______________ ________________
__________________________ ________ ______________________________ _______________ ________________
__________________________ ________ ______________________________ _______________ ______________
 HEALTH INFORMATION

School/s attended:
_______________________________________________________________________________________
(Elementary) (High school)
Best-Liked subject/s:
_____________________________________________________________________________________
Least-Liked subject/s:
_____________________________________________________________________________________
Grade/Average:
__________________________________________________________________________________________
(Elementary) (High School)
School Activities &Organization/s:
__________________________________________________________________________

PERSONALTY INFORMATION

Check those which describe you best:

( ) shy ( ) lazy ( ) talented

( ) submissive ( ) neat ( ) dull
( ) patient ( ) courteous ( ) optimistic
( ) easily-excited ( ) honest ( ) friendly
( ) nervous ( ) smart ( ) persevering
( ) jealous ( ) aggressive ( ) anxious
( ) confident ( ) easily confused ( ) pessimistic
( ) irritable ( ) stubborn ( ) easily tired

Others: _____________________________________________________________________

OTHER PERTINENT INFORMATION

Daily Allowance: ____________________________________________________________________

How do you come to school? __________________________________________________________
Language usually spoken at Home: _____________________________________________________
Other languages spoken: ______________________________________________________________
What places in the Philippines have you gone to or visited? __________________________________
Have gone abroad? Where? ___________________________________________________________
Significant events or experiences that happened in your life
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
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