Personal Information Sheet

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ANTIQUE NATIONAL SCHOOL

Guidance Department
San Jose, Antique

PERSONAL INFORMATION SHEET

I. PERSONAL CIRCUMSTANCES:

Name: ___________________________________________________________________________________________
(Surname) (First Name) (Middle Name)
Birth Date: _________________________________ Birth Place: ____________________________________________
Grade & Section: ____________________________ No. of Siblings: _________________________________________
Address: _________________________________________________________________________________________
(Brgy./Street No.) (Town/City) (Province)
Contact Number/Cellphone #: ______________________________ / Parents’ Contact Number: ____________________
Parents:
Mother: ___________________________ Occupation: ________________________
Father: ___________________________ Occupation: ________________________
Guardian : _________________________ Occupation: ________________________
II. CONCERNS:
Grades/Subjects: __________________________________________________________________________
Teachers: ________________________________________________________________________________
Classmates: ______________________________________________________________________________
Family: __________________________________________________________________________________
Friends: _________________________________________________________________________________
Medical Issues (If any): _____________________________________________________________________
Choice of Profession intended to pursue: _______________________________________________________
Others (Specify): __________________________________________________________________________

III. IMPRESSIONS:

___________________________ ____________________________
Name & Signature of Student Guidance Counselor

ANTIQUE NATIONAL SCHOOL


Guidance Department
San Jose, Antique

PERSONAL INFORMATION SHEET

I. PERSONAL CIRCUMSTANCES:

Name: ___________________________________________________________________________________________
(Surname) (First Name) (Middle Name)
Birth Date: _________________________________ Birth Place: ____________________________________________
Grade & Section: ____________________________ No. of Siblings: _________________________________________
Address: _________________________________________________________________________________________
(Brgy./Street No.) (Town/City) (Province)
Contact Number/Cellphone # : ______________________________ / Parents’ Contact Number: ____________________
Parents:
Mother: ___________________________ Occupation: ________________________
Father: ___________________________ Occupation: ________________________
Guardian : _________________________ Occupation: ________________________
II. CONCERNS:
Grades/Subjects: __________________________________________________________________________
Teachers: ________________________________________________________________________________
Classmates: ______________________________________________________________________________
Family: __________________________________________________________________________________
Friends: _________________________________________________________________________________
Medical Issues (If any): _____________________________________________________________________
Choice of Profession intended to pursue: _______________________________________________________
Others (Specify): __________________________________________________________________________

III. IMPRESSIONS:

___________________________ ____________________________
Name & Signature of Student Guidance Counselor

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