Personal Information Sheet
Personal Information Sheet
Personal Information Sheet
Guidance Department
San Jose, Antique
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
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