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Student Individual Inventory Form

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natsu dragneel
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2K views2 pages

Student Individual Inventory Form

Uploaded by

natsu dragneel
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Republic of the Philippines RECENT

Commission on Higher Education 1X1


Region V PICTURE WITH
POLANGUI COMMUNITY COLLEGE WHITE
Polangui, Albay BACKGROUND

STUDENT INDIVIDUAL INVENTORY


RECORD FORM
F.Y. __________________
Note: Please fill out the following information clearly and honestly. Rest assured that all information
gathered shall be dealt with utmost confidentiality for records and references.
A. PERSONAL INFORMATION
Name:_______________________________________________ Course and Year:__________________
(Surname) (First Name) (Middle Name)
Gender:__________ Age:_____ Civil Status:__________ Date of Birth:_________________________
Place of Birth:_____________________________________ Religion:____________________________
Present Address:____________________________________ Contact No.:________________________
Permanent Address:__________________________________ Email Address:______________________
B. FAMILY BACKGROUND
Name of Father: _________________________________________ Age:________ [] Living [] Deceased
Highest Educational Attainment: ____________________________ Contact No.:___________________
Occupation:_____________________________________________ Monthly Income:_______________
Name of Mother:_________________________________________ Age:________ [] Living [] Deceased
Highest Educational Attainment: ____________________________ Contact No.:___________________
Occupation:_____________________________________________ Monthly Income:_______________
Name of Guardian: _______________________________________ Age:________ [] Living [] Deceased
Highest Educational Attainment: ____________________________ Contact No.:___________________
Occupation:_____________________________________________ Monthly Income:_______________
Parent’s Marital Status: [] Married/Living Together [] Married/Not Living Together
[] Unmarried/Living Together [] Permanently/Legally Separated
[] Single Parent [] OFW Parents [] Others (Please Specify):________________
Number of Siblings: Brother(s):________ Sister(s):___________
Birth Order (1st child, 2nd child, etc.):______________________
In case of emergency, please notify ____________________________________ Relationship:_________
Address:____________________________________________ Contact No.:_______________________
III. EDUCATIONAL BACKGROUND
YEAR
LEVEL SCHOOL ATTENDED GRADUATED DATES OF SCHOLARSHIP/HONORS/
(if graduated) ATTENDANCE AWARDS RECEIVED
Elementary
Junior High
Senior High
Track:
Strand:
College
1st Year
2nd Year
3rd Year
4th Year
Nature of Schooling: [] Continuous [] Interrupted (State reasons):________________________________
Easiest Subjects:____________________________ Most Difficult Subjects:_______________________
Subjects with Highest Grades:____________________________________________________________
Subjects with Lowest Grades:_____________________________________________________________
Is your present course your personal choice? [] Yes [] No
If no, Who influenced you?________________________________________________________

©varioussources, IIRF2019
How do you feel about it?_____________________________________________________
What is your personal choice?__________________________________________________
Who finances your schooling? [] Parents [] Siblings [] Relatives [] Self (Working Student) [] Scholarship
How much is your weekly allowance?______________________________________________________
Nature of Residence while schooling: [] Family Home [] Relative’s House [] Boarding House/Bed Spacer
[] Rented Apartment [] Others (Please Specify):________________
IV. SOCIAL INVOLVEMENT
A. Academic
NAME OF ORGANIZATION POSITION/TITLE

B. Extra Curricular
NAME OF ORGANIZATION POSITION/TITLE

V. HEALTH INFORMATION
Have you had any of the following illnesses? (Please check all applicable)
[] Asthma [] Hearing Defect [] Pneumonia
[] Convulsions [] Heart Disease [] Chickenpox
[] Diabetes [] Hernia [] Stammering
[] Epilepsy [] Influenza [] Typhoid Fever
[] Visual Defect [] Mumps [] Others (Please Specify):
[] Malaria [] Tuberculosis __________________________
[] Fainting Spells [] Measles
[] Frequent Headaches [] Nervousness
Do you have any medications taken regularly? [] Yes (Please specify):____________________________
[] No

VI. PERSONAL DESCRIPTION (Tell me about yourself)

_____________________________________ ___________________________________
Student’s Signature over Printed Name Date Accomplished

©varioussources, IIRF2019

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