Republic of the Philippines

Department of Education
Province of Cebu
San Fernando NATIONAL HIGH SCHOOL
South Poblacion, San Fernando, Cebu

Guidance Form 1
INDIVIDUAL INVENTORY RECORD
I. PERSONAL DATA
Name : _________________________________________________________________ Sex : _____ Age : ______
(Last Name) (First Name) (Middle Name)
Date of Birth : _________________________ Place of Birth : _________________ Religion : _________________
Home Address : ___________________________ Citizenship : ___________________ Contact Nos. : _____________

II. FAMILY BACKGROUND

FATHER MOTHER
Name
Date of Birth
Age
Occupation
Educational Attainment
Home Address

Children in the Family:

NAME SEX AGE EDUCATIONAL CIVIL STATUS OCCUPATION
ATTAINMENT

(If you are not living with your parents, pls. fill this up)
GUARDIAN
Name
Date of Birth
Age
Occupation
Educational Attainment
Home Address
Marital Condition of Parents :
( ) married and living together ( ) separated ( ) solo parent ( ) one parent is deceased ( ) both parents are deceased
Source of Income/Livelihood: ___________________________________
Living With : ( ) parents ( ) grandparents ( ) relatives ( ) friends ( ) others (pls. specify)______________
Type of Discipline : ( ) lax ( ) strict ( ) democratic
Ambient of Growth : ( ) city ( ) province
Birth Rank : _________________________________________________
Problems met/experienced with:
Father
Mother
Brother/s
Sister/s
Others (specify)
III. SCHOLASTIC RECORD
NAME OF SCHOOL HONORS/AWARDS RECEIVED
Elementary
High School
College
Vocational

IV. ACADEMIC PERFORMANCE

1ST YEAR 2ND YEAR 3RD YEAR 4TH YEAR
SUBJECT (__________) (___________) (____________) (___________) REMARKS

ENGLISH
FILIPINO
A.P.
E.P.
M.A.P.E.H.
E.P.
MATHEMATICS
SCIENCE
GEN. AVE.
REMARKS

V. MEDICAL HISTORY
Height : _________ Weight : __________ Visual Acuity : ______________________ Hearing : _____________
Do you get sick often? ( ) yes ( ) no frequency _________________________________________
Illnesses since childhood :
______________________________________________________________________________________
Physical disabilities/handicaps : _________________________________________________________________________________
Do you have a permanent/family doctor? ___________________ How often do you visit the doctor? ______________________
Additional Health Information (pls. specify): ________________________________________________________________________
___________________________________________________________________________________________________________

VI. ORGANIZATIONAL AFFILIATION

NAME OF ORGANIZATION INCLUSIVE DATES POSITION

VII. PSYCHOLOGICAL TESTS TAKEN

NAME OF TEST DATE SCORE INTERPRETATION

VIII. PERSONALITY, ATTITUDES & INTERESTS

Identify at least 5 most disturbing problems that you have presently encountered. Number them from 1-8 according to their degree of
significance.
Academic Failures Health Problem Pre-Marital Sex Others (pls. specify)
Alcoholism Communication Religion/Faith
Boy-Girl Relationship Love Life Conflict With Peers
Broken Home Homosexuality Study Habit
Drug Addiction Inferiority Complex Depression
Emotional Problem Masturbation
Financial Problem Parent-Child Relationship
What problem would you like to discuss with a counselor? (pls. check)
______ job ______ education ______ finance ______ relation with others
______ personal ______ others (pls. specify) ______________________________________________________________

What kind of work have you done?

Job Inclusive Dates Did you like it? Why?
_________________ ______________________ ___________
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_________________ ______________________ ___________
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_________________ ______________________ ___________
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_________________ ______________________ ___________
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_________________ ______________________ ___________
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What occupations/jobs would you like to enter?

Job Reason/s
_______________________________________________________________________________________________________
______________________________________________________________________________________-_______________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_________________ ______________________________________________________________________________________
Hobbies:
____________________________________________________________________________________________________
Talents/Skills:
________________________________________________________________________________________________
Interests: ___________________________________________________________________________________________________
Sports: _____________________________________________________________________________________________________
Most Liked Subjects: __________________________________________________________________________________________
Least Liked Subjects:
__________________________________________________________________________________________
Plans For The Future: _________________________________________________________________________________________
___________________________________________________________________________________________________________

(do not write on this portion, for counselor ’s use only)

IX. GUIDANCE NOTES

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