Document No.
WVSU-UGS-SOI-01-F01
INDIVIDUAL INVENTORY
Issue No. 1
FORM
Revision No. 0
Date of Effectivity: April 27, 2018
WEST VISAYAS STATE
Issued by: Guidance Services
UNIVERSITY
Page No. Page 1 of 1
INDIVIDUAL INVENTORY FORM
I. PERSONAL INFORMATION
Student No:_________________
Name:________________________________ Nickname:_________________________
Course/Yr/Sec.:_________________ Civil Status: ( ) Single ( ) Married ( ) Others: ________
If married, indicate name of spouse and contact no.: _______________________________
Date of Birth:___________Place of Birth:______________ Age:_____ Gender: _________
Present address:____________________________________________________________ 2x2 ID
Phone No:____________ E-mail address:_______________Religion:_________________ Picture
Home/Provincial Address:_______________________________ Phone No:____________
Living arrangement:
( ) living with parents ( ) living with relative/s Others: (Specify)_______________
If member of a minority group/indigenous people, please specify ______________________
II. HOME AND FAMILY
Father/ Guardian Mother/ Guardian
Name: _____________________________ _______________________________
Age:_______________________________ _______________________________
Occupation: _________________________ _______________________________
Office/Address:_______________________ _______________________________
Contact No.:_________________________ _______________________________
Estimated annual family income: Php_____________________
Sources of income (check which is applicable to you) :
( ) salaries/wages ( ) business others (specify):_____________
Siblings (Brothers/Sisters): If more than four, please use a separate sheet.
Name Age School/Occupation
________________________ __________ __________________________
________________________ __________ __________________________
________________________ __________ __________________________
________________________ __________ __________________________
III. EDUCATIONAL BACKGROUND
School Year Graduated
Elementary:________________________________________________________________
High School:_______________________________________________________________
College(for transferees):_____________________________________________________
Membership in school organization (High School):__________________________________
_________________________________________________________________________
Extra-curricular activities (High School):__________________________________________
_________________________________________________________________________
IV. HEALTH
General condition of health: ( ) good ( ) not good, why? _____________________
Physical Disabilities/Defects:__________________________________________________
__________________________________ __________________
Student’s Signature Date