GUIDANCE AND COUNSELING OFFICE

COLLEGE STUDENT INFORMATION SHEET

06/09/2021
Date Filed: ____________
1x1
 Freshmen  Transferee  Returning Student Number: _____________________
18NE0089
ID picture
BSED-MATH Year & Section: _________
Course: __________ III Semester: ( ) First (✔) Second 2020-2021
School Year: __________

Instruction: Please COMPLETE this INFORMATION SHEET. Rest assured that all information contained in this form will be
kept CONFIDENTIAL.

A. PERSONAL DATA
Name: TEVES, PETER JOHN F. Nickname: PJ
(Surname) (Given Name) (Middle Name)
Age: 21 Civil Status: (✔)Single ( )Married: ( )Separated Sex: (✔)Male ( ) Female
Date of birth: 12/28/19999 Place of birth: VIRAC, CATANDUANES Birth order among siblings: 2
Religion: CATHOLIC Nationality: FILIPINO Dialects/Language Spoken: FILIPINO,ENGLISH
Contact No: 09268407626 Email Address: [email protected]
Current Address: Nagpandayan Guimba N.E. Contact No: 09268407626
Permanent Address: Nagpandayan Guimba N.E. Contact No: 09268407626

B. FAMILY BACKGROUND
Father Mother
(Mark with  if deceased) Mark with  if deceased
Name: PEDRO T. TEVES MYRNA F. TEVES
Date of Birth: 08/05/1963 04/18/1965
Place of Birth: SAN MIGUEL, CATANDUANES Nagpandayan Guimba N.E.
Current Address: Nagpandayan Guimba N.E. Nagpandayan Guimba N.E.
Contact Number: N/A 09654452130
Permanent Address: Nagpandayan Guimba N.E. Nagpandayan Guimba N.E.
Contact Number: N/A 09268407626
Highest Educational Attainment: HIGH SCHOOL HIGH SCHOOL
Occupation: FARMER HOUSE KEEPER
Annual Income (optional): P15,000 N/A

Parents:
✔
___________ Married ____________ Father OFW
___________
✔ Living together ____________ Mother OFW
___________ Legally separated ____________ Mother with another partner
___________ Marriage annulled ____________ Father with another partner

Name of guardian (if not living with parents): Age:

Relationship with guardian: Occupation:
Address:
Contact Numbers:

Siblings from eldest to youngest including yourself:

Name of Siblings School/Name of Company Age
HONEY JOY F. TEVES N/A 28
PAULAINE JEWEL F. TEVES NAGPANDAYAN HIGH SCHOOL 17

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Persons to notify in case of emergency:
Name Relationship Contact Numbers Address
MYRNA F. TEVES MOTHER 09268407626 NAGPANDAYAN, GUIMBA N.E

C. EDUCATIONAL BACKGROUND
Educational Level School Attended Public Private Course Inclusive Years
Elementary NAGPANDAYAN ELEMENTARY SCHOOL ✔ 2006-2012
High School NAGPANDAYAN HIGH SCHOOL ✔ 2012-2018
College/University
(for transferee or second courser)

Subject with highest grade in HS: ENGLISH What grade: 92

Subject with lowest grade in HS: SCIENCE What grade: 84
Awards received:
Average grade during high school:
90% and above 80% to 84% 74 and below
✔ 85 to 89% 75% to 79%
Highest degree that I plan to pursue in the near future:
✔ Take up another bachelor ‘s degree (Please indicate the course): BSED
A master’s degree
A doctorate degree
Others, pls. specify:
If you are a transferee, please write the name of your previous school:
Reason(s) for transfer:
Subject with highest grade: What grade:
Subject with lowest grade: What grade:
Awards received:
Memberships:
Name of organization Position Inclusive Dates
PNB Choir Instrmentalist/Sound Technician 2017-Present

D. UNIQUE FEATURES
Interests/Skills/Talents:
Hobbies/Recreational activities: Playing Music Instuments, DJing, Audio/Video Editing
Ambitions/Goals: To be a good Citizen
Guiding Principle in Life/Motto: True success is when you find your peace in mind.
Characteristics that best describes you: Joyful

E. HEALTH CONDITION
Disabilities/Impairments: N.A

Illnesses in the past: N/A

Accidents experienced/effect: N/A

Operations experienced/effect: N/A

Previous psychological consultations:

Have you consulted a Psychiatrist before? No ( ) Yes (✔)
For what? For how many sessions?
Have you consulted a Psychologist before? No ✔
( ) Yes ( )
For what? For how many sessions?
Have you consulted a Guidance Counselor before? No (✔) Yes ( )
For what? For how many sessions?
Present concerns/problems that may affect academic tasks and individual well-being:
Failing grades Harassment Internet addiction
Poor study habits Anxiety Separation of parents
Peer pressure Boy-Girl Relationship Abusive parents/guardian
Low Self-esteem Identity crisis/confusion Sibling rivalry
Bullying Separation anxiety Financial
Discrimination Suicidal ideation/thoughts Health issues
Others, pls. specify:

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F. SELF- ASSESSMENT

Below Above
Categories Poor Average Excellent
Average Average
Self-Confidence ✔
Interpersonal Skills ✔
Self-Discipline ✔
Motivation ✔

Sense of Responsibility ✔
Leadership Potential ✔
Emotional Stability ✔

I hereby declare that all information I have given are correct.

PETER JOHN TEVES BSED-III 06/09/2021
Signature over Printed Name Course & Year Date

(To be filled-up by the Guidance Personnel)

TEST RECORDS
Test Administered Result Academic Year Taken

GUIDANCE ACTIVITIES

SERVICES 1ST YEAR 2ND YEAR 3RD YEAR 4TH YEAR 5TH YEAR

INFORMATION

INTAKE/ ROUTINE
INTERVIEW

COUNSELING
(Individual/ Group/ Academic/
Disciplinary Case Referral/ Counselor’s
Discovery)

FOLLOW-UP

CONFERERENCES
(Parent/ Teacher/ Administrator/
School Personnel)

EXTERNAL REFERRAL