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Gco Form 1personal Data Record

This document contains a guidance form collecting personal, family, educational, vocational, health, and psycho-social information about a student. It includes sections on the student's personal details; parents' information; socio-economic status; educational background; vocational interests; health profile; and psycho-social factors like hobbies, ambitions, problems, and relationships. The form is intended to help provide guidance to the student and gather a holistic understanding of their situation.

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ROMELYN BALBIDO
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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94 views

Gco Form 1personal Data Record

This document contains a guidance form collecting personal, family, educational, vocational, health, and psycho-social information about a student. It includes sections on the student's personal details; parents' information; socio-economic status; educational background; vocational interests; health profile; and psycho-social factors like hobbies, ambitions, problems, and relationships. The form is intended to help provide guidance to the student and gather a holistic understanding of their situation.

Uploaded by

ROMELYN BALBIDO
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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Guidance Form 1

Republic of the Philippines


Department of Education
Region 02 (Cagayan Valley)
SCHOOLS DIVISION OFFICE OF ISABELA
MALALINTA NATIONAL HIGH SCHOOL
300513, MALALINTA, SAN MANUEL, ISABELA

INDIVIDUAL INVENTORY
JUNIOR HIGH SCHOOL

Personal Data & Family Background


Name:___________________________________________ Nickname:__________________ Age: ______
Address:_______________________________________________________________________________
Nationality:___________________ Religion: __________________ Sex: __________
Date of Birth:_____________________ Place of Birth: ____________________ Birth Order among siblings: ____________
Number of Children in the family: _____________ Languages/Dialects Spoken: _____________________________
CP #_______________________________Official FB Account_________________________________________________
Parents Information
Father Mother
Information
__Living __Deceased __Living __Deceased
Name
Age
Date of Birth
Place of Birth
Address
Nationality
Religion
Contact number
Highest Educational Attainment
Occupation
Languages/Dialects spoken
Parents Marital Status
__Married __Living Together __Widow __Annulled __Separated __Others (Specify)____________
Living with whom?
__Both parents __Mother __Father __Others (Specify)_____________
Guardian (if not living with Parents): ________________________________ Address: _____________________________________
Relationship with Guardian: ____________________________ Contact number: ___________________________________

Socio-Economic Status
Monthly Household Income of family (check)
Below P1,000 P5,001-P8,000
P1,000-P2,000 P8,001-P15,000
P2,501-P5,000 OVER P15,000
Which of the following describe the student’s house?
___Concrete ___Semi Concrete ___Wooden ___ Bamboo/Nipa Hut
Information about family dwelling
a. The Family ___owns house and lot ___rents house ___others, please specify:_______________
b. Type of toilet ___flush ___pit ___water sealed
c. Sources of water ___faucet/tap water ___deep well ___others, please specify:__________
Appliance/s or gadgets owned ___1. TV ___2. Laptop _____3. CP ___4. Ref ___ 5. Washing machine__6. Others (pls specify)______
Vehicle/s owned ___1. Tricycle/motorcycle ___2. Car ___3. Jeep 4. Truck ___5. Others (specify)_______________
Land owned ___1. Residential ___2. Farm/field ___3. Commercial/industrial ___4. Kaingin ____5. None

Educational Background
Schools Attended:
Early Childhood Education:_____________________________ Year: _____________
Elementary: _________________________________________ Year: ____________
Easiest subject/s:_____________________________ Most difficult subject/s:__________________
Subject/s with lowest grades____________________ Subjects with highest grades ___________________
Extracurricular activities liked or participated in:_________________________________________________
Significant school experiences:_______________________________________________________________
Has the student ever dropped out of school? Yes_____ No_____
If Yes, for how long? _____________________ What reason/s?__________________________________
Is the student receiving any type of financial assistance to attend school? Yes_____ No_____
If Yes, from what source/s (specify)____________________________________________________________
Vocational Information
Do you plan to pursue Senior High school? _____ What Track/Strand do you prefer? __________
Do you plan to go to college? Why?___________________________________________________________
What life occupation do you like?
*First choice: ________________________
*Second choice :________________________
*Third Choice: ________________________

Health Profile
Height: _______ Weight: _______ Normal Vision: ( )YES ( )NO Normal Hearing: ( )YES ( )NO
Ailments (please check the item/s which is/are applicable to you)
____1. Anemia ____4. Diabetes ____7. others (specify)___________________
____2. Asthma ____5. Hypertension
____3. Heart Problem ____6. Allergies
Disability (please check the item/s which is/are applicable to you)
____1. Speech impairment ____4. Left-handed ____7. others (specify)___________________
____2. Visual impairment ____5. Harelip
____3. Hearing impairment ____6. Physical disability (specify)______________________
Have you been hospitalized? ___________________ Have you undergone operation? _______________________

Psycho-Social
Hobbies: __________________________ Talents/Skills ______________________
Ambitions/Goals:_______________________________ Characteristics that describe you best: ______________________

Problems/Concerns: (please check the item/s which is/are applicable to you)


____1. Financial concerns ___9. Overcoming shyness
____2. Issues on alcohol & other drugs ___10. Depression (extreme sadness
____3. Study habits/academic concerns Relationship with:
____4. Self-confidence ___11. Parents
____5. Social skills ___ 12. Teachers
____6. Time Management ___ 13. Girls
____7. Peer Pressure ___ 14. Boys
____8. Family Relations ___ 15. Friends
____9. Abuses, trauma, (physical, sexual, verbal, etc.) ___16. Neglect (by parents)

Is your home or family happy? (please check one) Yes___ No____. Why?
__________________________________________________________________________________________

Present Fears: _______________________________________________________________________________

Please complete the following phrases honestly:


1. Ang nanay ko ay palaging ___________________________________________________________
2. Madalas, ang tatay ko ay____________________________________________________________
3. Pakiramdam ko ang mga magulang ko ay _______________________________________________
4. Kapag ako’y may bakanteng oras _____________________________________________________
5. Ang pinakamalungkot na karanasan ko sa buhay ay _______________________________________
6. Sa paaralan, ako ay _________________________________________________________________
7. Ako ay nahihirapan sa_______________________________________________________________
8. Ako at mga kaibigan ko ay ___________________________________________________________
9. Masaya ako kapag _________________________________________________________________
10. Nag-aalala ako ____________________________________________________________________
11. Nakikita ko ang sarili ko na isang __________________________balang araw
12. Sana ____________________________________________________________________________
13. Malungkot ako kapag_________________________________________________________________
14. Pinapangarap kong __________________________________________________________________
15. Gusto ko palaging ___________________________________________________________________

___________________________
Student’s Name & Signature

ROMELYN B. BALBIDO
Guidance Designate/Teacher III
Guidance Form 1
Republic of the Philippines
Department of Education
Region 02 (Cagayan Valley)
SCHOOLS DIVISION OFFICE OF ISABELA
MALALINTA NATIONAL HIGH SCHOOL
300513, MALALINTA, SAN MANUEL, ISABELA

INDIVIDUAL INVENTORY
SENIOR HIGH SCHOOL

Personal Data & Family Background


Name:___________________________________________ Nickname:__________________ Age: ______
Address:_______________________________________________________________________________
Nationality:___________________ Religion: __________________ Sex: __________
Date of Birth:_____________________ Place of Birth: ____________________ Birth Order among siblings: ____________
Number of Children in the family: _____________ Languages/Dialects Spoken: _____________________________
CP #_______________________________Official FB Account_________________________________________________
Parents Information
Father Mother
Information
__Living __Deceased __Living __Deceased
Name
Age
Date of Birth
Place of Birth
Address
Nationality
Religion
Contact number
Highest Educational Attainment
Occupation
Languages/Dialects spoken
Parents Marital Status
__Married __Living Together __Widow __Annulled __Separated __Others (Specify)____________
Living with whom?
__Both parents __Mother __Father __Others (Specify)_____________
Guardian (if not living with Parents): ________________________________ Address: _____________________________________
Relationship with Guardian: ____________________________ Contact number: ___________________________________

Socio-Economic Status
Monthly Household Income of family (check)
Below P1,000 P5,001-P8,000
P1,000-P2,000 P8,001-P15,000
P2,501-P5,000 OVER P15,000
Which of the following describe the student’s house?
___Concrete ___Semi Concrete ___Wooden ___ Bamboo/Nipa Hut
Information about family dwelling
a. The Family ___owns house and lot ___rents house ___others, please specify:_______________
b. Type of toilet ___flush ___pit ___water sealed
c. Sources of water ___faucet/tap water ___deep well ___others, please specify:__________
Appliance/s or gadgets owned ___1. TV ___2. Laptop _____3. CP ___4. Ref ___ 5. Washing machine__6. Others (pls specify)______
Vehicle/s owned ___1. Tricycle/motorcycle ___2. Car ___3. Jeep 4. Truck ___5. Others (specify)_______________
Land owned ___1. Residential ___2. Farm/field ___3. Commercial/industrial ___4. Kaingin ____5. None

Educational Background
Schools Attended:
Early Childhood Education:_____________________________ Year: _____________
Elementary: _________________________________________ Year: ____________
Easiest subject/s:_____________________________ Most difficult subject/s:__________________
Subject/s with lowest grades____________________ Subjects with highest grades ___________________
Extracurricular activities liked or participated in:_________________________________________________
Significant school experiences:_______________________________________________________________
Has the student ever dropped out of school? Yes_____ No_____
If Yes, for how long? _____________________ What reason/s?__________________________________
Is the student receiving any type of financial assistance to attend school? Yes_____ No_____
If Yes, from what source/s (specify)____________________________________________________________
Vocational Information

Do you plan to go to college? ( )YES ( )NO


Why?___________________________________________________________________________________________________
What life occupation do you like?
*First choice: ________________________
*Second choice :________________________
*Third Choice: ________________________

Health Profile
Height: _______ Weight: _______ Normal Vision: ( )YES ( )NO Normal Hearing: ( )YES ( )NO
Ailments (please check the item/s which is/are applicable to you)
____1. Anemia ____4. Diabetes ____7. others (specify)___________________
____2. Asthma ____5. Hypertension
____3. Heart Problem ____6. Allergies
Disability (please check the item/s which is/are applicable to you)
____1. Speech impairment ____4. Left-handed ____7. others (specify)___________________
____2. Visual impairment ____5. Harelip
____3. Hearing impairment ____6. Physical disability (specify)______________________
Have you been hospitalized? ___________________ Have you undergone operation? _______________________

Psycho-Social
Hobbies: __________________________ Talents/Skills ______________________
Ambitions/Goals:_______________________________ Characteristics that describe you best: ______________________

Problems/Concerns: (please check the item/s which is/are applicable to you)


____1. Financial concerns ___9. Overcoming shyness
____2. Issues on alcohol & other drugs ___10. Depression (extreme sadness
____3. Study habits/academic concerns Relationship with:
____4. Self-confidence ___11. Parents
____5. Social skills ___ 12. Teachers
____6. Time Management ___ 13. Girls
____7. Peer Pressure ___ 14. Boys
____8. Family Relations ___ 15. Friends
____9. Abuses, trauma, (physical, sexual, verbal, etc.) ___16. Neglect (by parents)

Is your home or family happy? (please check one) Yes___ No____. Why?
__________________________________________________________________________________________

Present Fears: _______________________________________________________________________________

Please complete the following phrases honestly:


16. Ang nanay ko ay palaging ___________________________________________________________
17. Madalas, ang tatay ko ay____________________________________________________________
18. Pakiramdam ko ang mga magulang ko ay _______________________________________________
19. Kapag ako’y may bakanteng oras _____________________________________________________
20. Ang pinakamalungkot na karanasan ko sa buhay ay _______________________________________
21. Sa paaralan, ako ay _________________________________________________________________
22. Ako ay nahihirapan sa_______________________________________________________________
23. Ako at mga kaibigan ko ay ___________________________________________________________
24. Masaya ako kapag _________________________________________________________________
25. Nag-aalala ako ____________________________________________________________________
26. Nakikita ko ang sarili ko na isang ____________________________________________balang araw.
27. Sana ____________________________________________________________________________
28. Malungkot ako kapag_________________________________________________________________
29. Pinapangarap kong __________________________________________________________________
30. Gusto ko palaging ___________________________________________________________________

___________________________
Student’s Name & Signature

ROMELYN B. BALBIDO
Guidance Designate/Teacher III

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