CAMARINES NORTE STATE COLLEGE

GUIDANCE AND TESTING OFFICE

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INDIVIDUAL INVENTORY
TO THE STUDENTS:

You are requested to provide us with essential information that will enable us to help you meet your specific needs and future plans.
All information will be kept with utmost confidentiality. Please fill in the blanks accurately and sincerely to the best of your knowledge and
belief.
PERSONAL DATA

Name _____________________________ ________________ Nickname: ___________________ LRN: __________________________

(Last Name, First Name, Middle Name)
Age ________________ Date of Birth ________________ Place of Birth _______________ Nationality _____________
Sex [ ] Male [ ] Female Birth Order among Siblings ___________
Current Address: _________________________________________________________________________________________
Permanent Address: _________________________________________________________________________________________
Contact No: _______________________________________ E-mail Address: ___________________________________________
Languages/Dialects Spoken at Home _________________________________________________________________________________
Languages/Dialects Most Fluent In __________________________________________________________________________________
Religion from Birth ________________________________________ Current Religion ____________________________________________

FAMILY DATA

Father Mother(Maiden Name)

Name ______________________________________ __________________________________________
Date of Birth ______________________________________ __________________________________________
Place of Birth ______________________________________ __________________________________________
Current Address ______________________________________ __________________________________________
Permanent Address ______________________________________ __________________________________________
Contact Number ______________________________________ __________________________________________
e-Mail Address ______________________________________ __________________________________________
Educational Attainment ______________________________________ __________________________________________
Occupation ______________________________________ __________________________________________
Business Address ______________________________________ __________________________________________
Business Telephone ______________________________________ __________________________________________
Annual Income (previous year) ______________________________________ __________________________________________
Language/s spoken ______________________________________ __________________________________________
Religion Raised with ______________________________________ __________________________________________
Current Religion ______________________________________ __________________________________________
Marital Status of Parents: Please check and underline the choices.

[ ] Married/Annulled /Legally Separated [ ] Temporarily Separated [ ] Mother with other partner [ ] Father with other partner
[ ] Widow/Widower/ Living Together [ ]Permanently Separated [ ]Mother OFW [ ] Father OFW
Guardian _______________________________________ Relationship with Guardian ____________________________________
Address _________________________________________________ Contact No. ________________________________________
PERSON TO CONTACT IN CASE OF EMERGENCY:

Name ________________________________________ Contact Number _______________________________________________

Please name below your siblings form eldest to youngest, include yourself. Put X opposite your name, if married, please provide the
information called for using the same table below.

Name Sex Age Educational Attainment Occupation Name Sex Age Educational Attainment Occupation
 UNIQUE FEATURES Page [2] of [3]

Name of Friends:
In School ____________________________________________________________________________________
Outside School ____________________________________________________________________________________
Special Interest ____________________________________________________________________________________
Special Skills/Talents ____________________________________________________________________________________
Hobbies/ Recreation Activities ____________________________________________________________________________________
Ambition/Goal ____________________________________________________________________________________
Characteristics that describe
you best ____________________________________________________________________________________

HEALTH CONDITIONS

Accidents Experienced ____________________________________ Effect _________________________________________________

Accidents Experienced ____________________________________ Effect _________________________________________________

Immunizations you have had:

[ ] Chicken Pox [ ] Booster [ ] Measles MMR [ ]Hepatitis B

[ ] Mumps [ ] Influenza [ ] Small Pox [ ] Others: ____________
Height ____________________ Weight _____________________ Physical Disadvantage ___________________________

Illness this year _____________________________________ (previous year) ___________________________________________

EDUCATIONAL BACKGROUND

School Attended (with Address) Inclusive Years of Attendance Awards Received

Preparatory ________________________________________ __________________________ _________________
Elementary (Grade 1 – 6 ) ________________________________________ __________________________ _________________
Junior High (Grade 7 – 10) ________________________________________ __________________________ _________________
Senior High (Grade 11 – 12) ________________________________________ __________________________ _________________

Subjects with Lowest Grades/What Grades __________________ Subjects with Highest Grades/What Grades ________________________
Inclinations:

Performing Arts __________________________________________ Sports __________________________________________________

Leadership __________________________________________________________________________________________________________
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INTEREST

[ ] Painting [ ] Singing [ ] Poem Writing [ ] Playing Instruments [ ] Planting

[ ] Declamation/Oration [ ] Dancing [ ] Composing [ ] Stage/ Act [ ] Cooking

What other skills and hobbies do you have? __________________________________________________________________________

What extra-curricular activities would you like to participate in? ________________________________________________________________
What books and magazines do you enjoy reading? __________________________________________________________________________

Are you [ ] right handed? No. of hours devoted daily to:

[ ] left handed?
Class Library Works Studying Lessons Rest Recreation Others
 MEMBERSHIP IN ORGANIZATIONS

Inside the School Outside the School

Name of Organization Position/Title Name of Organization Position/Title
__________________________________ ___________________ __________________________________ ___________________
__________________________________ ___________________ __________________________________ ___________________
__________________________________ ___________________ __________________________________ ___________________

PERCEPTIONS

1. Ideal Monthly Allowance [ ] Php 100.00 - below [ ] Php 100.00 - 499.00 [ ] Php 500.00 - 1, 000.00 [ ] Php 1, 000.00 - above

Have you had any counselling experience? [ ] Yes [ ] No If YES, states the counselors’ name: ______________________

When: ________________________ Where: _______________________________________

Current Concerns:
______________________________________________________________________________________________________
____________________________________________________________________________________________________________________
___________________________________________________________________________________________________
Current Fears:
______________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________

_____________________________________________________ ___________________________________________________
Student’s Name & Signature Parent’s Name & Signature
Date: _________________ Date: _________________