GUIDANCE Cummulative Record
GUIDANCE Cummulative Record
FAMILY HISTORY
FATHER: ________________________________________________________________ Age: ___________________ Occupation: ________________________________
Business address: ________________________________________________________________________ Tel. No.: ___________________________________
MOTHER: _______________________________________________________________ Age: ___________________ Occupation: ________________________________
Business address: ________________________________________________________________________ Tel. No.: ___________________________________
MARITAL STATUS OF PARENT: _____ Married _____ Live-in _____Separated _____ Divorced/Annulled ____ Single parent _____ Widow/Widower
THE CHILD IS LIVING WITH : _______ Parent _____ Grandparent _____Uncle/Aunt ______Family friend ______Others, please specify_______________
OTHER SIBLINGS IN THE FAMILY:
Name Sex Age School / Occupation
1.
2.
3.
4.
5.
6.
SCHOOL HISTORY
Previous School Attended Address Grade School Year
ACADEMIC DIFFICULTY
______Writing ______Speaking ______Reading ______Computation ______Study habit ______Attention ______Interest
STUDY HABITS AND ATTITUDE
______ Very good ______ Good ______ Fair ______ Needs improvement
MEDICAL HISTORY
______Asthma ______Operation ______Therapy ______Convulsion ______Under Medication
______Eye Problem ______Hearing Problem ______Blood Type Allergic to: ________________________________________________
______others, please specify: __________________________________________________________________________________________________________________
PERSONAL HISTORY
HOBBIES AND INCLINATION:
______Dancing ______Reciting Poems ______Basketball ______Cooking others______________
______Singing ______Reading ______Gymnastics ______Playing PC Games
______Drawing ______Writing ______Playing Musical Instrument ______Cross-Stitching
Date Guidance Service Rendered Problem Presented Action Taken Guidance Advocate
Signature
Note: This is a confidential document, parents may assist their children in accomplishing this form.