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Student Inventory Record Form

The document is a Student Inventory Record from the City University of Pasay, collecting essential information about students including personal details, health, family background, hobbies, and interests. It includes sections for emergency contacts, transportation methods, and academic preferences. Additionally, there are areas for test records and significant notes regarding the student's circumstances and recommendations.

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54 views2 pages

Student Inventory Record Form

The document is a Student Inventory Record from the City University of Pasay, collecting essential information about students including personal details, health, family background, hobbies, and interests. It includes sections for emergency contacts, transportation methods, and academic preferences. Additionally, there are areas for test records and significant notes regarding the student's circumstances and recommendations.

Uploaded by

panesricho
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Republic of the Philippines

City University of Pasay


(formerly Pamantasan ng Lungsod ng Pasay)
Pasadeña St. F.B Harrison Pasay City
Tel. # 846-75-54
GUIDANCE AND COUNSELING OFFICE
Student Inventory Record PHOTO

I. GENERAL INFORMATION
NAME: COURSE: STUDENT NUMBER:
(SURNAME) (FIRST NAME) (MIDDLE NAME)

PLACE OF BIRTH: DATE OF BIRTH: AGE: SEX: NATIONALITY:


RELIGION: CEL/TEL #: EMAIL ADD:
PRESENT ADD:
PROVINCIAL ADD:
SCHOOL LAST ATTENDED:
SCHOOL ADD:
IF WORKING, NAME AND ADDRESS OF COMPANY:
CONTACT PERSON IN CASE OF EMERGENCY:
ADDRESS: CONTACT #:

II. HEALTH
WEIGHT: lbs. / kg.: HEIGHT:
DO YOU HAVE ANY PROBLEM WITH THE FOLLOWING? (please check):
YES NO YES NO
Your vision? Your speech?
Your hearing? Your General Health?
IF YES, please specify:

III. FAMILY
A. NAME OF FATHER: AGE: LIVING DECEASED
EDUCATIONAL ATTAINMENT: OCCUPATION:
COMPANY: MONTHLY INCOME:
B. NAME OF MOTHER: AGE: LIVING DECEASED
EDUCATIONAL ATTAINMENT: OCCUPATION:
COMPANY: MONTHLY INCOME:
C. NAME OF GUARDIAN: AGE: LIVING DECEASED
EDUCATIONAL ATTAINMENT: OCCUPATION:
COMPANY: MONTHLY INCOME:
BOY(S) GIRL(S)
D. NUMBER OF CHILDREN IN THE FAMILY INCLUDING YOURSELF:
POSITION IN THE FAMILY (1ST, 2ND child, etc…):
NO. OF BROTHER(S) GAINFULLY EMPLOYED:
NO. OF SISTE(S) GAINFULLY EMPLOYED:

NATURE OF RESIDENCE WHILE ATTENDING THE SCHOOL, PLEASE CHECK:


FAMILY HOME RELATIVES HOME WITH MARRIED BROTHER(S) OR SISTER(S)
DORMITORY (include board & lodging) BED SPACER
SHARE APARTMENT WITH FRIEND(S) OTHERS:

DO YOU SHARE ROOM WITH ANYONE? Please check: YES NO

HOW DO YOU GET TO SCHOOL? Please check:

BY PUBLIC TRANSPORATION BY SERVICE


BY FAMILY OWNED VEHICLE BY WALKING

HOW LONG DOES IT USUALY TAKE YOU TO GET TO SCHOOL FROM RESIDENCE? HOURS ____ MINUTES ____

IV. HOBBIES AND INTERESTS


WHAT ARE YOUR HOBBIES? WRITE THEM IN ORDER OF PREFERENCE:
1.) _____________________________________ 3.) _____________________________________
2.) _____________________________________ 4.) _____________________________________

EXTRA CURRICULAR ACTIVITIES:

WHAT ARE YOUR FAVORITE SUBJECTS?

WHAT SUBJECT DO YOU LIKE LEAST?

WHAT MAJOR FIELD OF STUDY DO YOU INTEND TO TAKE?

WHY DID YOU ENROLL IN THIS INSTITUTION?

TO WHOM DO YOU CONFIDE, IF YOU HAVE PROBLEMS? (Please check)

FACULTY MEMBER DEAN GUIDANCE COUNSELOR PARENTS


FRIEND(S) / PEER(S) PRIEST BROTHER(S) / SISTER(S) OTHERS:

V. TEST RECORDS
NAME OF TEST FROM DATE NORM SCORE/PERCENTILE

VI. SIGNIFICANT NOTES


DATE CIRCUMSTANCES ACTION/REMARKS/RECOMMENDATION

Guidance and Counselling Services

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