Individual Inventory FORM SEC 1
Republic of the Philippines
Department of
Education
REGION _______
________ SCHOOLS DIVISION
______HIGH SCHOOL
INDIVIDUAL INVENTORY FORM
Important: This is the Individual Inventory Form. It will be used by the Guidance Counselor as a means to assist you in every way
possible. Please supply the information required below honestly and thoroughly as you can. Rest assured that information gathered
here shall be utilized with utmost confidentiality and professionalism.
PERSONAL PROFILE
Name: Sex:
Grade/Year Section: Birthdate: / / (mm/dd/yr)
1X1 Address:
PICTURE of Birthplace: Contact Number:
the Student Person to be conducted in case of accident:
Relationship: Address:
Contact Number:
FAMILY BACKGROUND
Profile of Parents Father Mother
Name:
Age:
Contact Number:
Address:
Occupation:
Siblings Name(s) Age School/Work Address
Marital Status of Parents
Living Together Separated without other family Separated with other families
Who are you living with? (In the absence of your parents): Relationship:
Address: Contact No.: Occupation:
Economic Status: How much does your parents earn in a year?)
P25,000.00 – P50,000.00 P50,000.00 – P75,000.00 P75,000.00 and above
Sources (and other sources) of Income:
ACADEMIC BACKGROUND
Level Name of School School Address Year Attended General Average
Secondary Education
(If transferee)
Preferred
College/University(in
the future)
Favorite Subject(s):
English Social Studies Technical Vocational Education Sciences
Mathematics Filipino Values MAPEH Computer Education
Least Liked Subject(s):
English Social Studies Technical Vocational Education Sciences
Mathematics Filipino MAPEH Computer Education. Values E
Honors/Awards/Recognition Received:
SOCIAL BACKGROUND (Membership in School Clubs/Organization (in and outside the
school): Name of Organization Position(s) Held
Who are your friends in school (please name a few of the ones closest to you)?
Names Grade/Year & Section
Republic of the Philippines
Department of
Education
REGION _______
________ SCHOOLS DIVISION
______HIGH SCHOOL
HEALTH INFORMATION
Do you have problems with (Please Check)
Vision Speech Hearing General Health
[ ][ ] [ ][ ] [ ][ ] [ ][ ]
YES NO (If Yes, please specify) YES NO (If Yes, please specify) YES NO (If Yes, please specify) YES NO (If Yes, please
specify)
OTHER INFORMATION
What is/are your motto(s) in life?
Have you consulted/been sent to see the Guidance Counselor before? Yes No
What was/were the reason(s)?
How may your Guidance Counselor help you (today and in the future)
Family matters Academic concerns Financial matters
Relationship problems Career concerns (for College) Health Concerns
Concerns with teachers Self
If your Guidance Counselor should conduct a seminar, which topic(s) do you prefer?
Family matters Academic concerns Financial matters
Relationship problems Career concerns (for College) Health Concerns
Concerns with teachers Self
Others (Please Specify):
PARENT CONSENT
COUNSELING is a confidential process designed to help you address your concerns, come to a greater understanding of yourself, and
learn effective personal and interpersonal coping strategies. It involves a relationship between you and a trained counselor who has
the desire and willingness to help you accomplish your individual goals. Counseling involves sharing sensitive, personal, and private
information that may at times be distressing. During the course of counseling, there may be periods of increased anxiety or
confusion. The outcome of counseling is often positive; however, the level of satisfaction for any individual is not predictable. Your
counselor is available to support you throughout the counseling process.
CONFIDENTIALITY: All interactions with Counseling Services, including scheduling of or attendance at appointments, content of
your sessions, progress in counseling, and your records are confidential. No record of counseling is contained in any academic,
educational, or job placement file. You may request in writing to release specific information about your counseling to persons
you designate.
EXCEPTIONS TO CONFIDENTIALITY:
• The counseling staff works as a team. Your counselor may consult with other counseling staff to provide the best possible care.
These consultations are for professional and training purposes.
• If there is evidence of clear and imminent danger of harm to self and/or others, a counselor is legally required to report this
information to the authorities responsible for ensuring safety.
• Philippine law requires that staff of Counseling Services who learn of, or strongly suspect, physical or sexual abuse or neglect of
any person under 18 years of age must report this information to county child protection services.
• A court order, issued by a judge, may require the Counseling Services staff to release information contained in records and/or
require a counselor to testify in a court hearing.
There is no fee for counseling services. If you are referred off campus to health, mental health, or substance abuse professionals you
are responsible for their charges.
I have read and discussed the above information with my child’s school guidance counselor. I understand the risks and benefits of
guidance and counseling services, the nature and limits of confidentiality, and what is expected of me as a parent and student of
the school guidance and counseling services.
Signature of the Parent over Printed Name Signature of the Student over Printed Name
Date