Republic of the Philippines

DEPARTMENT OF EDUCATION
Negros Island Region
Division of Negros Occidental
SIPALAY CITY NATIONAL HIGH SCHOOL (Attach Most Recent
(SENIOR HIGH SCHOOL) Photo Here)
SIPALAY [Link] OCCIDENTAL
GUIDANCE DEPARTMENT

INDIVIDUAL INVENTORY FORM

S.Y. 2022 – 2023 Grade/Section: COOKERY 11

Class Adviser: VILMA P. SERRANO
S.Y. 20 ___ - 20 ___ Grade/Section: _____________________________
S.Y. 20 ___ - 20 ___ Grade/Section: _____________________________
S.Y. 20 ___ - 20 ___ Grade/Section: _____________________________

I. PERSONAL DATA
LRN: _____________________________ Date Filled: _________________
Name of Student: ___________________________________________________ Nickname: ___________________
Sex: ____ Yr. & Section: _______________________ S.Y. ________ Adviser: ________________________________
Age: ____ Date of Birth: _______________________ Place of Birth: _______________________________________
Home Address: _________________________________________________________________________________
Citizenship: __________________ Religion: ___________________________
Tel./Mobile No. (Student): _______________________ Tel./Mobile No.(Parent): _____________________________
E-mail: ________________________________________ FB Account: ______________________________________
Elementary School Graduated from (for 1 st Year only) __________________________________________________
Name of School last attended (for 2nd and 4th Year only) _________________________________________________
School Address: _________________________________________________________________________________
Easiest Subjects: _________________________________________________________________________________
Most Difficult Subjects: ___________________________________________________________________________
Subjects with Lowest Grades/ What Grades: __________________________________________________________
Subjects with Highest Grades/ What Grades: __________________________________________________________
Plan after High School: ____________________________________________________________________________
Awards/ Honors Received: _________________________________________________________________________
Are you a 4P’s recipient? __Yes ___No (Please Check)
Health (Disabilities/Impairments): _________________________

Membership in Organizations
In School:
Name of Organization Position/ Title
___________________________________ _____________________________________
___________________________________ _____________________________________
___________________________________ _____________________________________

Outside School:
Name of Organization Position/ Title
___________________________________ _____________________________________
___________________________________ _____________________________________
___________________________________ _____________________________________

Unique Features
Friends: In School: ______________________________________________________________________________
Outside School: _____________________________________________________________________________
Hobbies / Recreational Activities: __________________________________________________________________
Ambition / Goals: _______________________________________________________________________________
Guiding Principle in Life / Motto: ___________________________________________________________________
Characteristics that describes you best: ______________________________________________________________
______________________________________________________________________________________________
Present Concerns / Problems: ______________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Present Fears: ___________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
 II. FAMILY BACKGROUND
Please fill in the blanks and check the appropriate data.

Name of Father: ______________________________ Maiden Name of Mother: _____________________________

Educational Attainment Educational Attainment

___ College Graduate ___ College Graduate
___ College Undergraduate ___ College Undergraduate
___ High School Graduate ___ High School Graduate
___ Elementary Graduate ___ Elementary Graduate
___ Others please specify ___ Others please specify

Occupation _______________________________ Occupation _________________________________

Employer ________________________________ Employer __________________________________
Tel./Mobile No. ___________________________ Tel./Mobile No. _____________________________
Address __________________________________ Address ____________________________________

Monthly Income: (check only one) Monthly Income: (check only one)
___ P 5,000 – below ___ P 5,000 – below
___ P 6,000 – 10,000 ___ P 6,000 – 10,000
___ P 10,000 – 20,000 ___ P 10,000 – 20,000
___ P 21,000 – 30,000 ___ P 21,000 – 30,000
___ P 30,000 and above ___ P 30,000 and above

Number of children in the family: ____ Your rank in the family: ___________________

II. FAMILY STATUS

1. Parents/ Family Status: ___ Married ___ Single Parent ___ Separated ___ Widow

2. Are you living with both parents? ___ Yes ___ No

Reasons:
a. Parents are living together under one roof? ___ Yes ___ No
b. Parent/Parents is/are deceased? ___ Yes ___ No
(Please Specify) ___ Father ___ Mother ___ Both
c. Parent/Parents has/have another family? ___ Yes ___ No
(Please Specify) ___ Father ___ Mother ___ Both
d. Parent/Parents is/are working abroad? ___ Yes ___ No
(Please Specify) ___ Father ___ Mother ___Both
e. Only living with relatives or guardian? ___ Yes ___ No

(For No. 2 – e only)

Guardians Name: __________________________________ Relationship: ______________
Address:___________________________________________________________________
Contact No.:________________________________________________________________

Remarks/ Other Pertinent Data gathered/ Observed: ________________________________________________

___________________________________________________________________________________________

III. Draw a sketch of the direction to your house. If your address is difficult to locate, start from an identified known landmark in your
area to your house.