Republic of the Philippines
BOHOL ISLAND STATE UNIVERSITY
Zamora, Bilar, 6317, Bohol, Philippines
Guidance and Counseling Services Center
Balance I Integrity I Stewardship I Uprightness
INDIVIDUAL INVENTORY FORM
Dear Student,
The purpose of this form is to gather essential information that will enable your Guidance Counselor to help you in whatever way possible. Be assured
that all information shall be kept with utmost confidentiality.
Date: A.Y. 20
Student/ID No.: Program:
Name:
(Family Name) (First Name) (Middle Name) (Nickname)
2x2
Age: Sex: Civil Status:
Place of ID with name tag
Date of Birth: Birth:
Religion: Nationality:
Mobile No.: Contact No.:
Email Address:
Current Address:
Home Address:
Parents: ☐ Living Together ☐ Permanently Separated ☐ Temporarily Separated ☐ Single Father ☐ Single Mother ☐ OFW
FATHER MOTHER
Name:
Home Address:
Contact Number:
Date of Birth:
Nationality:
Educational Attainment:
Occupation:
Place of Employment:
Monthly Income:
Name of Brothers/Sisters Age School/Place of Work
Place + sign after name, if deceased.
Guardian (if not living with Parents):
Relationship with Guardian: Contact No.:
Address
:
Easiest
Subjects: Difficult Subjects:
F-SAS-GDC-009 | Rev. 2 | 07/01/24 | Page 1 of 2
Republic of the Philippines
BOHOL ISLAND STATE UNIVERSITY
Zamora, Bilar, 6317, Bohol, Philippines
Guidance and Counseling Services Center
Balance I Integrity I Stewardship I Uprightness
INDIVIDUAL INVENTORY FORM
Inclusive Years of
Name & Address of School Honors/Awards Received
Attendance
Elementary
Secondary
Tertiary*_______________________
Graduate
Studies*_______________________
*Please write the degree and major.
Name of Organization/s that You are a Member of Position School Year
Interest: Skills/Talent:
Hobbies: Ambitions:
Present Concerns: Fears:
Philosophy/Motto in
Life:
Traits that you possess:
☐ Friendly ☐ Reserved ☐ Imaginative ☐ Group-oriented ☐ Shy
☐ Stubborn ☐ Self-assured ☐ Suspicious ☐ Happy-go-Lucky ☐ Dominant
☐ Relaxed ☐ Individualistic ☐ Serious ☐ Calm ☐ Flexible
☐ Tense ☐ Easily Troubled ☐ Outgoing ☐ Practical ☐ Traditional
☐ Worrier ☐ Confident ☐ Perfectionist ☐ Trusting ☐ Others:_____________
Chronic Illness:
Disabilities/Impairments:
Medicine Taken Regularly:
Accidents Experienced/Effect:
Operations Experienced/Effect:
To whom would you like to share your concerns and problems with?
Why him/her?
Would you like to see and talk to your guidance counselor? ☐ Yes ☐ No
____________________________________________
Name & Signature over Printed Name
F-SAS-GDC-009 | Rev. 2 | 07/01/24 | Page 2 of 2