CEGUERA TECHNOLOGICAL COLLEGES
Highway 1, Francia, Iriga City
GUIDANCE OFFICE
INDIVIDUAL INVENTORY RECORD
Student No.:___________________
Department: College of
Program: Bachelor of
I. PERSONAL INFORMATION
Name: _____________________________________________________________________
Surname) (First Name) (Middle Name)
Present Address: _______________________________________
Permanent Address: _____________________________________
Place of Birth: _________________________________________ Date of Birth: _____________
Email Address: ________________________ Mobile No.: _______________Gender: ______ Age: ____
Civil Status: _____________ Religion:________________Citizenship:_________________________
Language Spoken/s: ______________________________________ Height: cm. Weight: kg.
If working, indicate name of agency/company: _________________________
Person to be contacted in case of accident/serious illness: ________________________________
Relationship: ________________________ Contact Number: ______________________
II. EDUCATIONAL BACKGROUND
Year
Level Name of School School Address Honors/Awards
Graduated
Elementary
School
Junior High
School
Senior
High
School
Vocational
School
III. HOME AND FAMILY BACKGROUND
Father’s Name: _______________________________
Date of Birth: __________________ Age: _________ Occupation: ______________________________
Status: ☐ Alive ☐ Deceased
Educational Attainment:
☐ Elementary Graduate ☐ High School Graduate ☐ College Graduate
☐ Vocational ☐ Master’s Graduate ☐ Doctorate Graduate
Mother’s Maiden Name: _________________________________________________
Date of Birth: __________________ Age: _________ Occupation: ______________________________
Status: ☐ Alive ☐ Deceased
Educational Attainment:
☐ Elementary Graduate ☐ High School Graduate ☐ College Graduate
☐ Vocational ☐ Master’s Graduate ☐ Doctorate Graduate
Name Guardian (if not living with parents): _______________________________________________
Date of Birth: __________________ Age: _________ Occupation: ______________________________
Status: ☐ Alive ☐ Deceased
Educational Attainment:
☐ Elementary Graduate ☐ High School Graduate ☐ College Graduate
☐ Vocational ☐ Master’s Graduate ☐ Doctorate Graduate
Parent’s Martial Relationship:
☐ Married and staying together ☐ Married but separated ☐ Not married but living together
☐ Single parent ☐ Others: _____________________________________________________
Number of children in the family (including yourself): ______
Number of brothers: _____ Number of sisters: _____
Who finances your schooling?
☐ Parents ☐ Spouse ☐ Self-supporting/Working student
☐ Sibling ☐ Relative ☐ Scholarship ☐ Others: __________________ Weekly Allowance: ________
Parent’s Total Monthly Income:
☐ Below Php 5,000 ☐ Php 5,001 – Php 10,000 ☐ Php 10,001 – Php 15,000
☐ Php 15,001 – Php 20,000 ☐ Php 20,001 – Php 25,000 ☐ Above Php 25,000
Do you have a quiet place to study? ☐ Yes ☐ No
Do you share your room? ☐ Yes ☐ No
Nature of Residence while attending school:
☐ Family home ☐ House of married sibling ☐ Shared apartment ☐ Relative’s house
☐ Rented apartment ☐ Dormitory ☐ Bed spacer
IV. HEALTH
A. Physical
Do you have problems with (Please check):
Vision: Yes☐ No☐ IF YES, PLEASE SPECIFY:
Hearing: Yes☐ No☐ IF YES, PLEASE SPECIFY:
Speech: Yes☐ No☐ IF YES, PLEASE SPECIFY:
General Health: Yes☐ No☐ IF YES, PLEASE SPECIFY:
B. Psychological
Previous Consultation:
Consulted YES NO IF YES, FOR WHAT?
Psychiatrist
Psychologist
Counselor
VI. SIGNIFICANT NOTES: (To be filled out by Guidance Coordinator / Staff)
DATE INCEDENT REMARKS