Individual Inventory Record Form

Individual Inventory Record Form
This will be your initial inventory with the Office of Guidance and Counseling. We would like to request you to please honestly fill out this form. The information that you would share with us could be utilized to assist you and discover other factors that may contribute to the formation of your individuality.
Rest assured that all information gathered from this form shall be dealt with utmost confidentiality.
Thank you very much.
- Ms. Desh
I. Personal and Family Data
Name
Last NameFirst NameMiddle NameName Extension
Present Address
Street/Block/Lot/Unit
Street Address Line 2
BarangayCity
State/Province
Age
Date of Birth
Place of Birth
Birth Order
Sex
Email Address
Hobbies/Interests
Talents/Skills
Parent's Status
Are you living with your parents?
If No, who is your guardian?
Complete Name
Relationship with Guardian
OccupationAge
Contact Number
Parent's Record
Rows Father's Information Mother's Information
Name
Age
Highest Educational Attainment
Occupation
Contact Number
Children in the Family starting with the eldest (including you). Kindly put N/A if not applicable.
Rows Name Age Birthday Civil Status School/Employer
1
2
3
4
5
6
7
8
9
10
II. Educational Background
Please put N/A if not applicable.
Rows Name of School Year Completed Awards/Honors Received
Senior High School
Junior High School
High School (old curriculum)
If transferee: (Please put N/A if not applicable)
Previous SchoolUntil what year/grade level?
Are you a member of any club/organization outside or inside the school?
If yes, please state the club/organization and your position:
Rows Name of Club/Organization Position
1
2
3
4
5
III. Health
Do you have any of the following illnesses? Please check those that affected you for the past 5 years up to present.
Others, please specify: (please put N/A if not applicable)
Do you have special needs and concerns (e.g ADD, ADHD, LD, etc.)? Please specify.
Have you ever been involved in any serious accident? If so, please specify.
IV. Career Plans
Ambition
Goal in Life
Occupation you are most interested in:
V. Knowing You
Favorite Subject
Subject you find difficult
I learn best in:
I think I am better when:
To help me finish my assignment at home, I:
What I wish to do now that I failed to do before is blanks*.
I am usually misunderstood because of my blanks*.
I deal with my problems by blanks*.
I wish my teachers would treat me blanks*.
Likes
Dislikes
How would you describe yourself as a learner?
Family Concerns
School Concerns
Photo
Signature
Clear
Should be Empty:

Rows	Father's Information	Mother's Information
Name
Age
Highest Educational Attainment
Occupation
Contact Number

Rows	Name of School	Year Completed	Awards/Honors Received
Senior High School
Junior High School
High School (old curriculum)

Rows	Name	Age	Birthday	Civil Status	School/Employer
1
2
3
4
5
6
7
8
9
10

Rows	Name of Club/Organization	Position
1
2
3
4
5

Individual Inventory Record Form

I. Personal and Family Data

II. Educational Background

III. Health

IV. Career Plans

V. Knowing You