LRN: ______________
STUDENT TRACKING SYSTEM
NAME: _____________________________________________________________ NICKNAME: _______________
Last Name
Given Name
Middle Name
AGE: _____ GENDER: _____ DATE OF BIRTH: ______________ PLACE OF BIRTH: __________________
ADDRESS: _________________________________________________________TELEPHONE NO. ___________
________________________________________________________ MOBILE NO. _______________
_______________
NATIONALITY: _______________ RELIGION: _______________ BARANGAY _____ ZONE ______
FAMILY BACKGROUND PROFILE:
Father’s Name: _____________________________________________Age: ____ Occupation: ________________
Mother’s Maiden Name: ____________________________________Age: ____ Occupation: ________________
Guardian’s Name: __________________________________________ Age: ____ Occupation: ________________
Parental Status: Living together ____
Separated ____
Deceased: Father ____
Mother ____
No. of Children in the Family:
Brother/s ____
Sister/s ____
Step brother/s ____
Step sister/s ____
Drop-Out History: yes ____
no ____
How long? ____________ Reasons: _____________________
Means of Transportation to School: walk ____
service ____
public transpo ____
w/ “sundo”: yes ____
no ____
Recipient of Financial Assistance: 4Ps ____
Scholarship LGU ____
Others ___________
Pupil living with: parents ____
grandparents ____
guardian ____
Ethnicity: (eg.Bikolano, Cebuano) _________________ Common Sickness: __________________________
Disability: ___________________________________
EDUCATIONAL PROFILE:
Grade
Level
Kinder
School Attended
School Year Gen. Ave.
Teacher
I
II
III
IV
V
VI
Student Emergency Release Contact Information and Student-Family Reunification
People with permission to pick-up
child in case of emergency or disaster
Contact Information
Destination
1. ____________________________
1. ____________________________
1. ____________________________
2. ____________________________
2. ____________________________
2. ____________________________
3. ____________________________
3. ____________________________
3. ____________________________