DC-GF1
BALAGUNAN NATIONAL HIGH SCHOOL
Balagunan, Sto. Tomas, Davao del Norte
_________________________________________
Guidance Office
STUDENT PERSONAL INFORMATION
PHOTO HERE
Note: All information is considered confidential.
PLEASE FILL-UP CORRECTLY AND WRITE LEGIBLY.
LRN No._______________________________
Surname
First Name
Middle Name
Sex: [ ] Male [ ] Female
Email Add: _____________ Nickname:_____________ Contact No. ____________
Religion:
Cultural Group: (Ex. Bilaan, Manobo, Mandaya, etc.)
Dialect Spoken: _________________________________ Pls. indicate your cultural group:
Date of Birth:
Birth Order Among Siblings:__________________________________
Birthplace:_______________________________________________________________________ Age:_______________________________
Current Address:
____________________________________________________
Permanent Address:_________________________________________________________________________________________________
Person to contact in case of emegency:
Name:__________________________________________Relationship:______________________ Contact No.:___________________
If working, please indicate below:
Name of Employer :
Address:
Contact No.:
Person/s supporting your studies: [ ] Parents
[ ] Aunt/Uncle
[ ] Brother/Sister
[ ] Employer
[ ] Others, please specify:
If you are a scholar, please specify the scholarship: (Ex. 4Ps, Batch 70, Sul Orchids, Indv’l grant)
_______________________________________________________________
I.
Family Background
Father
Mother
( mark with + if deceased)
( mark with + if deceased)
Name:
Age:
Highest Educational Attainment:
Occupation:
Contact No.:_________________________________________
Working Abroad? [ ]Yes
[ ] No
Employer:
Office Address :
Name:
Age:
Highest Educational Attainment:
Occupation:
Contact No.:_________________________________________
Working Abroad?
[ ]Yes
[ ] No
Employer:
Office Address:
Tel No.:
Tel No.: _________________________________________________
a.
__
My Parents:
[ ] Living Together
[ ] Temporary Separated
[ ] Permanently Separated
[
[
[
] Mother with another Partner
[
] Father with another Partner
] Marriage Annulled/Legally Separated
] Solo Parent
b.
Please name below siblings from eldest to youngest. Include yourself.
Name of
Civil
Educational Working Schooling
Age Sex
Attainment
Brother/Sister
Status
(yes/no)
(yes/no)
Contact
Number
c.
Residential Status:
[
d.
] concrete
[
[
II.
[
] informal settler
[
] owner
[
] semi-concrete
[
] others, please specify________________________
[
]deep well
[
] others, please specify _______________________
[
]kerosene
[
] others, please specify _______________________
] faucet/tap water
Source of Power:
[
g.
] house sharer
Source of Water:
[
f.
[
Type of House:
[
e.
] house renter
] electricity
Annual Income of Family (Check one below):
] Below P 60,000
] P 61,000.00 – P 80,000.00
[
[
] P 81,000.00 – P 100,000.00
] P 101,000.00 – P 150,000.00
[
] Above 151,000.00
Educational Background
a.
Schools Attended:
1. Elementary School:
Address
:
Type of School :
Year Graduated :
[
] Private Sectarian
2. Last School Attended (For Transferees) :
Address
:
Type of School :
[ ] Private Sectarian
School Year last attended: _____
[
] Private Non-Sectarian
[
] Public
[
] Private Non-Sectarian
[
] Public
b.
Awards/Honors Received
c.
Check the subject/s below that you think you need help or assistance. On the space provided, please
write the specific area (Ex. English: grammar or vocabulary, Math: Geometry, etc.).
[
[
[
[
Sponsor
Date
] English
] Science
] Math
]others, pls. specify
III. Self
a. I share my problems with my…. [
[
[
b.ppI live with….
[ ] alone
[ ] parents
[
[
] father
] friends
] counselor
] aunt/uncle
] friends
[
[
[
] mother
[ ] brother/sister
] teacher
[ ] aunt/uncle
] others, please specify ________________
[
[
]guardians
[ ] grandparents
] others, please specify________________
c.rrI use my allowance for…
[
[
[
[
[
[
] meals
] fare
] internet surfing
] school supplies
] clothes
] medicines
[
[
[
[
[
[
] snacks
[ ] computer games
] projects
[ ] leisure
] internet research [ ] cell phone load
] class contribution [ ] movies
] dating
[ ] school books
] others, please specify _________________
IV. Unique Features
Hobbies/Recreational Activities: ___________________________________________________
Ambitions/Goals: _______________________________________________________________
Guiding Principle in Life/Motto: ___________________________________________________
Characteristics that describe you best: _______________________________________________
V.
Membership in Organization
a.
In School: Name of Organization
Position/Title
______________________________________________________
__________________________
______________________________________________________
______________________________________________________
______________________________________________________
__________________________
__________________________
__________________________
b.
Outside School: Name of Organization
Position/Title
______________________________________________________
______________________________________________________
______________________________________________________
c.
__________________________
__________________________
__________________________
Please write the name of your friends/ acquaintances/neighbors below
In School
Year/
Outside School
Name of Friends
Section
Name of Friends
VI.
Contact Number

Problems or Difficulties: Check which of the items below present a problem or difficulty to you.
[
] Confidence
[
] Relationships/love
] Stress Management
] Communication Skills
] Teacher (s)
] Parents
[
[
[
[
] Anger Management
] Peer Pressure
] School Adjustment
] Sibling Rivalry
] Brother/Sister
[
] Friends
[
] My Appearance
[
] Finances
[
] Concentration
[
] Time Management
[
] Study Habits
[
] Privacy/Freedom
[
] Health/Nutrition
[
] Diet/Drugs/Smoking/Drinking
[
] Test Anxiety
[
] Not interested in coming to school
[
] Others (If you check others, please write the problem or difficulty on the space below)
______________________________________________________________________
[
[
[
[
[
________________________________________________________________
_______________________________________________________________________
VII.
CAREER CHOICE/PLANS
(TO BE FILLED-UP END OF GRADE 8)
1st Choice
2nd Choice
3rd Choice
a.
My course choices (in order):
b.
I choose my course or major for it will give me a chance to
[ ] work abroad
[ ] help my family financially
[ ] earn money
[ ] put up my own business
[ ] serve others
[ ] meet people
[ ] travel/adventure
[ ] have power/prestige
[ ] no particular reason
[ ] others (please write on the space below the reasons for choosing the course)
_________________________________________________