Individual Inventory Record Form Page 2
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2How much is your weekly allowance? (please specify the amount) _____________________________________
Parents’ Total Monthly Income:
[ ] Below Php5,000
[ ] Php 15,001-Php 20,000
[ ] Php 30,001-Php 35,000 [ ] Php 45,001-Php 50,000
[ ] Php 5,001- Php 10,000 [ ] Php 20,001-Php 25,000
[ ] Php 35,001-Php 40,000 [ ] Above Php 50,001
[ ] Php 10,001-Php15,000 [ ] Php 25,001-Php 30,000
[ ] Php 40,001-Php 45,000 [ ] Others please specify
____________
Do you have a quiet place to study? (Please Check)
[ ] Yes
[ ] No
Do you share your room with anyone? (Please Check)
[ ] Yes
[ ] No If yes with whom? ______________
Nature of Residence while attending school: (Please Check)
[ ] family home
[ ] bed spacer
[ ] house of married brother/sister
[ ] relative’s house
[ ] rented apartment
[ ] dorm (including board & lodging
[ ] shares apartment with friends/relatives (Please Underline)
IV. HEALTH
A. Physical
Do you have problems with (Please Check)
YES
NO
If Yes, please specify
YES
NO
If Yes, please specify
Your Vision
[ ]
[ ]
_________________ Your speech
[ ]
[ ]
________________
Your Hearing
[ ]
[ ]
_________________ Your general health [ ]
[ ]
________________
B. Psychological
Previous Consultations
CONSULTED
YES
NO
WHEN
FOR WHAT?
Psychiatrist
Psychologist
Counselor
V. INTERESTS AND HOBBIES
A. Academic
[ ] Math Club
[ ] Science Club
[ ] Others, please specify
[ ] Debating Club
[ ] Quizzer’s club
What is/are your favorite subject/s? __________________________________________________________
What is /are the subject/s you like least? _______________________________________________________
B. Extra-Curricular
What are your hobbies? Write them in the order of your preferences.
1. ___________________________________________
3. ____________________________________
2. ___________________________________________
4. ____________________________________
Which of the following organizations have you participated in and which interest you most? (Please specify)
[ ] Athletics
[ ] Religious organization
[ ] Glee Club
[ ] Others, please specify ______________
[ ] Dramatics [ ] Chess Club
[ ] Scouting
Occupational position in the organization: [ ] Officer
[ ] Member
[ ] Others, please specify__________
VI. TEST RESULTS
DATE
NAME OF TEST
RS
PR
DESCRIPTION
VII. SIGNIFICANT NOTES (For Guidance Counselors only)
DATE
INCIDENT
REMARKS
_________________________
(Student’s Signature)
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