ELIZABETH SETON SCHOOL

Center for Student Well-being

INDIVIDUAL INVENTORY RECORD

Grade/Year & Section: 5 - Catanduanes Student Number: 201810120 1x1 recent

ID picture
House Name (HS only): School Year: 2020 - 2021 here
Year/Level Started in ESS: Grade 2 Academic Strand (SHS only):

The learner’s personal information is used exclusively by the Center of Student Well-being to help identify
needs and concerns that can be addressed by the center. The information you are asked to provide will
be part of the learner’s cumulative record. All information will be kept strictly confidential. Please be honest
and sincere in answering this form to enable us to better understand your child.

I. STUDENT’S PERSONAL INFORMATION

Name: Albino Ishmael Medina Nickname: Ishi

(Last) (First) (Middle)
Address: #15 Pioneer St. Moonwalk Subd. Las Pinas City
Birthdate: May 29, 2010 Place of Birth: Las Pinas Birth Order: second-born
Nationality: Filipino Religion: Catholic Telephone No.: 82960618
Mobile No.: Email Address: albino.ishmael@ess.edu.ph

II. FAMILY BACKGROUND

Father Mother
(as reflected on the learner’s (as reflected on the learner’s Guardian
birth certificate) birth certificate)
Gary T. Albino Elisa M. Albino
Name
Master's Degree College
Educational Attainment
Architect House Wife
Occupation
09283392858 09995669562
Contact Number
garyalbino@gmail.com emalbino0905@gmail.com
Email Address

Name of Sibling/s If alumni, indicate what batch in

Birthdate Level / Occupation
(Eldest – Youngest) ESS / College Degree and School
Angel M. Albino Mar.5, 2005 Grade 10

Althea M. Albino Feb. 14, 2012 Grade 3

Athena M. Albino June 18, 2019

OTHER PERSON/S STAYING AT HOME

Name Relationship Contact Number
Resan P. Azucena Housemaid 09102866520

Child lives with: ✔ Both Parents Father Mother Guardian Relative

Supervision of School Work: ✔ Father ✔ Mother Tutor Others
Language/s or Dialect/s Spoken at Home: English and Tagalog
 ELIZABETH SETON SCHOOL
Center for Student Well-being
INDIVIDUAL INVENTORY RECORD

III. PERSONAL CHARACTERISTICS

(Your child’s adviser may see your comments on this portion)

1. What strengths, interests and preferences does your child have?

Perseverance, he doesn't give up easily

Strengths

Drawing, building legos, watching movies, loves creating things, listening to music
Interests

He likes building things

Preferences

2. What does your child need to improve on in terms of the following…

Science, Filipino, Math
Academics

N/A
Behavior

Career Plans
*JHS/SHS learners only

3. Do you have special concerns about your child? If yes, kindly specify how the guidance counselor/ level
mentor can help him/her.
N/A

4. Has your child consulted with a medical professional / outside specialist for any challenges or concerns he/she
might have? If yes, kindly indicate assessment and recommendations.
N/A

5. Please list two (2) goals that you would like to set with your child for this year.
5. - To improve his academic skills
6. - Interest in other subjects

CONFORME
o
✔ I certify that the information I have provided in this form is true and correct to the best of my knowledge. I
am also allowing ESS to use the data in this inventory for routine interviews, mentoring/counseling,
academic coordination and for research purposes while adhering to the Data Privacy Act of 2012.*

Father’s Signature over Printed Name Guardian’s Signature over Printed Name

Mother’s Signature over Printed Name Date

*In lieu of your digital signature, checking the box and inputting your name in the spaces above signify that you agree to the
aforementioned Conforme statement.