Republic of the Philippines

Department of Education
Region VIII
Catbalogan City Division
SAMAR NATIONAL SCHOOL
Catbalogan City

STUDENT TRACKING SYSTEM

Middle Birth Ethnic

Surname: First Name: Age:
Name: Date: Affiliation:

STS Form 1: STUDENT’S EDUCATIONAL PROFILE STS Form 4: ABSENTEEISM & DROP OUT PROFILE

Educational Status (Rating by Grading Period) Absenteeism Status

Drop Out History
in School Year

No. of Failing Marks

Learning Faltering
% of Failure

% of Attendance
GRADE ADVISER/ School Family

Dropped Out
Days Present
Days Absent
SECTION
LEVEL TEACHER YEAR member

Reasons
Reason
1st 2nd 3rd 4th FR How Long Remarks
who
dropped out

Mo Y
Grade 7
Grade 8
Grade 9

Grade 10
STS Form 3: HEALTH AND NUTRITION PROFILE
Common Illness/
NUTRITIONAL STATUS Major Accident Immunization
Diseases
GRADE
LEVEL No. of No. of Whooping
Weight (Baseline) Height (Baseline) Weight (End line) Height (End line) Illness Days Name Days BCG DPT Tetanus Polio Measles Hepa B Cough
Pertussis
Absent Absent
Kg. AN N BN Cm N Short Tall Kg AN N BN Cm N Short Tall

Grade 7

Grade 8

Grade 9

Grade 10
 Republic of the Philippines
Department of Education
Region VIII
Catbalogan City Division
SAMAR NATIONAL SCHOOL
Catbalogan City

STUDENT TRACKING SYSTEM

STS Form 2/2-A STUDENT’S FAMILY BACKGROUND PROFILE
Surname: First Name: Middle Name: Birth Date: Age: Ethnic Affiliation:
Address: Nationality: Sex: Male____ Female ____ Birth Place: Birth Reg.: Yes____ No: ____
Has any member Does the Student Nutritional Status (Initial)
Has the Student Distance
of the family receive any type of Who helps the student in doing the
dropped out of from home Means of Transportation to School With whom the student lives?
dropped out of assistance to homework?
School? to School
School? attend School?
Yes ___ No_ Yes____ No__ Yes____ No ___

Remarks

Remarks
Pedi cab

Walking
Motoriz

Mother

Mother
Parents

Parents
Sidecar

Specify

Specify
Others

Others

Height
Father

Father

in Cm.
Reason: _ Reason: From whom: Weight

None
Both

Both
Boat
Jeep
Car

ed
in Kg.

_____ km.
PARENTS’ INFORMATION
Date of Age Living Monthly Ethnic Language Marital Status
Name Nationality Education Occupation Religion
Birth Yes No Income Affiliation Spoken Married Lived-in
Widow/er Separated
Annulled Others
HOUSEHOLD MEMBERS’ INFORMATION
Educational Level
Date of Relationship to Migrated Out of
Name of Household Member SEX Age In School Pre- Elem. Sec. College Post
Birth Student How long? School Non Formal Occupation
School (Grade) (Year) (Grad./Yr.) Graduate

FAMILY DWELLING INFORMATION

With Toilet : _______
No. of Persons living House Source of Water Power
Land Ownership Type of House Without Toilet: _____ Sources of information available at home.
with the Student Ownership Supply Source
Type ot Toilet

Electricity

Magazine
Kerosene
Concrete

Concrete

Faucet/
Nipa Hut

Others

Others
Books
Radio
Deep
Mother
Parents

Well
Others

tap
Sealed
Father

TV
Water

paper
News
None

None

Flush
Semi
Both

Own

Own
Rent

Rent

Pit

Accomplished by: