ANECDOTAL RECORD OF A CHILD

NAME OF A CHILD: _______________________________________________

DATE OF BIRTH: ______________ AGE: _____ GENDER: ()Male ()Female
PARENT’S INFORMATION:
Mother:: _____________________
Father:
Educ’l. STATUS: _____________________

INFORMATION:
A. No. of sister(s):___________ Brother(s):__________
Place in the family (check)
Eldest ( ) Middle ( ) Youngest ( )
Members staying with the family (check)
Grandparents ( ) Uncle ( ) Aunt ( ) Helpers ( )
B. Age of Child in Grade I (Check)
5 ( ) 6 ( ) 7 ( ) 8( ) Others: ______
School record (check)
Passed ( ) Repeater ( ) Drop ( )
C. Child relationship to parents (check)
Good ( ) Slightly Good ( ) Drop ( )
D. Child relationship to brothers/sisters (check)
Good ( ) Slightly Good ( ) Drop ( )
E. Child’s remarkable traits (check)
Obedient ( ) Slightly Good ( )
F. Interest of child (check)
Play ( ) Study ( )
G. Study Habit ( check)
Always ( ) Sometimes ( ) Seldom ( )
H. Subject weakness (check)
English ( ) Math ( ) Filipino ( ) A.P. ( )
Science ( ) Others ( )
I. Child’s defect (check)
Eye ( ) Ears ( ) nose ( ) mental ( )
Health illness ( ) none ( )
J. Brief History of the child since birth
____________________________________________________________
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ELEANOR T. OLIVA
ADVISER
_________________

PARENT/GUARDIAN

JUNE 8, 2018
DATE