Republic of the Philippines

Department of Education
REGION III
SCHOOLS DIVISION OFFICE OF BATAAN
DISTRICT OF LIMAY

STUDENT INDIVIDUAL INVENTORY

Dear Students: Kindly fill-out this form. The following information will aid the Guidance Office develop a program to address
your needs. Rest assured that information provided will be treated with confidentiality. Thank you.
PERSONAL DATA
LRN No. _____________________________________ Date Filled ________________________________
Name ________________________________________ Nickname _________________________________
Age __________ Date of Birth_______________________ Place of Birth ________________________
Sex __________ Birth order among siblings ____________
Complete Address __________________________________________________________________________
Landline _____________________ Cellphone __________________ Email ________________________
Languages/Dialects Spoken at Home ___________________________________________________________
Languages/Dialects Most Fluent In _____________________________________________________________
Religion from Birth ___________________________________ Current Religion ______________________
FAMILY DATA
Father Mother
(Mark + if deceased) (Mark + if deceased)
Name ________________________________________ ___________________________________________
Date of Birth __________________________________ ___________________________________________
Place of Birth __________________________________ ___________________________________________
Address ______________________________________ ___________________________________________
Landline ______________________________________ ___________________________________________
Cellphone _____________________________________ ___________________________________________
Highest Educational Attainment___________________________ ___________________________________________
Occupation ____________________________________ ___________________________________________
Business Address _______________________________ ___________________________________________
Business Landline _______________________________ ___________________________________________
Annual Income _________________________________ ___________________________________________
Language/s Spoken ______________________________ __________________________________________
Religion Raised with _____________________________ __________________________________________
Current Religion ________________________________ __________________________________________
Number of Brothers & Sisters ______________________ __________________________________________
(Please name below siblings from eldest to youngest. Include yourself.)
Name of Siblings School/Place of Work Age
_________________________________ _____________________________ __________________
_________________________________ _____________________________ __________________
_________________________________ _____________________________ __________________
_________________________________ _____________________________ __________________
_________________________________ _____________________________ __________________
_________________________________ _____________________________ _________________
Parents (Please Check)
_________ Living together __________ Temporarily separated
_________ Permanently separated __________ Father OFW

School Address: National Road, Townsite, Limay, Bataan

E-Mail: 104632@deped.gov.ph
Cellphone No: 0976 175 3986
 Republic of the Philippines
Department of Education
REGION III
SCHOOLS DIVISION OFFICE OF BATAAN
DISTRICT OF LIMAY

Picture 1234437514 ... Marriage Annulled/Legally Separated

_________ __________ Mother OFW
_________ Father with another partner __________ Mother with another partner
Guardian (if not living with parents) ___________________________________________________________________________
Address __________________________________________________________________________________
Landline ___________________________________________ Cellphone ___________________________
Relationship with guardian ___________________________________________________________________
EDUCATIONAL DATA
Grade/Year Level School Attended Inclusive Years of Attendance

Membership in Organizations
In School:
Name of Organization Position/Title
______________________________________________________ __________________________________________
______________________________________________________ __________________________________________
______________________________________________________ __________________________________________
Attendance Record
Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6
Days of School
Days Present
Days Absent
No. of times late
Test Records
Nature of Test/Title of Test Result /Grade Date

DepEd Vision:
We dream of Filipinos who passionately love their country and whose
competencies and values enable them to realize their full potential and
contribute meaningfully to building the nation.
As a learner-centered public institution, the Department of Education
continuously improve itself to better serve its stakeholders.
To protect and promote the right of every Filipino to quality, equitable,
culture-based education where:
LETICIA I. MAGPOC
Guidance Designate
DepEd Mission:
1. Students learn in a child-friendly, gender-sensitive, safe, and motivating
environment.
2. Teacher facilitate learning and constantly nurture every learner.
3. Administrators and staff, as stewards of the institution, ensure an enabling and
supportive environment for learning to happen.
4. Family, community and other stakeholders are actively engaged and share
responsibility for developing life-long learners.

School Address: National Road, Townsite, Limay, Bataan

E-Mail: 104632@deped.gov.ph
Cellphone No: 0976 175 3986
 Republic of the Philippines
Department of Education
REGION III
SCHOOLS DIVISION OFFICE OF BATAAN
DISTRICT OF LIMAY

School Address: National Road, Townsite, Limay, Bataan

E-Mail: 104632@deped.gov.ph
Cellphone No: 0976 175 3986