Individual Inventory Form Personalbackground: Binmaley Catholic School, Inc. Binmaley, Pangasinan

Form 1
Binmaley Catholic School, Inc.

Binmaley,Pangasinan Most recent
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INDIVIDUAL INVENTORY FORM
(Elementary)
PERSONALBACKGROUND
Name: ____________________________________________Nickname________________________________________
Age:_______________ Date of Birth: ___________________Place of Birth:____________________________________
Sex: ( ) Female ( ) Male Birth Order among Siblings:_________________________________________________
Current Address: ___________________________________________________________________________________
Permanent Address: _________________________________________________________________________________
Cellphone:____________________________ Email add:____________________________________________________
Language/Dialects Spoken at home:____________________________________________________________
Language/Dialects Most Fluent in:_____________________________________________________________
Religion:_________________________________________________________________________________
Person to contact in case of emergency:
Name:_____________________________________ Contact Number:_________________________________________
Relationship:_______________________________________________________________________________________
FAMILY BACKGROUND
Father Mother
(Mark with ┼ if deceased) (Mark with ┼ if deceased)
Name: ________________________________ _________________________________
(Maiden Name)
Date of Birth: ________________________________ _________________________________
Place of Birth: ________________________________ _________________________________
Permanent Address: ________________________________ _________________________________
Tel. No: _______________________________ _________________________________
Cellphone No.: ________________________________ _________________________________
Highest Educational
Attainment: ________________________________ ________________________________
Occupation: ________________________________ ________________________________
Business Address: ________________________________ ________________________________
Annual Income : ________________________________ ________________________________
Number of Siblings: ________________________________ ________________________________
Parents _____ Living together _____ temporarily separated
_____ permanently separated _____ Father OFW
_____ Marriage Annulled/Legally Separated _____ Mother OFW
_____ Father w/ another partner _____ Mother w/ other partner
_____ Single Parent (Mother ____; Father _____)
_____ Guardian if not living with parent
Name of Guardian:________________________________________________
EDUCATIONAL BACKGROUND
Last school attended:________________________________________________________________________________
Easiest subject/s: ___________________________________________________________________________________
Most difficult subject/s: ______________________________________________________________________________
Awards/Honors received:_____________________________________________________________________________
UNIQUE FEATURE
Special Interest/s:___________________________________________________________________________________
Special Skills/talents:________________________________________________________________________________
Hobbies/Recreational Activities:_______________________________________________________________________
Ambitions/Goals:___________________________________________________________________________________
HEALTH
A. Disability B. Illness C. Perceived Physical Health rating
____Vision ____ Allergy (Specify ________) ____Very Good
____ Hearing Impairment ____ Others (Specify_________) ____ Good
____ Speech ____ Average
____ ADHD
_________________________________________ _____________________________________
Parent/Guardian’s Signature over Printed Name Student’s Signature over Printed Name
Form 1

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(Junior High School)
PERSONALBACKGROUND
Name: ____________________________________________Nickname________________________________________
Current Address: ___________________________________________________________________________________
Religion:_________________________________________________________________________________
Relationship:_______________________________________________________________________________________
FAMILY BACKGROUND
Father Mother
Name: ________________________________ _________________________________
(Maiden Name)
Date of Birth: ________________________________ _________________________________
Place of Birth: ________________________________ _________________________________
Tel. No: _______________________________ _________________________________
Cellphone No.: ________________________________ _________________________________
Highest Educational
Attainment: ________________________________ ________________________________
Occupation: ________________________________ ________________________________
Annual Income : ________________________________ ________________________________
Name of Guardian:________________________________________________
UNIQUE FEATURE
Ambitions/Goals:___________________________________________________________________________________
HEALTH
____ ADHD
_________________________________________ _____________________________________
Form 1

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(Senior High School)
PERSONALBACKGROUND
Name: ____________________________________________Nickname________________________________________
Current Address: ___________________________________________________________________________________
Religion:_________________________________________________________________________________
Relationship:_______________________________________________________________________________________
FAMILY BACKGROUND
Father Mother
Name: ________________________________ _________________________________
(Maiden Name)
Date of Birth: ________________________________ _________________________________
Place of Birth: ________________________________ _________________________________
Tel. No: _______________________________ _________________________________
Cellphone No.: ________________________________ _________________________________
Highest Educational
Attainment: ________________________________ ________________________________
Occupation: ________________________________ ________________________________
Annual Income : ________________________________ ________________________________
Name of Guardian:________________________________________________
UNIQUE FEATURE
Ambitions/Goals:___________________________________________________________________________________
HEALTH
____ ADHD
_________________________________________ _____________________________________

Individual Inventory Form Personalbackground: Binmaley Catholic School, Inc. Binmaley, Pangasinan

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Individual Inventory Form Personalbackground: Binmaley Catholic School, Inc. Binmaley, Pangasinan

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Form 1

Binmaley Catholic School, Inc.

Binmaley Catholic School, Inc.

Binmaley Catholic School, Inc.

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