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STS Form 2A Department of Education Region - Division of - District of

This document is a student information form that collects details about a student's personal background, family, living situation, and home environment. It collects information such as the student's name, age, address, parents' details, distance to school, siblings' education levels, household income, property ownership, utilities access, and possessions owned. The form is used to understand the student's circumstances and potential needs or challenges.

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Jun Casono
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© Attribution Non-Commercial (BY-NC)
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3K views2 pages

STS Form 2A Department of Education Region - Division of - District of

This document is a student information form that collects details about a student's personal background, family, living situation, and home environment. It collects information such as the student's name, age, address, parents' details, distance to school, siblings' education levels, household income, property ownership, utilities access, and possessions owned. The form is used to understand the student's circumstances and potential needs or challenges.

Uploaded by

Jun Casono
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

STS Form 2A

Department of Education
Region ______________
Division of ________________
District of _______________
_______________________
1. Students Name: ____________________________________________ Age: ________ Sex: _____________
Address:______________________________________________________________________________________
Nationality __________________________________________________ Religion: _______________________
Ethnic Affiliation: ______________________________________________________________________________
Date of Birth ___________________________ Place of Birth: _______________________________________
Birth Registered

Yes

No

2. Has the student ever dropped-out of school?


Birth Registered

Yes

No

If yes, for how long: ____________________________________________________


What reason (s) ________________________________________________________
3. Distance from home to school: _______________ km.
Means of transportation to school:
Car

Motorized side car

Jeepney

Pedicab

Others ____________

4. Has any members of the family ever dropped f school?


Yes
No
5. Is the student receiving any type of financial assistance to attend school?
Yes
No
6. With whom does the student live?
Both Parents

Mother

Father

Others: ______________

Father

Others: ______________

7. Who helps the student in doing homework?


Both Parents

Mother

None
8.
Father
Information

Living

Mother
Deceased

Living

Deceased

Name:
Age:
Address:
Nationality:
Religion:
Language9s) dialect(s) spoken

9. Parental Marital Status:


Married

Live-in

Window

Annulled

Separated

Others (specify) ______________________________________________________________

10. List of members of the household including who have migrated, specify/check the information
needed.
Sex
Name of Household

Age

Relationship
to student

Migrated
How
Long?

Education
Enrolled/
Completed

Highest Grade/
NFE
Degree Completed Course Completed

Occupation
Full Time

Part Time

*Early childhood Education (service such as daycare and preschool)


11. Is the family a member of any community development organization?
Yes
No
12. Monthly Household Income
Below P1,000.00
P1,000-P2,500.00
P2,501-P5,000.00

P5,001-P8,000.00
P8,001-P16,000.00
Over P15,000.00

13. Information about the family:


A. The Family

D. Source of water supply

Owns house and lot


Rent house
Others, please specify _______

Faucet/Tap Water supply


Deep Well
Others, please specify _______

B. Type of House

E.

Concrete
Semi-Concrete
Others, please specify _______

Electricity
Kerosene lamp (gas)
Others, please specify _______

C. Type of Toilet
Flush
Pit
Water Sealed
No toilet
Others, please specify _______
14. Which of the following are available at home?
TV

Newspaper

Magazine

Radio

Book

Others, specify: ___________________________

Accomplished by: _________________________________


Date: __________________

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