OUR LADY OF PERPETUAL SUCCOR COLLEGE 1x1
Center for Counseling and Career Development Picture
PERSONAL DATA SHEET
Track / Strand: Acad-GAS
___________ LRN #:___________
406798151660 QVA ✔ ESC Grantee ✔ New / Transferee Old
Lana Anzelie Balino Puro
Name: ____________________________________________________________ Nickname: _______________
Lana
Date of birth: __________________
October 1, 2003 Place of birth: _____________________
Marikina City Age: ______
17 Gender: ________________
Female
Religion: ___________________________ Nationality: _______________________ Birth Order: ____________________
Roman Catholic Filipino Middle
Mobile Number: _____________________
09452880836 Landline number: ___________________
N/A Email Address:_________________
[email protected]Permanent Address:__________________________________________________________________________________
0015 Unit A Second Floor Lot 1 Perisos Compound Apitong Street Marikina Heights Marikina City
Check which of the following is applicable:
✔ Parents living together Both parents are working Mother is re – married ______ is working abroad
abroad
Parents are separated Father is re - married Single parent
Child is currently living with whom?
Both parents
✔
Mother only Grandparents
Father only Relatives others: _______________________________
House is: Owned ✔ Rented Relatives’ Grandparents’
Parents’ Record:
Father’s Information Mother’s Information Guardian’s Information
Name: Marcelino A. Puro Merlita B. Puro
Address: 0015 Unit A Second Floor Lot 1 0015
Perisos Unit A Second
Compound FloorStreet
Apitong Lot 1 Perisos
MarikinaCompound ApitongCIty
Heights Marikina Street Marikina Height
Age: 45 47
Birthdate: March 11, 1975 August 17, 1973
Birth Place: Ragay, Bicol Burauen, Leyte
Nationality: Filipino Filipino
Religion: Roman Catholic Roman Catholic
Educational Attainment: High School Graduate High School Graduate
Occupation: Construction Worker Labandera
Company Name:
Company Address:
Office Telephone Number:
Active Mobile Number: 09066590768 09619140715
Annual Income:
Sibling’s Record: (eldest to youngest including the student)
Name Age Civil Status Birthdate School / Office
Marty Jannetty T. Balino 28 Julywith
Common-Law Marriago (Living 12,Partner)
1993 Tattoo Artist
Lana Anzelie B. Puro 17 Single October 1, 2003 Marist School
Marcel Cain B. Puro 12 Single December 6, 2008 Marikina Heights High School
Other Relative(s) living with the child:
Name Age Civil Relationship to the Occupation Contact Number
Status student
All information in this Personal Data Sheet is strictly confidential and will be used strictly for Counseling purposes only Page 1
Educational Background:
Level School School Year Awards / Recognition School Clubs /
Organizations
Grade 7 Marist School 2015-2016 Annual Honor Top 5 Marist School Afternoon Shift Coordin
Grade 8 Marist School 2016-2017 Marist School Afternoon Shift Coordin
Grade 9 Marist School 2017-2018 Annual Honor Top 5 Marist School Afternoon Shift Coordin
Grade 10 Marist School 2018-2019 Marist Youth Chorus
Grade 11 Marist School 2019-2020 Annual Honor Top 5 Marist School Afternoon Shift Coordin
Grade 12 Marist School 2020-2021 Marist Youth Chorus
**College
Transferee
Special Interests Anime, Broadway Musicals, Theater
_______________________ Singing, Drawing
Special Skills / Talents: _______________________________
Personality Information: (please check the personality(ies) that best describe your child)
[] Aggressive ✔[] Courteous ✔[] Feels inferior [] Lacks motivation [] Optimistic
[] Anxious
✔ [] Depressed [] Friendly
✔ []✔ Lazy [] Passive
[] Calm [] Dull [] Honest []✔ Lovable [] Patient
[] Cheerful [] Easily confused [] Independent ✔[] Moody []✔ Persevering
[] Confident [] Easily excited [] Irritable [] Neat [] Pessimistic
[] Conscientious [] Easily tired [] Jealous []✔ Nervous [] Quick
[] Quiet
✔ ✔[] Sensitive [] Smart [] Submissive [] Talkative
[] Sarcastic ✔[] Shy [] Stubborn ✔[] Talented [] Others
_______________
Capacity and Interest: (please check the personality(ies) that best describe your child)
[]
✔ Impatient [] Slow learner [] Has academic difficulties [] Eager to do activities
[] Poor in comprehension [] Has short memory [] Creative
✔
[] Finishes task(s) easily
[] Learns quickly
✔ ✔[] Orderly [] Inquisitive [] Imaginative
✔
Social Relationships: (please check the personality(ies) that best describe your child)
A. At home
[] Tells problem(s) with [] Generous with his / her [] Difficult to deal with [] Other ______________________
father things _____________________________
[] Tells problem(s) with [] Demanding [] often fights with people _____________________________
mother in the house
[] Close to sibling(s) [] Goes only with a [] Prefers to be left alone
✔
familiar people
B. In school
[] Would
✔ rather be a []✔ Interested and joining []
✔ Would rather be alone [] Others:
follower school activities _____________________________
[]Friendly with the []✔ Is looked as a leader []
✔ Goes only with familiar _____________________________
people in school people
[]✔ Enjoys the company of [] Afraid of teachers and [] Always in trouble with
classmates classmates classmates
Health Record:
Poor vision
Disabilities / Illness which may need special attention: ___________________________________________________
Medicine regularly taken: _____________________________
Immunizations you’ve had: ___________________________
MARCELINO A. PURO
________________________________________ LANA ANZELIE B. PURO
_______________________________________
Parent’s Signature over Printed Name Student’s Signature over Printed Name
All information in this Personal Data Sheet is strictly confidential and will be used strictly for Counseling purposes only Page 2
FOR COUNSELING & CAREER DEVELOPMENT USE ONLY
Counseling Record
Level / Section
Probation
Academic / Conduct / Others
Counseling
• Routine
• Walk – In
• Individual / Group
• Career
• Consultation
• Referral
• Follow – Up
• Information
• Parent – Teacher
Counselor
Others
Test Record
Test Administered Result Remarks Level Date
Counseling Record
Level / Section
Probation
Academic / Conduct / Others
Counseling
• Routine
• Walk – In
• Individual / Group
• Career
• Consultation
• Referral
• Follow – Up
• Information
• Parent – Teacher
Counselor
Others
Test Record
Test Administered Result Remarks Level Date
All information in this Personal Data Sheet is strictly confidential and will be used strictly for Counseling purposes only Page 3
