KOLEHIYO NG LUNGSOD NG DASMARIÑAS
OFFICE OF THE VICE PRESIDENT FOR ACADEMIC AFFAIRS
Institute Of Student Affairs, Character Education, And Citizenship
GUIDANCE SERVICES AND CAREER DEVELOPMENT UNIT
GSCD Form 7
ROUTINE INTERVIEW FORM
Name: __________________________________________________Date: __________________
Year Level, Course & Section: _______________________ Email Add _________________________
Age: ___________ Birthday: _____________________Mobile No.: __________________________
Gender: Woman Man Non-Binary Prefer not to say
A. Academic Information
Reason/s for choosing the course:
_______________________________________________________________________________
Subject that you find easy:
_______________________________________________________________________________
Why did you find it easy?
_______________________________________________________________________________
Subject that you find difficult:
_______________________________________________________________________________
Why did you find it difficult?
_______________________________________________________________________________
So far, what is/are the problem/s you encountered in your program?
____________________________________________________________________________
____________________________________________________________________________
How was it resolved?
____________________________________________________________________________
____________________________________________________________________________
B. Family Background
Please indicate if the parent/s is/are still living or not.
Father Mother
Present Address
Contact Number
Highest
Educational
Attainment
Occupation
Business Address
Religion
Parents’ Set-up
Put a check ( / ) on the appropriate box
Living Together Mother working in another place (local or OFW)
Separated Father working in another place (local or OFW)
Marriage Annulled/ Legally Separated
Guardian (if not living with parents):
Relationship: Contact Number:
Emergency Contact:
Relationship: Contact Number:
Building the foundation for the Dasmarineños
kldogc@[Link] l College Building 1, Upper Ground Floor 1106 l Brgy. Burol Main, City of Dasmarinas, Cavite, Philippines 4114
KOLEHIYO NG LUNGSOD NG DASMARIÑAS
OFFICE OF THE VICE PRESIDENT FOR ACADEMIC AFFAIRS
Institute Of Student Affairs, Character Education, And Citizenship
C. Co-Curricular/ Extra Curricular Activities
Membership in Organizations
Campus- Based (Inside KLD) Community- Based (Outside KLD)
D. Personal Experiences
1. Who is the most significant person in your life now and why?
_______________________________________________________________________________________
2. Who do you consider is the person who greatly influenced your life and why?
_______________________________________________________________________________________
3. What are your interests?
______________________________________________________________________________________
4. What are your skills or talents?
______________________________________________________________________________________
5. If you are going to describe yourself, how would that be?
______________________________________________________________________________________
6. What are your other dreams/ ambitions/ goals in life?
_______________________________________________________________________________________
7. How do you see yourself five (5) years from now?
_______________________________________________________________________________________
8. What are your fears?
_______________________________________________________________________________________
9. What are your concerns or problems that we (the Counselors) can help you with?
_______________________________________________________________________________________
10. Have you consulted the following before? (check all that applies)
Psychiatrist When? ______________ For what reason? ____________________
Psychologist When? ______________ For what reason? ____________________
Counselor When? ______________ For what reason? ____________________
11. Are you taking any medications right now? Yes No
If yes, what kind? ________________________
When did you start taking it? _______________
I certify that all kind of facts and information stated in this form are true and correct.
_____________________________________ ________________________
Signature over Printed Name of the Student Date
Building the foundation for the Dasmarineños
kldogc@[Link] l College Building 1, Upper Ground Floor 1106 l Brgy. Burol Main, City of Dasmarinas, Cavite, Philippines 4114
