TALA HIGH SCHOOL
STUDENT’S WELFARE AND SERVICES
STUDENT’S PERSONAL CUMULATIVE RECORD
NAME OF STUDENT: _________________________________________________________________GRADE & SECTION______________________ S.Y. ______________
DATE OF BIRTH: ______________________________________________________________________PLACE OF BIRTH: ________________________________________
NATIONALITY: _______________________________________________________________________SEX: ______________________ AGE: ________________________
HOME ADDRESS: ____________________________________________________________________________________________________________________________
TELEPHONE NO.: ____________________________________________________________________MOBILE NO.: ____________________________________________
YEAR ENTERED AT TALA HIGH SCHOOL: ________________________________________________ SCHOOL LAST ATTENDED: __________________________________
SIBLING POSITION: _______________________NO. OF BROTHER: __________ NO. OF SISTER________ RELIGION: _________________________________________
FAMILY HISTORY
FATHER: ________________________________________________________________ Age: ___________________ Occupation: ________________________________
Business address: ________________________________________________________________________ Tel. No.: ___________________________________
MOTHER: _______________________________________________________________ Age: ___________________ Occupation: ________________________________
Business address: ________________________________________________________________________ Tel. No.: ___________________________________
MARITAL STATUS OF PARENT: _____ Married _____ Live-in _____Separated _____ Divorced/Annulled ____ Single Parent _____ Widow/Widower
THE CHILD IS LIVING WITH: _______ Parent _____ Grandparent _____Uncle/Aunt ______Family friend ______Others, please specify_______________
OTHER SIBLINGS IN THE FAMILY:
Name Sex Age School / Occupation
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3.
4.
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6.
SCHOOL HISTORY
Previous School Attended Address Grade School Year
AWARDS, ACHIEVEMENTS AND HONORS RECEIVED:
__________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________
PSYCHOLOGICAL TEST RECORD / ACHIEVEMENT TEST:
Name of Psychological Test Date taken Result / Interpretation Recommendation
ACADEMIC DIFFICULTY
______Writing ______Speaking ______Reading ______Computation ______Study habit ______Attention ______Interest
STUDY HABITS AND ATTITUDE
______ Very good ______ Good ______ Fair ______ Needs improvement
MEDICAL HISTORY
______Asthma ______Operation ______Therapy ______Convulsion ______Under Medication
______Eye Problem ______Hearing Problem ______Blood Type Allergic to: ________________________________________________
______others, please specify: __________________________________________________________________________________________________________________
PERSONAL HISTORY
HOBBIES AND INCLINATION:
______Dancing ______Reciting Poems ______Basketball ______Cooking others______________
______Singing ______Reading ______Gymnastics ______Playing PC Games
______Drawing ______Writing ______Playing Musical Instrument ______Cross-Stitching
WHAT DO YOU CONSIDER AS YOUR STRENGTHS? __________________________________________________________________________________________________
WHAT DO YOU CONSIDER AS YOUR WEAKNESSES? _________________________________________________________________________________________________
SIGNIFICANT EVENTS IN YOUR LIFE: (happiest moment, loneliest moment and the likes)
1. _________________________________________________________________________________________________________________________________
2. _________________________________________________________________________________________________________________________________
3. _________________________________________________________________________________________________________________________________
PLEASE CHECK () THE ITEMS THAT BEST DESCRIBE TO YOU:
Friendly Talkative Irritable Imaginative Intelligent Stubborn
Nervous Aggressive Studious Cooperative Diligent Responsible
Fearful Bossy Moody Quarrelsome Hot-Tempered Obedient
Impatient Calm Loving Lazy Good-Natured Trustworthy
Extrovert Happy Proud Dependent Prayerful Active
Shy Polite Submissive Insecure Respectful Creative
AMBITION IN LIFE: ________________________________
OTHER IMPORTANT INFORMATION YOU WOULD LIKE US TO KNOW: __________________________________________________________________________________
___________________________________________________________________________________________________________________________________________
To be filled-out by the Guidance Advocate.
Date Guidance Service Rendered Problem Presented Action Taken Guidance Advocate
Signature
Note: This is a confidential document, parents may assist their children in accomplishing this form.
