Republic of the Philippines

Department of Education
Region V (Bicol)
DIVISION OF CATANDUANES
Virac

PUPILS CUMULATIVE RECORD AND PROFILE

I. PERSONAL DATA
1. Name _____________________________________________ Age ___________________________________________
2. Birth Date _______________________________________ Place of Birth _________________________________
3. Address __________________________________________ Nationality _____________ Religion ______________
II. FAMILY DATA
A. Father/Guardian B. Mother
_______________________________________________________ Name _________________________________________________
____________________________________________________ Date of Birth _____________________________________________
____________________________________________________ Place of Birth _____________________________________________
______________________________________________ Educational Attainment ________________________________________
_____________________________________________________ Occupation ______________________________________________
_______________________________________________________ Religion ________________________________________________
______________________________________________ Date of Death (if deceased) ______________________________________
________________________________________________________ Cause ________________________________________________
C. Children in the Family-Boys __________________________ Girls ______________________ Total ________________
D. Home and Family Problems (Please check)
I II III IV V VI Remarks
Broken Home
Very Strict Parents
Very Lax Parents
Very Crowded Homes
Indigent
School Far from Home
Others
Teacher-Adviser’s Initial
E. Economic Status: Very Good ___________________ Moderate _______________ Low __________________
F. Language Used at Home __________________________________________________________________________
III. HEALTH STATUS: Normal ____________________________________ Handicap _________________________
Ex F
1. Health Examination I II III IV V VI Remarks
G P
a. Hearing
b. Vision
c. Speech
d. Skin and Scalp
e. General Health
f. Height
g. Weight
h. Blood Pressure
i. Eyes and Ears
j. Teeth and Gums
k. Throat and Tonsils
l. Respiratory System
m. Nutrition
Teacher-Adviser’s Initial
2. Diseases/Sickness since Birth
Typhoid Fever _____________________ Chicken Fox __________________ Dysentery __________________
Whooping Cough __________________ Influenza ____________________ Mumps ____________________
Asthma ___________________________ Measles ______________________
Action Taken: ___________________________________
Examined by: ___________________________________
3. Immunization & Immunity Tests:
Kind Date Given Result
 4. Operation Undergone _________________________________________________________________________
5. Physical Defects ______________________________________________________________________________

IV. SCHOLASTIC ACHIEVEMENT

Subjects Done Subjects Done General Teacher-Adviser’s
A. School Attended Grade
Well Poorly Average Initial
I
II
III
IV
V
VI
B. Standard Test Record
Grade Date Score Interpretation
Knox Tube Test
Printer Personality
Philippine Personality
Otis Lennon Mental Ability
Others

V. APPRAISAL OF PUPIL BEHAVIOR

O VS S NS NI (To be rated after the semester)
A. Personal Qualities I II III IV V VI Remarks
1. Honesty
2. Courtesy
3. Helpfulness and Cooperation
4. Resourcefulness and Creativity
5. Consideration for Others
6. Sportsmanship
7. Obedience
8. Self-Reliance
9. Industry
10. Cleanliness and Orderliness
11. Promptness and Punctuality
12. Sense of Responsibility
13. Love of God
14. Patriotism/Love of Country
Teacher-Adviser’s Initial

B. School Problems
1. Underachiever
2. Slow Learner
3. No Interest
4. Potential Dropouts
5. Frequently Absent
6. Frequently Late
7. Others
Teacher-Adviser’s Initial

C. Home Visits
E-Excellent G-Good F-Fair N-Need Improvement
Dwelling Waste Home
Date Surroundings Recommendation Teacher
Facilities Disposal Project

D. Significant Notes on Personal and Social Traits

Grade Teachers Comments Teacher-Adviser’s Initial
I
II
III
IV
V
VI

NOTED:

________________________________________
Guardian Counselor/Teacher-Adviser