REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF EDUCATION GC FORM 001

Region V

Latest Photo DIVISION OF CAMARINES SUR

Freedom Sports Complex, San Jose, Pili, Camarines Sur
(Passport Size)
BULA SOUTH DISTRICT

STUDENT INDIVIDUAL INVENTORY

I. PERSONAL BACKGROUND
FATHER MOTHER
Name: _________________________________ Nickname: ______________ Name
Age: _____ Date of Birth: _____________ Place of Birth: ________________ Date of Birth
Gender: M ____ F ____ Birth Order Among Siblings: ____________________
Place of Birth
Current Address:
Current Address
_______________________________________________________________
Present Address
_______________________________________________________________
Landline/ Cellphone
_______________________________________________________________
Highest Educational Background
Present Address:
Business Address
_______________________________________________________________
Business Telephone
_______________________________________________________________
_______________________________________________________________ *Note: Write (+) for Deceased
Landline: _______ Cellphone: _______________ Email: _________________ A. Parent: (Please Check)
_________ Living Together
Language/Dialect Spoken At Home: _________________________________ _________ Permanently Separated
Language/Dialect Most Fluent In: ___________________________________ _________ Marriage Annulled/ Legally Separated
_________ Father Living with another
_________ Temporarily Separated
Religion: _______________________________________________________
_________ Mother OFW
_________ Father OFW
_________ Mother living with another

Interest/ Talents/ Skills/ Hobbies:

 REPUBLIC OF THE PHILIPPINES
DEPARTMENT OF EDUCATION
Region V
DIVISION OF CAMARINES SUR
Freedom Sports Complex, San Jose, Pili, Camarines Sur

BULA SOUTH DISTRICT

STUDENT INDIVIDUAL INVENTORY

B. (Please write below siblings from eldest to youngest include yourself) IV. EDUCATIONAL BACKGROUND
GRADE/ YEAR LEVEL SCHOOL HONORS/ INCLUSIVE YEARS
NAME OF SIBLINGS STATUS LIVNG WITH SCHOOL/ PLACE OF ATTENDED AWARDS OF ATTENDANCE
FAMILY OR NOT WORK RECEIVED

C. Guardian (if not living with parents)

Name: _____________________________________________________________
V. SOCIAL INVOLVEMENT
Landline/ Cellphone Number: __________________________________________
A. IN SCHOOL
Relationship with the Guardian: ________________________________________
NAME OF ORGANIZATION POSITION/ TITLE
D. Person to contact n case of emergency
Name: _____________________________________________________________
Contact Number: ____________________________________________________
B. OUTSIDE THE SCHOOL
E. Closest Member of the Family (Please Check) NAME OF ORGANIZATION POSITION/ TITLE
________ Father ________ Mother ________ Sibling (Write the name) __________

F. Health
Disabilities/ Impairment ____________________________________________________
Latest Ailment/ Illness SIGNATURE OVER PRINTED NAME OF STUDENT
Medicine Regularly Taken Date Accomplished: ____________________