CAMARINES NORTE STATE COLLEGE

GUIDANCE AND TESTING OFFICE Page [1] of [4]

INDIVIDUAL INVENTORY

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TO THE STUDENTS:

You are requested to provide us with essential information that will enable us to help you meet your specific needs and future plans.
All information will be kept with utmost confidentiality. Please fill in the blanks accurately and sincerely to the best of your knowledge and
belief.

PERSONAL DATA

Name Zapatero Nickname Student No.

(Last Name, First Name, Middle Name) (Extension Name)
Age Date of Birth Place of Birth Nationality
Sex [ ] Male [ ] Female Birth Order among Siblings Civil Status
Current Address:
Permanent
Address:
Contact No: E-mail Address:
Languages/Dialects Spoken at Home
Languages/Dialects Most Fluent In
Religion from Birth Current Religion

FAMILY DATA

Father Mother(Maiden Name) Spouse(if Married)

Name
Date of Birth
Place of Birth
Current Address
Permanent Address
Contact Number
e-Mail Address
Educational Attainment
Occupation
Business Address
Business Telephone
Annual Income (previous year)
Language/s spoken
Religion Raised with
Current Religion
Marital Status of Parents: Please check and underline the choices.

[ ] Married/Annulled /Legally Separated [ ] Temporarily Separated [ ] Mother with other partner [ ] Father with other partner
[ ] Widow/Widower/ Living Together [ ]Permanently Separated [ ]Mother OFW [ ] Father OFW
Guardian Relationship with Guardian
Address Contact No.

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 CAMARINES NORTE STATE COLLEGE
GUIDANCE AND TESTING OFFICE
PERSON TO CONTACT IN CASE OF EMERGENCY:

Nam
e Contact Number
Please name below your siblings form eldest to youngest, include yourself. Put X opposite your name, if married, please provide the
information called for using the same table below.

Name Sex Age Educational Attainment Occupation Name Sex Age Educational Attainment Occupation

UNIQUE FEATURES

Name of Friends:
In School
Outside School
Special Interest
Special Skills/Talents
Hobbies/ Recreation Activities
Ambition/Goal
Characteristics that describe
you best

LIVING CONDITIONS

[ ] Own House [ ] Boarding House Exclusive for Male/Female? [ ] Yes [ ] No

[ ] With Relatives Name of Land Lady/lord ___________________________________________

Complete Address ____________________________________________

Where do you live now?

How many are you in the present place? ________ How many persons share the room with you? __________

HEALTH CONDITIONS

Accidents Experienced Effect

Accidents Experienced Effect

Immunizations you have had:

[ ] Chicken Pox [ ] Booster [ ] Measles MMR [ ]Hepatitis B

[ ] Mumps [ ] Influenza [ ] Small Pox [ ] Others: ____________

Heigh
t Weight Physical Disadvantage
Illness this (previous
year year)

EDUCATIONAL BACKGROUND

School Attended (with Address) Inclusive Years of Attendance Awards Received

Preparatory
Elementary (Grade 1 – 6 )

 
 
 CAMARINES NORTE STATE COLLEGE
Page [3] of [4]

GUIDANCE AND TESTING OFFICE

Junior High
(Grade 7 – 10)
Senior High (Grade 11 – 12)
Technical/Vocational Degree
Collegiate
Course currently enrolled Major

Are you satisfied with your present schedule? [ ] Yes [ ] No Why? _____________________________________________

Is the course you have enrolled, the first choice you wrote in your application form? [ ] Yes [ ] No

State your reason. You may check more than one of the choices below:

[ ] Course is suited to my interest and aptitude. [ ] Course is offered at minimal cost, within the capacity of my parents.
[ ] I was invited by my friends. [ ] It was my parent’s choice.
[ ] Good job opportunities here and abroad. [ ] other reason/s:

Subjects with Lowest Grades/What Grades __________________ Subjects with Highest Grades/What Grades ________________________

Inclinations:

Sport
Performing Arts s
Leadership

INTEREST

[ ] Painting [ ] Singing [ ] Poem Writing [ ] Playing Instruments [ ] Planting

[ ] Declamation/Oration [ ] Dancing [ ] Composing [ ] Stage/ Act [ ] Cooking

What other skills and hobbies do you have? __________________________________________________________________________

What extra-curricular activities would you like to participate in? ________________________________________________________________
What books and magazines do you enjoy reading? __________________________________________________________________________

Are you [ ] right handed? No. of hours devoted daily to:

[ ] left handed?
Class Library Works Studying Lessons Rest Recreation Others

MEMBERSHIP IN ORGANIZATIONS

Inside the School Outside the School

Name of Organization Position/Title Name of Organization Position/Title

MODE OF TRANSPORTATION TO AND FROM CNSC

Frequency Fare Frequency Fare

Tricycle Bus
Jeepney Van
Boat

 
 
 CAMARINES NORTE STATE COLLEGE
Page [4] of [4]
GUIDANCE AND TESTING OFFICE

PERCEPTIONS
1. Ideal Monthly Allowance
[ ] Php 100.00 - below [ ] Php 100.00 - 499.00 [ ] Php 500.00 - 1, 000.00 [ ] Php 1, 000.00 - above
2. In what field do you intend to work after graduation?
[ ] Professional [ ] Agriculture [ ] Business
[ ] Technical [ ] Overseas Worker
[ ] Religious [ ] Public Service [ ] Others: _________________
In what field do you intend to work after graduation?
[ ] Professional [ ] Agriculture [ ] Business [ ] Public Service [ ] Technical/Industrial [ ] OCW [ ] Religious
Have you done any counselling experience? [ ] Yes [ ] No If YES, states the counsellors’ name: ______________________

When: ________________________ Where: _______________________________________

Current Concerns:

____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
_____________________________________________________________________________________
Current Fears:

____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
______________________________________________________________________________________________________

____________________________
Signature

Date: __________________