Republic of the Philippines

DEPARTMENT OF EDUCATION
Region XI
Division of Davao Del Norte
LIMBAAN NATIONAL HIGH SCHOOL
Limbaan, New Corella, Davao del Norte
TIN No. 005208525

GUIDANCE FORM 1

STUDENT PERSONAL INFORMATION

Note: All information is considered confidential.

PLEASE FILL-UP CORRECTLY AND WRITE LEGIBLY.
PHOTO HERE
LRN No._______________________________

Surname First Name Middle Name

Sex: [ ] Male [ ] Female Email Add: _____________ Nickname:_____________ Contact No. ____________
Religion: Cultural Group: (Ex. Bilaan, Manobo, Mandaya, etc.)
Dialect Spoken: _________________________________ Pls. indicate your cultural group:
Date of Birth: Birth Order Among Siblings:__________________________________
Birthplace:_______________________________________________________________________ Age:_______________________________
Current Address: ____________________________________________________
Permanent Address:_________________________________________________________________________________________________
Person to contact in case of emegency:
Name:__________________________________________Relationship:______________________ Contact No.:___________________
If working, please indicate below:
Name of Employer :
Address: Contact No.:
Person/s supporting your studies: [ ] Parents [ ] Aunt/Uncle [ ] Brother/Sister
[ ] Employer [ ] Others, please specify:
If you are a scholar, please specify the scholarship: (Ex. 4Ps, Batch 70, Sul Orchids, Indv’l grant)
_______________________________________________________________

I. Family Background
Father Mother
( mark with + if deceased) ( mark with + if deceased)

Name: Name:
Age: Age:
Highest Educational Attainment: Highest Educational Attainment:
Occupation: Occupation:
Contact No.:_________________________________________ Contact No.:_________________________________________
Working Abroad? [ ]Yes [ ] No Working Abroad? [ ]Yes [ ] No
Employer: Employer:
Office Address : Office Address:

Tel No.: __ Tel No.: _________________________________________________

a. My Parents:
[ ] Living Together [ ] Mother with another Partner [ ] Solo Parent
[ ] Temporary Separated [ ] Father with another Partner
[ ] Permanently Separated [ ] Marriage Annulled/Legally Separated
b. Please name below siblings from eldest to youngest. Include yourself.
Name of Civil Educational Working Schooling Contact
Age Sex
Brother/Sister Status Attainment (yes/no) (yes/no) Number
 DC-GF1 Revision Date: 5/15/2014 Revision Status: 0 Page 1 of 4

c. Residential Status:
[ ] house renter [ ] house sharer [ ] informal settler [ ] owner
d. Type of House:
[ ] concrete [ ] semi-concrete [ ] others, please specify________________________
e. Source of Water:
[ ] faucet/tap water [ ]deep well [ ] others, please specify _______________________
f. Source of Power:
[ ] electricity [ ]kerosene [ ] others, please specify _______________________
g. Annual Income of Family (Check one below):
[ ] Below P 60,000 [ ] P 81,000.00 – P 100,000.00 [ ] Above 151,000.00
[ ] P 61,000.00 – P 80,000.00 [ ] P 101,000.00 – P 150,000.00
II. Educational Background
a. Schools Attended:
1. Elementary School:

Address :

Type of School : [ ] Private Sectarian [ ] Private Non-Sectarian [ ] Public

Year Graduated :

2. Last School Attended (For Transferees) :

Address :

Type of School : [ ] Private Sectarian [ ] Private Non-Sectarian [ ] Public

School Year last attended: _____

b. Awards/Honors Received Sponsor Date

c. Check the subject/s below that you think you need help or assistance. On the space provided, please
write the specific area (Ex. English: grammar or vocabulary, Math: Geometry, etc.).

[ ] English

[ ] Science

[ ] Math

[ ]others, pls. specify

III. Self

a. I share my problems with my…. [ ] father [ ] mother [ ] brother/sister

[ ] friends [ ] teacher [ ] aunt/uncle
[ ] counselor [ ] others, please specify ________________

b.ppI live with….

[ ] alone [ ] aunt/uncle [ ]guardians [ ] grandparents
[ ] parents [ ] friends [ ] others, please specify________________
 c.rrI use my allowance for…
[ ] meals [ ] snacks [ ] computer games
[ ] fare [ ] projects [ ] leisure
[ ] internet surfing [ ] internet research [ ] cell phone load
[ ] school supplies [ ] class contribution [ ] movies
[ ] clothes [ ] dating [ ] school books
[ ] medicines [ ] others, please specify _________________
IV. Unique Features

Hobbies/Recreational Activities: ___________________________________________________

Ambitions/Goals: _______________________________________________________________
Guiding Principle in Life/Motto: ___________________________________________________
Characteristics that describe you best: _______________________________________________

DC-GF1 Revision Date: 5/15/2014 Revision Status: 0 Page 2 of 4

V. Membership in Organization

a. In School: Name of Organization Position/Title

______________________________________________________ __________________________
______________________________________________________ __________________________
______________________________________________________ __________________________
______________________________________________________ __________________________

b. Outside School: Name of Organization Position/Title

______________________________________________________ __________________________
______________________________________________________ __________________________
______________________________________________________ __________________________

c. Please write the name of your friends/ acquaintances/neighbors below

In School Year/ Outside School Contact Number
Name of Friends Section Name of Friends 
       
       

VI. Problems or Difficulties: Check which of the items below present a problem or difficulty to you.

[ ] Confidence [ ] Relationships/love
[ ] Stress Management [ ] Anger Management
[ ] Communication Skills [ ] Peer Pressure
[ ] Teacher (s) [ ] School Adjustment
[ ] Parents [ ] Sibling Rivalry
[ ] Brother/Sister [ ] Friends
[ ] My Appearance [ ] Finances
[ ] Concentration [ ] Time Management
[ ] Study Habits [ ] Privacy/Freedom
[ ] Health/Nutrition [ ] Diet/Drugs/Smoking/Drinking
[ ] Test Anxiety [ ] Not interested in coming to school
[ ] Others (If you check others, please write the problem or difficulty on the space below)
______________________________________________________________________
________________________________________________________________
_______________________________________________________________________
VII. CAREER CHOICE/PLANS (TO BE FILLED-UP END OF GRADE 8)
a. My course choices (in order): 1st Choice
2nd Choice
3rd Choice
b. I choose my course or major for it will give me a chance to
[ ] work abroad [ ] help my family financially
[ ] earn money [ ] put up my own business
[ ] serve others [ ] meet people
[ ] travel/adventure [ ] have power/prestige
[ ] no particular reason
[ ] others (please write on the space below the reasons for choosing the course)

__________________________________________

DC-GF1 Revision Date: 5/15/2014 Revision Status: 0 Page 3 of 4