Page 109 - PARAMETER B

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IFUGAO STATE UNIVERSITY photo
Potia Campus, Alfonso Lista, Ifugao
Guidance and Counseling Service

Direction: Please complete this inventory as accurately as you can. The purpose of collecting information
is to be of assistance to you in making choices and decisions. All information which you provided about
yourself will be treated confidentially.
` Date: ______
I. INDIVIDUAL APPRAISAL FORM (Guidance Form 1)
Name ____________________________________________ Course/Year: _______________
Last Name First Name Middle Name Civil Status: _______________
Sex: ______ Birth Date: _____ Birth Place: _______________ Religion: __________________
Home Address: ______________________ Boarding Address: __________________________
Name of Landlady/Landlord: ___________________________

II. FAMILY AND CULTURAL BACKGROUND
Father Mother
Name: __________________________ __________________________
Highest Educational Attainment: ________________________________ ________________________________
Approximate Annual Family Income: _____________________________
If NOT living with Parents, Name of Guardian: _____________________ Relationship: ______________________
Who is financially supporting you in your studies? _____________________________
Marital Status of Parents: _____ living together in the Philippines _____ living together but one working abroad
_____ both working abroad _____ separated w/o having each a family
_____ separated with other families _____ living with other than parents

Name of Brothers and Sisters including yourself (in birth order)
Name Age School (if enrolled) Occupation

The person in the family you are very close and confident with: Father: _____, Mother: _____
Sister: _____, Brother: _____

How do you describe your relation with: (Please Check) Very Close Just OK better than not
Father _____ _____ _____
Mother _____ _____ _____
Sisters _____ _____ _____
Brothers _____ _____ _____

III. EDUCATION
Name of School Inclusive Years Honors Obtained Extra/Co-Curricular Activities
Of Attendance
Elementary _________________________ ____________ ______________ ________________________
Secondary __________________________ ____________ ______________ ________________________
Senior High School________________________ _____________ ________________ ___________________________
Other Schools Attended ____________________ _____________ ________________ ___________________________
Grade Point Average in Senior High School: _____ Highest Final Grade: _____ Lowest Final Grade: _____
Favorite subject in High School: _______________________ Least liked subject: _____________________
Inclinations: _____ performing arts _____ sports _____ class leadership
Interests: _____ religious groupings; _____ creative arts; _____ Acting; _____ Singing; _____ Dancing;
_____ Oration/Declamation; _____ others.

Course Preferences: 1 choice _____________ 2 Choice ___________ 3 Choice ___________
st
rd
nd
Reason(s) for these preference? (Please check) _____ personal choice _____ parents’ choice
_____ suggested by others
Reason (s) for choosing IFSU Potia Campus: ________________________________________________
How are you supported in your studies? (Please check) _____ parents _____ relatives ______ self-
supporting_____ scholarship. ( If through scholarship, pls. specify) _______________________________