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Olrms Form

1) This document is a record form containing personal and educational information about a student named Gabrealla Marie Buclatin. 2) It includes details about her family, health, interests, and participation in school activities. 3) The form is used to document counseling sessions and important notes about the student.

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Marie April Daet
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52 views

Olrms Form

1) This document is a record form containing personal and educational information about a student named Gabrealla Marie Buclatin. 2) It includes details about her family, health, interests, and participation in school activities. 3) The form is used to document counseling sessions and important notes about the student.

Uploaded by

Marie April Daet
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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OLRMS FORM-01-000-22

GCO Individual Inventory


Record Form

GUIDANCE AND COUNSELING OFFICE 2X2 ID PICTURE


INDIVIDUAL INVENTORY RECORD FORM

Please PRINT clearly

I. PERSONAL INFORMATION

Name: BUCLATIN, GABREALLA MARIE DAET Gender: FEMALE Age: 6 YEARS OLD
(Surname) (First Name) (Middle Name)
Grade/Strand (SHS) and Section: __GRADE I - MAGDALENE_ Date of Birth: FEBRUARY 14, 2017
Height (ft): 3FT______ Weight: 20KGS____ Complexion: FAIR___ Place of Birth: TRECE MARTIREZ CITY
City Address: _________________________________________________ Email Address: [email protected]
Provincial Address: SAMPAGUITA ST. BICLATAN GENERAL TRIAS, CAVITE Telephone No.: (046) 238 9644______
Religion: ROMAN CATHOLIC_ Mobile No.: 09497819289/09215915876
Person to be contacted in case of accident or serious illness: MARIE APRIL DAET/ROMEL BUCLATIN
Address: SAMPAGUITA ST. BICLATAN GEN. TRIAS, CAVITE Relationship: PARENTS Contact Number: 09497819289/09215915876

II. EDUCATIONAL BACKGROUND


HONORS
LEVEL SCHOOL SCHOOL PUBLIC/PRIVATE DATES OF RECEIVED/SPECIAL
GRADUATED ADDRESS ATTENDANCE AWARDS
BUENAVISTA HAPPY HELPER AWARD
Pre-Elementary OLRMS GENERAL TRIAS, PRIVATE 2022-2023
CAVITE

Elementary
High School
Vocational
College if
any/SHS

Nature of Schooling: [X] Continuous [ ] Interrupted, Why? _____________________________________

III. HOME AND FAMILY BACKGROUND


Name of Father: ROMEL C. BUCLATIN Age: __40_ [X] Living [ ] Deceased
Educational Attainment: COLLEGE LEVEL Occupation: DRIVER
Name of Company: __________________________________________ Address:BICLATAN GEN. TRIAS, CAVITE
Name of Mother: MARIE APRIL T. DAET_______________________ Age: _39_ [X] Living [ ] Deceased
Educational Attainment: COLLEGE_____________________________ Occupation: HOUSE WIFE_____
Name of Company: ___________________________________________ Address:BICLATAN GEN. TRIAS, CAVITE
Name of Guardian: ___________________________________________ Age: _____ Relation:___________
Educational Attainment: _______________________________________ Occupation: __________________
Name of Company: ___________________________________________ Address:_____________________

Parents’ Marital Relationship: (Please Check)


[ ] Single Parent
[ ] Married and staying together [ ] Married but Separated
[X] Not Married but Living Together [ ] Other’s (please specify) _____________________

Number of children in the family including yourself:__2__Number of Brother/s: _1_ Number of Sister/s: _____
Number of brother/s or sister/s gainfully employed? _______ Ordinal Position (1st child, 2nd child etc. ) 2nd
Is your brother/sister who is gainfully employed providing support to your: (Please Check)

[ ] family? [ ] your studies? [ ] his/her own family?

Who finances your schooling?


[X ] Parents [ ] Spouse [ ] Relatives
[ ] Brother/Sister [ ] Scholarship [ ] Self-supporting/working student

Nature of Residence while attending school: (Please Check)


[X] family home [ ] bed spacer [ ] house of married brother/sister
[ ] relative’s house [ ] rented apartment [ ] dorm (including board & lodging
[ ] shares apartment with friends/relatives (Please Underline)
OLRMS FORM-01-000-22
GCO Individual Inventory
Record Form

IV. HEALTH
A. Physical
Do you have problems with (Please Check)
YES NO If Yes, please specify YES NO If Yes, please specify
Your Vision [] [X] _________________ Your speech [ ] [X] ________________
Your Hearing [] [X] _________________ Your general health [ ] [X] ________________

B. Psychological
Previous Consultations
CONSULTED YES NO WHEN FOR WHAT?
Psychiatrist
Psychologist
Counselor

C. Any medical history that was not mention (please


specify)____________________________________________

V. INTERESTS AND HOBBIES


A. Academic
[ ] Math Club [ ] Science Club [ ] Others, please specify
[ ] Debating Club [ ] Quizzer’s club

What is/are your favorite subject/s? __________________________________________________________


What is /are the subject/s you like least? _______________________________________________________

B. Extra-Curricular
What are your hobbies? Write them in the order of your preferences.
1. ___________________________________________ 3. ____________________________________
2. ___________________________________________ 4. ____________________________________

Which of the following organizations have you participated in and which interest you most? (Please specify)
[ ] Athletics [ ] Religious organization [ ] Others, please specify ______________
[ ] Dramatics [ ] Chess Club [ ] Scouting
Occupational position in the organization: [ ] Officer [ ] Member [ ] Others, please specify__________

_________________________ _____________________________
Parent’s Name and Signature Student’s Name and Signature

VI. SIGNIFICANT NOTES (For Guidance Counselor only)

DATE INCIDENT REMARKS

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