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    Student'S Information: Domingo Lacson National High School

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    Anit Eiram Ocram
    This document contains a student information form for a Grade 10 student attending Domingo Lacson National High School in Bacolod City, Philippines. The multi-page form collects personal details about the student such as name, address, family members, family income, medical history, living conditions, education history, and responses to questions about relationships within the family and community and how these factors influence the student's experience and performance in school.

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    © All Rights Reserved
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    Student'S Information: Domingo Lacson National High School

    Uploaded by

    Anit Eiram Ocram
    159 views3 pages
    This document contains a student information form for a Grade 10 student attending Domingo Lacson National High School in Bacolod City, Philippines. The multi-page form collects personal details about the student such as name, address, family members, family income, medical history, living conditions, education history, and responses to questions about relationships within the family and community and how these factors influence the student's experience and performance in school.

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    Studetns profile for fics

    Original Title

    Students Profile

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    This document contains a student information form for a Grade 10 student attending Domingo Lacson National High School in Bacolod City, Philippines. The multi-page form collects personal details about the student such as name, address, family members, family income, medical history, living conditions, education history, and responses to questions about relationships within the family and community and how these factors influence the student's experience and performance in school.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    159 views3 pages

    Student'S Information: Domingo Lacson National High School

    Uploaded by

    Anit Eiram Ocram
    This document contains a student information form for a Grade 10 student attending Domingo Lacson National High School in Bacolod City, Philippines. The multi-page form collects personal details about the student such as name, address, family members, family income, medical history, living conditions, education history, and responses to questions about relationships within the family and community and how these factors influence the student's experience and performance in school.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 3

    Republic of the Philippines

    Department of Education
    Region VI-Western Visayas
    DOMINGO LACSON NATIONAL HIGH SCHOOL
    Division of Bacolod City
    Bacolod City

    STUDENT’S INFORMATION
    Grade and Section: GRADE 10 – TURQUOISE Adviser: ROSELYN O. NIPAY Date Administered: June 03, 2019
    LRN: ________________________________

    Name: _____________________________ ____________________________ _________________________


    Family Name First Name Middle Name
    Nickname: __________________________ Contact Number: ____________________________
    Address: ___________________________________________________________________________________
    Birth Date: _________________________ Birth Place: ___________________ Sex: ______________________
    Distinguished Feature: ___________________________________________ Complexion: __________________
    Age: ___________________________ Civil Status: __________________ Religion: ______________________
    Father’s Name:
    ___________________________ _____________________________ ________________________
    Family Name First Name Middle Name
    Birth Date: ________________________ Age: _____________________ Occupation: ______________________
    Highest Educational Attainment: _________________________________________________________________
    Mother’s Complete Maiden Name:
    ___________________________ _____________________________ _________________________
    Family Name First Name Middle Name
    Birth Date: ________________________ Age: _____________________ Occupation: ______________________
    Highest Educational Attainment: _________________________________________________________________
    Family Income: (pls. check)
    ___P5,000 & below ___P15,001-P20,000 ___P30,001-P35,000
    ___P5,001-P10,000 ___P20,001-P25,000 ___P35,001-P40,000
    ___P10,001-P15,000 ___P25,001-P30,000 ___P40,000 above

    Scholarship Grant: (pls. specify) _________________________________________________________________


    Medical History of Illness or Operation:
    ___Asthma ___Diabetes ____Tuberculosis ___Hepatitis
    Others (pls. specify): __________________________________________________________________________
    Living Condition (House):
    Materials: _____Light Materials ____Concrete _____Combination of light materials and concrete
    Number of Members Currently Living in your Household include Yourself: ______________
    Number of Bedrooms: _____________ Have owned toilet in the house: ___Yes ___No
    Siblings:
    Brothers: _____
    Name: _______________________________________________________Age: __________ Status: _________
    Name: _______________________________________________________Age: __________ Status: _________
    Name: _______________________________________________________Age: __________ Status: _________
    Name: _______________________________________________________Age: __________ Status: _________
    Name: _______________________________________________________Age: __________ Status: _________
    Sisters: _____
    Name: _______________________________________________________Age: __________ Status: _________
    Name: _______________________________________________________Age: __________ Status: _________
    Name: _______________________________________________________Age: __________ Status: _________
    Name: _______________________________________________________Age: __________ Status: _________
    Name: _______________________________________________________Age: __________ Status: _________
    EDUCATION
    Elementary School Graduated: __________________________________________________________________
    School Address: ________________________________________________Year Graduated: _______________
    Residency Status for this School: (check appropriate box)
     Regular student of DLNHS who finished the year level during the last school year of attendance
     Continuing student of DLNHS who finished the year level during his/her last school year of attendance but
    did not enroll in the next school year.
     Returnee (drop-out of DLNHS during the last school year of attendance)
     Transferee: Last School Attended:_________________________________________________________
    School Address: _________________________________________________________________
    Back Subject/s: __________________________________________________________________
    THE FAMILY- INDIVIDUAL- COMMUNITY- SCHOOL (FICS) TOOL
    Refined by Michell L. Acoyong and Juna T. Flores

    Name of Student: ____________________________________________ Date of Birth: _____________________


    Year and Section: Grade 10- Turquoise Adviser: Roselyn O. Nipay Date Administered: June 01, 2018

    I. FAMILY INCOME
    How many are you in your family? _________
    Father’s Occupation: ________________________________ Monthly Income: ______________________
    Mother’s Occupation: _______________________________ Monthly Income: ______________________
    How much does you family spend for the following monthly?
    Food: __________________ Water: _____________________ Clothing: ____________
    Electricity: ______________ Transportation: ______________ Fuel: _______________
    School Allowance: _______ School Projects: ______________ Others: _____________
    Do you work? __________ Why? ____________________________ How much do you earn? __________
    What work? ___________________________ Since when? ____________________________________
    Were you forced? ______________________ Effect on your schooling: ___________________________
    Do you have a brother or sister who is out of school? ______ Why? _______________________________
    Do you have a brother or sister who stopped schooling because he/she must work?
    II. FAMILY STUCTURE AND RELATIONSHIP
    Are both parents still alive? _____________ if not: _____mother _____father
    Are your parents still living together? _________ if not. Why? __________________________________
    With whom are you living? ____________ How do members of your family treat each other? ___________
    III. FAMILY VALUING OF EDUCATION
    Father’s highest educational attainment: _____________________________________________________
    Mother’s highest educational attainment: ____________________________________________________
    Educational attainment of siblings: _________________________________________________________
    Do you have a brother or sister who has dropped out of school? __________________________________
    Why? _______________________________________________________________________________
    Do your parents check on or help with your assignments? _______________________________________
    Do your parents attend PTA meetings and other school-related activities? __________________________
    Do your parents personally and regularly get your report card? ___________________________________
    Do your parents regularly confer with your teachers regarding your progress in school? ________________
    Do your parents motivate you to deal well in school? ___________________________________________
    IV. HEALTH AND NUTRITIONAL STATUS
    Are you suffering from an illness? _______________ What illness? ________________________________
    Since when have you been suffering from your illness? _________________________________________
    Have you received any intervention (e.g. hospitalization, medication) _______________________________
    Have you stopped schooling because of your illness? __________________________________________
    V. ACADEMIC PERFORMANCES
    What was your General Average last School Year? _____ Do you have failing grades? __ Subject: ______
    How did you feel about failing? _____________________ Why did you fail: _________________________
    What help did you receive from your teachers? ________________________________________________
    VI. RELATIONSHIP WITH PEERS
    Do you have a “barkada”? ___________ Is your “barkada” a positive influence on your schooling? _______
    Have you done something you don’t want to gain the approval of your “barkada’? ____________________
    If yes, what was the effect on you? ___________________________________________________
    Have you been or felt bullied by your classmate/schoolmates? ___________________________________
    What are your feelings being bullied? _________________________________________________
    VII. COMMUNITY CONTEXT
    How far is your home from school? _______________________
    Is the road from your home to school passable by any means of transportation? ______________________
    How much is the fare for the available means of transportation?
    Is transportation any time? _______________ If not, when? _____________________________________
    Do you feel safe traveling from home to school? _______ If not, why? ______________________________
    What is the effect of your feeling not safe while travelling on your schooling? ________________________
    Are there out of school youth in your barangay? ___________ Do you have friends among them? ________
    Do they try to convince you to stop schooling ____________ What is your reaction? __________________
    VIII. SCHOOL ENVIRONMENT
    Do you enjoy being in school? ____ What makes you enjoy or not being in school? ____________________
    Are you proud of your school? ____ What makes you proud or ashamed of your school? _______________
    Is this your school of choice? _____ If not, why did you enroll here? _______________________________
    Do you find the following adequate, conducive and supportive of your learning?
    Classroom? ______________
    Why/Why not? ________________________________________________________________________
    Library? _________________
    Why/Why not? ________________________________________________________________________
    Laboratories? _____________
    Why/Why not? ________________________________________________________________________
    Clinic? __________________
    Why/Why not? ________________________________________________________________________
    Canteen? ________________
    Why/Why not? ________________________________________________________________________
    Activity Center ____________
    Why/Why not? ________________________________________________________________________
    Guidance Office? __________
    Why/Why not? ________________________________________________________________________

    Do you find all your teachers inspiring? ______________ If not, why? ___________________________________
    Do you understand the school rules, policies and procedures concerning your accountabilities as a student? ______
    Are the rules, policies, and procedures that you wish changed or scrapped? _______________________________
    What are these rules, procedures?
    __________________________________________________________________________________________
    __________________________________________________________________________________________
    __________________________________________________________________________________________

    I truly answered all the questions with honesty.

    ________________________________________________
    Signature over Printed Name

    ______________________________ ____________________________
    ROSELYN O. NIPAY
    Adviser Co- Adviser

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