I. Pupil's Personal Information

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DepEd National Capital Region

DIVISION OF CITY SCHOOLS-VALENZUELA


CONSTANTINO ELEMENTARY SCHOOL
Ilang-ilang St., Marulas, Valenzuela City

I. Pupil’s Personal Information:

Last Name: First Name: Middle Name:

Nick Name: Grade:

Place of Birth: Date of Birth: Gender:

Address: Cellphone/Tel. No:

II. Family Information:


FATHER

Last Name: First Name: Middle Name:

Age: Occupation: Salary:

Educational Attainment: Religion:

A: MOTHER
Last Name: First Name: Middle Name:

Age: Occupation: Salary:

Educational Attainment: Religion:

A: GUARDIAN
Last Name: First Name: Middle Name:

Age: Relationship: Educational Attainment:

Occupation: Business Address:

A:
Position of the Pupil in the Family:

A:
Siblings (Eldest to Youngest):

III.A:Economic Information
1. Financial Status Excellent Good Moderate Poor

2. Type of Dwelling Single Attached Row Duplex


Mansion Owned Rented Others

3. Materials of the house A. Concrete B. Wood A&B Others

4. Facilities Available Radio Television Dining Set Refrigerator


Computer Gas Stove Gadgets Not on the list
5. Language/Dialect Spoken at Home
Mother Tongue Filipino English Others pls Specify
6. Food Production Activities
Home Cooked Carpentaria Fast Food
7. Kind of Fence Concrete Wood Make Shift

8. How animals are kept Caged Leashed N/A

9. Is there a compost pit Observed None

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