Cumulative Record Collection Form

A comprehensive record schools use to gather a student's personal, family, academic, and health information in one place, complete with a signature.

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Page 1

No image

School Year

Full Name

Nickname

Grade Level & Section

Learning Reference Number (LRN)

Gender

Birth Order

Religion

Date of Birth

Place of Birth

Nationality

Telephone Number

Cellphone Number

Permanent Address

Name of Parent/Guardian

Relationship

Parent/Guardian's Contact Number

Parent/Guardian Email Address

Page 2

Father's Name

Father's Date of Birth

Father's Educational Attainment

Father's Occupation

Father's Company Name

Father's Email Address & Contact Number

Mother's Name

Mother's Date of Birth

Mother's Educational Attainment

Mother's Occupation

Mother's Company Name

Mother's Email Address & Contact Number

Parents' Marital Status

Page 3

Average Monthly Household Income (please include all family members)

Page 6

III. Residence (indicate your place of residence)

Owned house Rented house Living with relatives Boarding house

Page 7

Based on self-observation, feedback from others, and personal experiences, honestly rate yourself on the following areas using a scale of 1-4, where: 1 - Excellent, 2 - Very Good, 3 - Good, 4 - Fair

Page 8

Directions: Check any of the following words that best describe your general character

Page 10

Vocational/Career Planning: indicate the fields, courses, occupations, or careers you are considering (please note your interests and preferences)

Page 11

Personal Checklist: Please check the concerns that currently apply to you. Answer honestly

Academic difficulties Family problems Financial concerns Health issues Peer relationships None

1x1 Photo

Max 10 MB per file

Signature

Sign here

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Cumulative Record Collection Form

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