Individual Record Form and Needs Assessment for College Students

         This form is intended to gather important information about your personal, academic, family, and career background, as well as identify your academic, personal, social, emotional, mental health, and career development needs. The information you provide will enable the Guidance and Placement Center to better understand your unique circumstances and develop appropriate programs, counseling services, career guidance activities, and other student support initiatives that promote your holistic growth and well-being.

       All responses will be treated with strict confidentiality and will be used solely for legitimate educational, guidance, and student development purposes. Your honest and complete responses are greatly appreciated.

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In accordance with the Data Privacy Act of 2012 (RA 10173), all information collected in this form will be treated with strict confidentiality and will be used solely for evaluation and program improvement purposes. Your responses will not be disclosed to unauthorized individuals and will only be accessed by authorized personnel of the Guidance and Placement Office and Public Information Office. 

By proceeding, you voluntarily agree to the collection and use of your responses for the stated purpose.

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Date today *
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Name (Surname, First Name, Middle Initial) *
Year *
College *
Course *
Sex *
Citizenship *
Religion *
Mobile number *
Email Address *
Civil Status *
Age *
Date of Birth *
MM
/
DD
/
YYYY
Place of Birth *
Home Address ( Street, Subdivision/ Barangay, City/Municipality, Province) *
Name of Father *
Father's Age *
Father's Contact Number *
Father's School *
Father's Educational Attainment *
Father's Occupation *
Father's Monthly Income *
Name of Mother *
Mother's Age *
Mother's Contact Number *
Mother's School *
Mother's Educational Attainment *
Mother's Occupation *
Mother's Monthly Income *
Guardian's Name *
Relationship with Guardian *
Guardian's Age *
Guardian's Educational Attainment *
Guardian's Occupation *
Guardian's Contact Number *
Sibling(s)
Sibling's Age (s)
Sibling's School
Person Financing your Education *
Elementary School *
Year Graduated from Elementary *
Address of Elementary School *
High School *
Year Graduated from High School *
Address of High School *
  What is your biggest challenge as a college student?   *
  What programs or services would you like the Guidance and Placement Center to offer?   *
  What topics would you like the Guidance and Placement Center to discuss through seminars or workshops?   *
  Is there anything else you would like the Guidance and Placement Center to know about your needs or concerns?   *
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