PHILIPPINE SCIENCE HIGH SCHOOL SYSTEM
CAMPUS: ___________________________________________
1 X 1 ID
CUMULATIVE RECORDS FORM Picture
I. A. PERSONAL INFORMATION
Name _______________________________________________ Sex _________ Contact No. ____________
Family Name First Name Middle Name
Religion ___________________ E-mail Address______________________________ Cell # ________________
Age _______Date of Birth __________________Place of Birth ______________Nationality ___________
Permanent Address _______________________________________________________________________
B. FAMILY BACKGROUND
Father Mother
Name ____________________________ _____________________________
Age ____________________________ _____________________________
Educational Attainment ____________________________ _____________________________
School last attended ____________________________ _____________________________
Occupation ____________________________ _____________________________
Company Address ____________________________ _____________________________
Contact Number(s) ____________________________ _____________________________
Parent’s Marital Status: ___ married in church ___ married civilly ___ separated
(please check) ___ divorced ___ widowed ___ others (specify) ________
Brothers/Sisters Age Educational School Occupation
Attainment
_________________ ______ ___________________ _____________________ ___________________
_________________ ______ ___________________ _____________________ ___________________
_________________ ______ ___________________ _____________________ ___________________
_________________ ______ ___________________ _____________________ ___________________
_________________ ______ ___________________ _____________________ ___________________
Socio-economic level of the family: ___ very high ___ high ___ middle ___ low ___ very low
II. HEALTH AND PHYSICAL DEVELOPMENT
Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12
Height
Weight (kg.)
Sight
Do you
have any Hearing
problems Speech
with your: General health
Have you experienced any serious sickness or accident in the past? _____ Yes _____ No
If yes, specify when and describe the effect on you ____________________________________________
Any handicap/allergy/ailment? _____ Yes_____ No: specify (e.g. asthma)________________________
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III. RESIDENCE
Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12
Indicate your Family Home
place of
Guardian’s home
residence with
a check: School dormitory
Others: (specify)
(for externs only)
Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12
How do Public transportation
you get to Family-owned vehicle
school? Car-pool
Service
Others: (specify)
Do you come to school with bodyguards? ______ Yes _____ No
IV. EDUCATIONAL BACKGROUND (please underline)
School last attended __________________________________________________Public / Private
School Address ______________________________________________________COED / Exclusive
Honors/Awards Received ___________________________________________ Sectarian / Non-Sect.
Grade Level Section Scholarship Status Academic Status
_____________ _______________ ________________ _______________
_____________ _______________ ________________ _______________
_____________ _______________ ________________ _______________
_____________ _______________ ________________ _______________
_____________ _______________ ________________ _______________
_____________ _______________ ________________ _______________
Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12
Subject you like best
Subject you like least
Subject you find difficulty
Subject where you learned most
Subject where you learned least
Subject that was taught best
Subject that was taught worst
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V. SOCIAL PROFILE
Do you have real friends: (please answer Yes or No)
Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12
Of your age?
Older than you?
Younger than you?
Are most of your friends: (please answer Yes or No)
Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12
boys?
girls?
from another school?
from this school?
List down your best friends at PSHS
Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12
List down your hobbies, special talents, skills, interests or leisure time activities
Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12
VI. STUDENT’S SELF-ASSESSMENT
Based on self-observation, feedback gained from other people and personal experiences, honestly assess yourself on
the following areas in a scale of 1-5 where; 1 – Excellent, 2 – Very Good, 3 – Good, 4 – Fair, 5 – Poor. (Please check the
corresponding box)
Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12
PHYSICAL WELL-BEING (appearance, health,
grooming)
MENTAL Comprehension
Reasoning & Judgement
Alertness
SPEECH
(fluency, diction, * In English
voice, manner of expression,
spontaneity of thoughts) * In Filipino
WRITTEN COMMUNICATION SKILLS
Legibility and neatness, grammatical structure,
depth of thought, organization)
PERSONALITY (Self-confidence, social graces,
attitude and values, interpersonal skills,
PSHS-00-F-GCU-06-Ver02-Rev0-02/01/20 Page 3 of 10
emotional adaptability)
CHARACTER
Integrity
Industry & Resourcefulness
Observance of School Rules & Regulation
Cooperation
Responsibility
Respect for Others & Property
Underline any of the following words which describe your general make-up:
Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12
Persevering, Persevering, Persevering, Persevering, Persevering, Persevering,
calm, friendly, calm, friendly, calm, friendly, calm, friendly, calm, friendly, calm, friendly,
patient, patient, patient, patient, patient, patient,
stubborn, stubborn, stubborn, stubborn, stubborn, stubborn,
capable, tolerant, capable, tolerant, capable, tolerant, capable, tolerant, capable, tolerant, capable, tolerant,
impulsive, impulsive, impulsive, impulsive, impulsive, impulsive,
pessimistic, pessimistic, pessimistic, pessimistic, pessimistic, pessimistic,
jealous, shy, jealous, shy, jealous, shy, jealous, shy, jealous, shy, jealous, shy,
talented, self- talented, self- talented, self- talented, self- talented, self- talented, self-
confident, quick- confident, quick- confident, quick- confident, quick- confident, quick- confident, quick-
tempered, tempered, tempered, tempered, tempered, tempered,
cynical, tactful, cynical, tactful, cynical, tactful, cynical, tactful, cynical, tactful, cynical, tactful,
submissive, submissive, submissive, submissive, submissive, submissive,
conscientious, conscientious, conscientious, conscientious, conscientious, conscientious,
poor health, poor health, poor health, poor health, poor health, poor health,
cheerful, cheerful, cheerful, cheerful, cheerful, cheerful,
excitable, excitable, excitable, excitable, excitable, excitable,
irritable, anxious, irritable, anxious, irritable, anxious, irritable, anxious, irritable, anxious, irritable, anxious,
nervous, nervous, nervous, nervous, nervous, nervous,
unhappy, unhappy, unhappy, unhappy, unhappy, unhappy,
frequent frequent frequent frequent frequent frequent
daydreaming, daydreaming, daydreaming, daydreaming, daydreaming, daydreaming,
easily exhausted, easily exhausted, easily exhausted, easily exhausted, easily exhausted, easily exhausted,
unhappy, unhappy, unhappy, unhappy, unhappy, unhappy,
frequent periods frequent periods frequent periods frequent periods frequent periods frequent periods
of gloom or of gloom or of gloom or of gloom or of gloom or of gloom or
depression depression depression depression depression depression
PSHS-00-F-GCU-06-Ver02-Rev0-02/01/20 Page 4 of 10
Grade 7
Complete the following statements:
My father and my mother __________________________________________________
My greatest mistake _______________________________________________________
I wish my parents were ____________________________________________________
In school my teachers ______________________________________________________
I like friends because ______________________________________________________
Compared with most families, mine _________________________________________
I always wanted to ________________________________________________________
I feel that my father _______________________________________________________
At school I get along with __________________________________________________
My mother _______________________________________________________________
Grade 8
Complete the following statements:
My father and my mother __________________________________________________
My greatest mistake _______________________________________________________
I wish my parents were ____________________________________________________
In school my teachers ______________________________________________________
I like friends because ______________________________________________________
Compared with most families, mine _________________________________________
I always wanted to ________________________________________________________
I feel that my father _______________________________________________________
At school I get along with __________________________________________________
My mother _______________________________________________________________
Grade 9
Complete the following statements:
My father and my mother __________________________________________________
My greatest mistake _______________________________________________________
I wish my parents were ____________________________________________________
In school my teachers ______________________________________________________
I like friends because ______________________________________________________
Compared with most families, mine _________________________________________
I always wanted to ________________________________________________________
I feel that my father _______________________________________________________
At school I get along with __________________________________________________
My mother _______________________________________________________________
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Grade 10
Complete the following statements:
My father and my mother __________________________________________________
My greatest mistake _______________________________________________________
I wish my parents were ____________________________________________________
In school my teachers ______________________________________________________
I like friends because ______________________________________________________
Compared with most families, mine _________________________________________
I always wanted to ________________________________________________________
I feel that my father _______________________________________________________
At school I get along with __________________________________________________
My mother _______________________________________________________________
Grade 11
Complete the following statements:
My father and my mother __________________________________________________
My greatest mistake _______________________________________________________
I wish my parents were ____________________________________________________
In school my teachers ______________________________________________________
I like friends because ______________________________________________________
Compared with most families, mine _________________________________________
I always wanted to ________________________________________________________
I feel that my father _______________________________________________________
At school I get along with __________________________________________________
My mother _______________________________________________________________
Grade 12
Complete the following statements:
My father and my mother __________________________________________________
My greatest mistake _______________________________________________________
I wish my parents were ____________________________________________________
In school my teachers ______________________________________________________
I like friends because ______________________________________________________
Compared with most families, mine _________________________________________
I always wanted to ________________________________________________________
I feel that my father _______________________________________________________
At school I get along with __________________________________________________
My mother _______________________________________________________________
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VII. EXTRA CURRICULAR ACTIVITIES
POSITION HELD IN SCHOOL/OFF-CAMPUS ORGANIZATIONS
POSITION (President, Vice Pres., ORGANIZATION/CLUB
Member, etc.)
Grade 7
Grade 8
Grade 9
Grade
10
Grade
11
Grade
12
INVOLVEMENT IN ACTIVITIES/PROJECTS IN/OFF CAMPUS
EXTENT OF NATURE OF
ACTIVITY INVOLVEMENT
ACTIVITY (International, National, (Organizer, representative,
School-wide, Year-level, Participant)
Others)
Grade 7
Grade 8
Grade 9
Grade
10
PSHS-00-F-GCU-06-Ver02-Rev0-02/01/20 Page 7 of 10
Grade
11
Grade
12
SPECIAL ACADEMIC HONORS/AWARDS/DISTINCTIONS RECEIVED
AWARD ACTIVITY/COMPETITION/ETC. CLASSIFICATION (School-wide,
regional, national, international, etc.)
Grade 7
Grade 8
Grade 9
Grade
10
Grade
11
Grade
12
PARTICIPATION IN SEMINARS/CONFERENCES/CONTESTS/COMPETITIONS
SCOPE OF SEMINAR/ NATURE OF
TITLE OF SPONSORING CONFERENCE/
INVOLVEMENT
SEMINAR/CONFERENCE/ CONTEST/
AGENCY/ (speaker, Facilitator,
COMPETITION
CONTEST/COMPETITION DATE HELD Participant, Team Captain,
(International,
National, Regional, School,
Member)
Others)
Grade
7
Grade
8
Grade
PSHS-00-F-GCU-06-Ver02-Rev0-02/01/20 Page 8 of 10
9
Grade
10
Grade
11
Grade
12
VIII. VOCATIONAL PLANNING
Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12
1st
2nd
________________________________________
Year Level Counselor
(Signature Over Printed Name)
IX. PSYCHOLOGICAL TEST PROFILE (to be filled-up by the Guidance Counselor)
Mental Ability
Culture Fair Raw Score ______ DIQ _____ %ile _____ Description ___________
OLMAT Raw Score ______ IQ _____ %ile _____ Description ___________
Aptitude
VR NA VR+NA AR MR SR S L
Raw Score _______ _______ _______ _______ ______ _______ _______ _______
Percentile _______ _______ _______ _______ ______ _______ _______ _______
Description _______ _______ _______ _______ ______ _______ _______ _______
Study Habits and Attitudes
Delay Work Study Teacher Education Study Study
Avoidance Methods Habits Approval Acceptance Attitude Orientation
Raw Score ________ ________ ________ ________ ________ ________ ________
Percentile ________ ________ ________ ________ ________ ________ ________
Description ________ ________ ________ ________ ________ ________ ________
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Problem Checklist
Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12
Personality
1 2 3 4 5 6 7 8 9 10
Low Score Description High Score Description
RESERVED, detached, critical, cool . . . . . . . . . . OUTGOING, warmhearted, easy-going, participating
LESS INTELLIGENT, concrete-thinking . . . . . . . . . . MORE INTELLIGENT, ABSTRACT-THINKING,
bright
AFFECTED BY FEELINGS, emotionally less . . . . . . . . . . EMOTIONALLY STABLE, faces reality, calm
stable, easily upset, changeable
PHLEGMATIC, deliberate, inactive, stodgy . . . . . . . . . . EXCITABLE, IMPATIENT, DEMANDING,
OVERACTIVE
OBEDIENT, mild, conforming . . . . . . . . . . ASSERTIVE, independent, aggressive, stubborn
SOBER, prudent, serious, taciturn . . . . . . . . . . HAPPY-GO-LUCKY, Heedless, gay, enthusiastic
DISREGARDS RULES, undependable, by-passes . . . . . . . . . . CONCIENTIOUS, persevering, staid, rule-bound
obligations
SHY, restrained, diffident, timid . . . . . . . . . . VENTURESOME, socially bold, uninhibited,
spontaneous
TOUGH-MINDED, self-reliant, realistic, no- . . . . . . . . . . TENDER-MINDED, dependent, over-protected,
nonsense sensitive
VIGOROUS, goes readily with group, zestful, . . . . . . . . . . DOUBTING, obstructive, individualistic, reflective,
given to action internally restrained, unwilling to act
SELF-ASSURED, placid, secure, serene . . . . . . . . . . APPREHENSIVE, worrying, depressive, troubled
GROUP-DEPENDENT, a “joiner” and sound . . . . . . . . . . SELF-SUFFICIENT, prefers own decisions, resourceful
follower
CASUAL, careless of social rules, untidy, follows . . . . . . . . . . CONTROLLED, socially-precise, self-disciplined,
own urges compulsive
RELAXED, tranquil, torpid, unfrustrated . . . . . . . . . . TENSE, driven, overwrought, fretful
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