PHILIPPINE SCIENCE HIGH SCHOOL SYSTEM

CAMPUS: Central Mindanao Campus

2 X 2 ID
Picture
CUMULATIVE RECORDS FORM


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 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.)
Do you Sight
have any Hearing
Speech
problems
General Health
with your:

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)
III. RESIDENCE
Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12
Indicate your place
of residence with a
Family Home
Guardian’s home
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
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 & Judgment
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,
emotional adaptability)
 CHARACTER
Integrity
Industry & Resourcefulness
Observance of School Rules and Regulation
Cooperation
Responsibility
Respect for Others and 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, capable, capable, capable, capable, capable,
tolerant, tolerant, tolerant, tolerant, tolerant, 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, confident, confident, confident, confident, confident,
quick- quick- quick- quick- quick- 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, irritable, irritable, irritable, irritable, irritable,
anxious, anxious, anxious, anxious, anxious, 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 easily easily easily easily easily
exhausted, exhausted, exhausted, exhausted, exhausted, exhausted,
unhappy, unhappy, unhappy, unhappy, unhappy, unhappy,
frequent frequent frequent frequent frequent frequent
periods of periods of periods of periods of periods of periods of
gloom or gloom or gloom or gloom or gloom or gloom or
depression depression depression depression depression depression
 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 my 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 my 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 my 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 10

Complete the following statements:

My father and my mother

My greatest mistake
I wish my parents were
In school my teachers
I like my 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 my 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 my friends because
Compared with most families, mine
I always wanted to
I feel that my father
At school I get along with
My mother
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

ACTIVITY EXTENT OF NATURE OF

ACTIVITY INVOLVEMENT
(International, National, (Organizer, representative,
School-wide, Year-level, Participant)
Others)

Grade
7

Grade
8

Grade
9

Grade
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/CONTEST/COMPETITIONS

SCOPE OF SEMINAR/ NATURE OF

CONFERENCE/ INVOLVEMENT
TITLE OF SPONSORING CONTEST/ (speaker,
SEMINAR/CONFERENCE/ AGENCY/ COMPETITION Facilitator,
CONTEST/COMPETITION DATE HELD (International, Participant, Team
National, Captain,
Regional, School, Member)
Others)

Grade
7

Grade
8

Grade
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
OLSAT 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
 Problem Checklist

Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12

Personality

Low Score Description 1 2 3 4 5 6 7 8 9 10 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 . . . . . . . . . . EMOTIONALLY STABLE, faces
less stable, easily upset, changeable reality, calm
PHLEGMATIC, deliberate, inactive, . . . . . . . . . . EXCITABLE, impatient, demanding,
stodgy overactive
OBEDIENT, mild, conforming . . . . . . . . . . ASSERTIVE, independent,
aggressive, stubborn
SOBER, prudent, serious, taciturn . . . . . . . . . . HAPPY-GO-LUCKY, heedless, gay,
enthusiastic
DISREGARDS RULES, undependable, . . . . . . . . . . CONSCIENTIOUS, persevering,
bypasses obligations staid, rule-bound
SHY, restrained, difficult, timid . . . . . . . . . . VENTURESOME, socially bold,
uninhibited, spontaneous
TOUGH-MINDED, self-reliant, realistic, . . . . . . . . . . TENDER-MINDED, dependent, over-
no-nonsense protected, sensitive
VIGOROUS, goes readily with group, . . . . . . . . . . DOUBTING, obstructive,
zestful, given to action individualistic, reflective, internally
restrained, unwilling to act
SELF-ASSURED, placid, secure, serene . . . . . . . . . . APPREHENSIVE, worrying,
depressive, troubled
GROUP-DEPENDENT, a “joiner” and . . . . . . . . . . SELF-SUFFICIENT, prefers own
sound follower decisions, resourceful
CASUAL, careless of social rules, untidy, . . . . . . . . . . CONTROLLED. Socially-precise, self-
follows own urges disciplined, compulsive
RELAXED, tranquil, torpid, unfrustrated . . . . . . . . . . TENSE, driven, overwrought, fretful