Student Tracking System

1. MS- ELEMENTARY
Pupil___LumawodLorraine D.__________________NICKNAME:___Lorraine_________
____________________________________________AGE:_____9______ SEX:____F___
Nationality__Filipino_____EthnicAffiliation:______________ Religion: ___Catholic____
Date of Birth:___________ Place of Birth: ___________ Birth Registered______Yes___
Drop Out History
__________________ No How long?_____________ Reasons:_____________________
Distance of School from home: ________________ Means of trans. To school:________
Source of Financial Assistance:____________ Yes___________ No Sources________
Studentsliveswith:_____________ Personwho helpschild inHomework:____________
BACKGROUNDPROFILE
No. of Family Member Dropout:______________
Parental Status:____________________________
Member of Com.Dev.Org._______Yes _______No
Mo.Household Income:_____________ _______
Appliances at Home:________________ ________
_________________________________________
FAMILY DWELLING:
House/Lot Ownership:_______________ ________
Type of House:_____________________ ________
Type opf Toilet:____________________ _________
Source of Water Supply:______________ ________
Power Supply:_______________________________
ABSENTISMAND DROPOUT PROFILE I II III IV V VI
Year Level
No.of DaysAbsent
Reasons
SummerDropout
How long?
Reasons:
HEALTH ANDNUTRITION PROFILE
EDUCATIONAL PROFILE
GRADE ONE S.Y
GRADE THREE S.Y
GRADE FIVE S.Y
Pupil’sInformation FATHER MOTHER
Grade Level I II III IV V VI
School Year
Nut.Status
Wt. (kg)
Remarks
Ht.(cm)
Immunization
BCG
DPT
Polio
Hepa
WhoopingCough
ChickenFox
Measles
IllnessIncurredduring the year
Major Accidents