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Student Tracking System

This document contains a student tracking form used by Sapang Palay National High School. It collects information about a student's family background, educational history, health, nutrition, absenteeism, and risk of dropping out. The form gathers details such as the student's name, address, parents' information, siblings, household income, home conditions, immunization history, illnesses, and school performance over multiple years. The goal is to holistically understand factors that could impact the student's education and identify those who may need additional support.

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ara herrera
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78 views2 pages

Student Tracking System

This document contains a student tracking form used by Sapang Palay National High School. It collects information about a student's family background, educational history, health, nutrition, absenteeism, and risk of dropping out. The form gathers details such as the student's name, address, parents' information, siblings, household income, home conditions, immunization history, illnesses, and school performance over multiple years. The goal is to holistically understand factors that could impact the student's education and identify those who may need additional support.

Uploaded by

ara herrera
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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SAPANG PALAY NATIONAL HIGH SCHOOL

City of San Jose del Monte, Bulacan

STUDENT TRACKING FORM


A. STUDENT FAMILY BACKGROUND QUESTIONNAIRE
1 Student's Name: Age:
Learner's Reference Number (LRN): Sex
Address:
Number Street Municipality /City/Province
Nationality: Religion:
Ethnic Affiliation:
Date of Birth: (mm/dd/yyyy) Place of Birth:
Birth Registered? YES NO
2 Has student dropped out of school? YES NO
If yes, for how long? Reason:
3 Distance from home to school: km
Means of transportation to school:
car motorized side car others
jeepney pedicab
4 Has any member of the family ever dropped out of school? YES NO
5 Is the student receiving any type of financial assistance to attend school?
YES NO If yes, from what source?
6 With whom does the student live?
Both parents Mother Father Others
7 Who helps the student live?
Both parents Mother Father Others
8
Father Mother
Information
Living Deceased Living Deceased
Name:

Age:

Address:

Nationality:

Religion:
Language/s
Spoken

9 Parental Marital Status: Married Live-In Annulled Separated


10 List all members of the household including those who have migrated. Specify and check the info needed.

Education Occupation
Name of Sex Relationship to Migrated (How
Age Highest
Household Member Student long?)
Enrolled / Grade/Degr Full Part
M F NFE Course
Completed ee Time Time
Completed
Early Childhood Education (Day Care and Pre-School)
11 Is the family a member of any community development organization?
YES NO If yes, please specify:
12 Monthly Household Income
Below P1,000 P2,500-P5,000 P8,000-P15,000
P1,000 - P2,500 P5,001-P8,000 over P15,000
13 Information about the family dwelling
a The family
owns house and lot rents a house Others (Pls. specify).
b Type of house
concrete semi-concrete Others (Pls. specify).
c Type of toilet
Flush Pit No toilet Others (Pls. specify).
d Source of Water Supply
faucet/tap Others (Pls. specify).
e Power Source
electricity kerosene Others (Pls. specify).
14 Which of the following are available at home?
TV Newspaper Magazines
Radio Books Others (Pls. specify)

B. STUDENT EDUCATIONAL HISTORY


School School Year Grade & Section Class Adviser

C. HEALTH AND NUTRITION PROFILE


Grade Sex Nutritional Status Classification
Level Weight Height
M F Obese Overweight Normal Wasted Severely Wasted
(kg) (cm)
Grade 7
Grade 8
Grade 9
Grade 10

COMMON DISEASE / ILLNESS INCURRED WITHIN THE YEAR


GRADING PERIOD Major Accidents
School Year
1st 2nd 3rd 4th Nature No. of Days Absent

IMMUNIZATIONS
Psoriasis/Whooping
BCG Diphtheria Tetanus Polio Measles Cough Hepa B

D. ABSENTEEISM AND DROP-OUT PROFILE


School Year No. of Days Present No. of Days Absent Reason/s % of Attendance

Ever Dropped Out? How long?


School Year
Yes No Years Months

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