Document Code GTO-FO-020

SAINT MARY’S UNIVERSITY Revision 001

Bayombong, Nueva Vizcaya, Philippines Effectivity Date 2022/07/01

Page/s 1 of 6
GUIDANCE & TESTING OFFICE

CAREER WELLNESS INVENTORY TEST (CaWIT)

Dear Students:
The Guidance and Testing Office aims to assist you in your personal and career development. This form
will update the data you provided during your first year and will be kept confidential. Please accomplish all
information. Thank You.
STUDENT CONSENT
I agree to provide the SMU Guidance and Testing Office the data asked in this form with understanding that it
will be subjected to the SMU Data Privacy Policy for Students.

I. PERSONAL INFORMATION
Goldo Alexandra Torre
Name: ____________________________________________________________ Gender: __Female __Male 20
Age: _________
(Family Name) (Given Name) (Middle Name) 02/15/2004 Single
Birth Date: ___________ Civil Status: _______
Tagalog
Ethnicity (ex. Ilokano, Gaddang): _____________________________
Victoria, Alicia Isabela 3306
Permanent Address: ___________________________________________
BS Architecture
Course: _____________________ SEAIT
Department: _______________________________
3
Year Level: _____________________
Are you a ____? ___Continuing student ___Transferee
Non-OFW
Alexandra G. Goldo
Name of Father: ____________________________ _____OFW ____Non-OFW 09178388467
Contact no.: _________________
Line man
Occupation: ________________________________ Alex Goldo
Facebook messenger account: _________________________________
Marites T. Goldo
Name of Mother: ____________________________ _____OFW ____Non-OFW 09164054141
Contact no.: __________________
Housewife
Occupation: _________________________________ Marites Goldo
Facebook Messenger account: _________________________________
Parent’s Marital Status Non-OFW
__Married & staying together __Married but not staying together __ Married but separated
__Not married but living together __ Solo Parent __ Others, please specify.
__Separated __Widow/Widower
Place you are living this school year:
__Parent’s House __Boarding __Apartment __Dorm __Same as my permanent Address
Relative's House
__Others (Kindly specify)________________

Address of the place (If the place you are currently living was
Busilac, Bayombong Nueva Viscaya
changed):______________________________________________________________
Are you currently employed or working (part-time job)? __ Yes __ No
If yes, what is your work? ________________________
What is your position? ___________________________
How does it affect your study? ____________________________________
Can you list at least 3 friends that you have in SMU?
Name Course and Year Level CP Number Messenger Account
1. Ahron Angelo Maddela Conte BS Civil Engineering 2 Ahron Maddela
2. Raiza Minong Batanes BS Architecture 2 Raiza Minong Batanes
3. Jaecelle Ann Aquino BS Architecture 2 Jaecelle Ann Aquino
II. CONTACT INFORMATION
A. Personal Contact Information
(0956) 632-5386
Contact no.: ________________________ Personal e-mail: goldoalexandra@gmail.co...
_____________ hed-agoldo@smu.edu.ph
Corporate E-mail: ________________
How often do you use your corporate e-mail?
__Never __Rarely __Occasionally __Very frequently Alexandra Goldo
Messenger Account: ________________________
B. In case of emergency, kindly indicate person/s to be contacted (aside from parents)
Name Contact number Messenger account Relationship to the person
1. Levi Keith G. Flores 09772861278 Levi Keith Flores Cousin
2. Christine Joyce A. Flores 09177620005 Christine Joyce Agbalog-... Cousin's wife
3. Mary Jane G. Flores 09261656330 Mary Jane Flores Aunt

III. HEALTH INFORMATION

How is your physical health at the present time? __ Poor __ Unsatisfactory __Satisfactory __ Good __ Very Good
How long do you sleep every night?
__ Less than 1 hour __ 1-2 hours __ 3-5 hours __ 5-8 hours __ 8-10 hours __ 10 or more hours

Which of the following changes or difficulties with your sleeping habits did you experience?
__ Sleep too much __ Sleep too little __ Poor quality __ Disturbing dreams __ Others, please specify.

Are there any changes or difficulties with your eating habits? __ Yes __ No
If yes, kindly check what applies
__ Eating less __ Eating more __ Bingeing __ Restricting/Avoidant of food intake __ Others, please specify
Mental Health Status
In the past 2 weeks, have you had thoughts about harming yourself with the intention to die that distracted you in
carrying out your daily activities and academics?
__ Yes __ No
How distracted are you about harming yourself?
__ Not at all distracted
__ Slightly distracted
__ Distracted
__ Very distracted
In the past 2 weeks, did you hurt yourself physically but with no intention to die? __ Yes __ No
For the past year, has there been an incident of mental health concerns in the family? __ Yes __ No
If yes, kindly specify:
__ Anxiety Attack __ Obsessive Compulsive Disorder (OCD) __ Generalized Anxiety Disorder
__ Panic Attack __ Post Traumatic Stress Disorder (PTSD) __ Attention Deficit Hyperactivity Disorder (ADHD)
__ Depression __ Bipolar Disorder __ Suicide
__ Schizophrenia __ Alcohol/Substance Abuse __ Domestic Violence
__ Sexual Abuse __ Obesity __ Others, please specify: _____________________________
For the last 12 months, were you diagnosed with any medical condition? __ Yes __ No
If yes, kindly specify:
__ Heart Failure __ Dengue __ UTI __ Pneumonia __ Asthma
__ Hypertension __ Chest Pain __ Diabetes __ Heart disease __ Anemia
__ Cancer __ HIV __ Kidney Problem __ Skin disease __ Allergies
__ Hearing Loss __ Speech Problem __ Visual Problem __ Cancer __ Sleep Problem
__ None Pcos
__ Others, please specify: ______________________________________________
For the last 12 months, were you hospitalized (Confined to a hospital)? __ Yes __ No
If yes, kindly check all that applies
__ Flu __ Dengue __ UTI __ Pneumonia __ Asthma
__ Diarrhea __ Chest Pain __ Diabetes __ Heart disease __ Anemia
__ Cancer __ HIV __ Kidney Problem __ Skin disease __ None
__ Others, please specify: ______________________________________________
Are you currently on medication? (Medication is any medicine or preparation that is used to treat and cure illness.)
___ Yes ___ No
Birth control pills for Pcos
If yes, please specify: ____________________________________
Do you have any disability? ___ Yes ___ No
If yes, please specify:
__ Deaf or Hard of Hearing __ Psychosocial Disability __ Intellectual Disability
__ Speech and Language Impairment __ Learning Disability __ Visual Disability
__ Mental Disability __ Physical Disability (Orthopedic) __ Cancer
__ None __ Others, please specify: _______________________________________________________

How can SMU help you with your special needs?

___________________________________________________________________________

IV. ACADEMIC EXPERIENCES

How would you rate your overall satisfaction with your academic experience at our institution?
__ Very Satisfied
__ Satisfied
__ Dissatisfied
__ Very Dissatisfied
Last academic year, which among the following significant events happened to you? (Check all that applies to you.)
___Death of an immediate family member/s or someone close to me (relative/s or friend/s)
___Serious illness or injury of a family member/s
___Becoming sick or injured or being hospitalized
___Traumatic experience (physical/sexual abuse, victim of natural disaster/calamity)
___Divorce/separation of parents
___Transfer of residence/Boarding house
___Parent/s or sponsor suddenly lost their job/s
___ Absent due to health concerns
___ Academic failure
___ Academic break
___Transferred school
___Shifted from a course
___Bullying
___Scolded or embarrassed by a teacher in public
___None
___Other/s ____________________________
For the last academic year, how many failed subjects did you have?
__ 1-2 subjects
__ 3-4 subjects
__ 5 or more subjects
__ Not applicable
For the past 12 months, have you thought of transferring to another school? ___ Yes ___ No
If yes, what are your possible reason/s? (Pls check all that applies.)
__Academic failure __Lack of instructor __Lack of financial
__Bullying __Cut off policy __Change of course/major
__Parent’s decision __Lack of friends __The course/program I want is not
offered in SMU
__ The course I am currently __None __Others; please specify:
enrolled is not my interest __________________________________________
For the past 12 months, have you thought of shifting to another course? ___ Yes ___ No
If yes, what are your possible reason/s? (Pls check all that applies.)
__Academic failure __Lack of instructor __Lack of financial
__Bullying __Cut off policy __Change of course/major
__Parent’s decision __Lack of friends __The course/program I want is not
offered in SMU
__ The course I am currently __None __Others; please specify:
enrolled is not my interest __________________________________________
Where do you plan to transfer?
__Nueva Vizcaya State University __PLT College __Ifugao State University
__Aldersgate College __Isabella State University __ University of Baguio
__ Saint Louis University __ Others, please specify: _______________________________________
What are the factors that make you stay in SMU?
__Quality education
__Conducive environment
__Instructors/professors are approachable
__Proximity (The school is near my place.)
__ Others
I am aware of the different scholarship services offered in SMU.
__ Not at all aware
__ Slightly aware
__ Somewhat aware
__ Moderately aware
__ Extremely aware

What are the university scholarship or assistance program that you are enjoying or availing?
__ Entrance Scholarship (e.g. with __ Academic Scholarship (Gold merit, __ Service Grants (e.g. SCC President,
highest honor, with high honors, Silver Merit, Bronze merit) Editor-in-Chief of The Marian, ROTC
with honors) Corps Commander, Varsity Players,
Member of SMU Performing Groups)
__ Cash Discount __ Siblings Discount __ BIBAK Discounts
__ DOST __ CHED Scholarship __ Socialized Tuition Fee Discount
__ Discount for Working __ Tertiary Education Subsidy (TES) of __ OWWA Scholarship
Students/Student Librarians UNIFAST
__ Others. Please specify ________________________________

V. WELL-BEING INVENTORY
Please rate yourself depending on how each statement is true to you.
Not Neither
Not at True Always
true True or
Statements all true of true of
of not true
of me me me
me of me
1. I engage in physical exercise regularly (e.g. 30 minutes or at
least 5x a week or 10, 000 steps a day).
2. I get 7-9 hours of sleep each night and feel rested in the
morning.
3. I consult health care professionals if I have a health concern I
cannot solve on my own.
4. I have ways or techniques on how to manage my time for
studies.
5. I am comfortable reaching out to my professor/instructors
when I don’t understand the topic.
6. I am comfortable reaching out to my classmates when I don’t
understand the topic in class.
7. I feel fulfilled with the course I am currently enrolled.
8. I have someone to turn to when I need support (e.g. family,
friends, guidance counselors, etc.).
9. I felt excluded or isolated here in SMU.
10. I feel I belong in SMU.
11. I participate in school activities (e.g. departmental week,
university week, etc.)
12. I often felt sad or down in the past month.
13. I often felt happy and contented in the past month.
14. I often felt anxious or worried for the past month.
15. I often spend time with friends outside of academic activities.
16. I feel that my parents can afford my fees in school.
17. I feel safe inside SMU.
18. My parents motivate me with my studies.
19. The scholarship that I have this semester is sufficient to
support my fees in my studies.
20. I feel that I have a purpose in life.
21. I can easily adjust to a new environment.
22. I feel that my instructors care for my feelings or emotions
inside the classroom.
23. I know how to cope with the problems I encounter.
24. I am comfortable sharing my problems/concerns to my
parents.
VI. GUIDANCE AND TESTING OFFICE EXPERIENCES
There will soon be a time when your guidance counselor would like to have a conversation with you. Your
feedback is important to us as we strive to improve our services in the Guidance and Testing Office. Please answer
the following questions honestly and to the best of your ability.
When is the best day to talk to you this semester?
__Monday __Tuesday __Wednesday __Thursday __Friday
When is the best time to talk to you? __Morning __Afternoon
In case of emergency or other special situation, which mode do you prefer talking with your Guidance Counselor?
(check all that applies)
__ Face to Face __Chat __Call __Text __E-mail __ Others; pls. specify:
________________
To what extent do you need to talk to your guidance counselor for the next two weeks?
__ No need
__ Little need
__ Moderate need
__ Great need
Which of the following programs or activities of the guidance office have you availed for the past 12 months?
(Check all that applies.)
__ Intake interview __ Seminar during NSTP __ Group Counseling
__ Counseling __Class visit __Mock interview
__ MARIAN STARS (Emotional __E-mail (e.g. __Others; please specify ____________________________
Quotient, Study Attitude announcements,
Method Survey) Information dissemination,
etc.)
Based on your experience, please rate the service provided by the Neither
Not Fairly Very
Guidance and Testing Office by putting a check mark. true/Not True
true true true
true
a. The guidance counselors are available when I need to get in
touch with them.
b. The GTO staff are warm and welcoming.
c. The guidance counselors are pleasant to talk with.
d. I feel safe in sharing my concerns to the guidance counselor.
e. I am satisfied with the conversation I had with the guidance
counselor during the counseling session.
f. I feel relieved after talking with the guidance counselor.
g. Effectiveness of services provided (e.g. Counseling, intake interview, etc.)
__ Very poor ___ Poor __ Fair __ Good __ Excellent
h. Overall experience
__ Very poor ___ Poor __ Fair __ Good __ Excellent
The Guidance and Testing Office (GTO) is inspired by the good shepherd that every student should be valued and
cared for here in SMU. To what extent do you feel valued and cared here in SMU?
___ Very dissatisfied
___ Dissatisfied
___ Neutral
___ Satisfied
___ Very Satisfied

What do you think would the Guidance and Testing Office improve with its services?
NA
________________________________________________________________________________________________________________________
I hereby certify that the information I provided are true and correct:
__________________________ _________________
Signature (Printed Name) Date Signed