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PERSONAL DATA SHEET FOR STUDENT COUNSELLING
PERSONAL DATA SHEET FOR STUDENT COUNSELLING
Student Name :
Roll No :
DOB :
Branch :
Year :
Semester :
Mobile :
Email :
Contact Address :
Father's Name :
Father's Age :
Father's Education :
Father's Occupation :
Father's Income :
Mother's Name :
Mother's Age :
Mother's Education :
Mother's Occupation :
Mother's Income :
ACADEMIC / PERSONAL PROBLEMS:-
(Please tick on the following problems which you have)
Problems
Mark
Problems
Mark
Problems
Mark
Stress
Stage Phobia
Time Management Problem
Anger
Poor Concentration
Lack of Expression
Emotional Problem
Poor Memory Problem
Low Self Confidence
Low Self-Esteem
Adjustment problem
Poor Decisive Power
Examination Anxiety
Frustration
Conflicts
Negative Thoughts
Migraine Headache
Emotional Problems
Exam Phobia
Relationship Problems
Low Self-Motivation
Stammering
Fear of public speaking
Procrastination
Other Problems Not Listed above