Edufruit

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