Republic of the Philippines
Department of Education
Region VI – Western Visayas
Schools Division of Bacolod City
BACOLOD CITY NATIONAL HIGH SCHOOL
P. Hernaez St., Brgy. Taculing, Bacolod City
FICS TOOL (Refined Version)
Name of Student: ____________________________________________Date of Birth: __________________
(Last Name, First Name, Middle Name)
Year and Section: _________________________ Section Counselor: _______________________________
Date Administered: _____________________________
I. FAMILY INCOME
How many are you in your family? _________
Father’s Occupation: _______________________________ Monthly Income: _________________________
Mother’s Occupation: _______________________________ Monthly Income: _________________________
How much does your family spend for the following monthly:
Food: __________________________________ Water: _________________________________
Clothing: ________________________________ Electricity: ______________________________
Transportation: ___________________________ Fuel: __________________________________
School Allowance: ________________________ School Projects: _________________________
Others: ________________________________
Do you work? ________ Why? _________________________ How much do you earn? ____________
What work? ____________________________________ Since when? ______________________
Were you forced? _______________________________ Effect on your schooling? ____________
Do you have a brother or sister who is out of school? _________ Why? ____________________________
Do you have a brother or sister who stopped schooling because he/ she has to work? __________________
II. Family Structure and Relationship
Are both your parents still alive? _____________
Are your parents living together? ____________ If NOT, why? ______________________________
With whom are you living? _________________
How do members of your family treat each other? _______________________________________________
III. Family Valuing of Education
Father’s highest educational attainment: _______________________________________________________
Mother’s highest educational attainment: ______________________________________________________
Educational attainment of siblings: ___________________________________________________________
Do you have a brother or a sister who has dropped out of school? __________________________________
Why? ____________________________________________________________________________
Do your parents check on or help with your school assignments? _______________
Do your parents attend PTA meetings and other school-related activities? _______________
Do your parents personally and regularly get your report card? _______________
Do your parents regularly confer with your parents regarding your progress in school? _______________
Do your parents motivate you to do well in school? _______________
IV. Health and Nutritional Status
Are your suffering from an illness? ________ What illness? ____________________________
Since when have you been suffering from your illness? __________________________________________
Have you received any intervention (hospitalization, medication)? __________________________________
Have you stopped schooling because of your illness? __________
V. Academic Performance
What was your General Average last school year?
Did you have failing grades? ____________ If YES, what subject/s? ___________________________
How did you feel about failing? ______________________________________________________________
Why did you fail? _________________________________________________________________________
What help did you receive from your teachers? __________________________________________________
VI. Relationship with Peers
Do you have a “Barkada”? ___________
If YES, what things do you usually do with them? __________________________________________
Is your Barkada a positive influence on your schooling? _____________________________________
Have you done something you do not want to gain approval from your Barkada? _______________________
If YES, what was the effect on you? ____________________________________________________
Have you been or felt bullied by your classmates/ schoolamtes? ____________________________________
What are your feelings in being bullied? _________________________________________________
VII. Community Context
How far is your home from school? _____________
Is the road from your home to school passable by any means of transportation? __________________
How much is the fare for the available means of transportation? ______________
Is there transportation any time? ______________ If NOT, when? ____________________________
Do you feel safe travelling from home to school? _______ If NOT, why? _____________________________
What is the effect if you are not feeling safe while travelling to school? _______________________________
Are there out-of-school youth in your barangay? __________
Do you have friends among them? __________
Do they try to convince you to stop schooling? ___________
What is your reaction? _______________________________________________________________
VIII. School Environment
Do you enjoy being in school? ________ What makes you enjoy or not enjoy being in school?
____________________________________________________
Are you proud of your school? ________ What makes you proud or ashamed of your school?
____________________________________________________
Is this your school of choice? ________ If NOT, why did you enroll here?
____________________________________________________
Do you find the following adequate, conducive and supportive of your learning:
classrooms? _______ Why/ Why NOT? ____________________________________________
library? _______ Why/ Why NOT? ____________________________________________
laboratories? _______ Why/ Why NOT? ____________________________________________
clinic? _______ Why/ Why NOT? ____________________________________________
canteen? _______ Why/ Why NOT? ____________________________________________
activity center? _______ Why/ Why NOT? ____________________________________________
guidance office? _______ Why/ Why NOT? ____________________________________________
Do you find your teachers inspiring? ________ If NOT, why? ___________________________________
Do you understand the school rules, policies, and procedures concerning your
accountabilities as a student? ___________
Are there rules, policies, and procedures that you wish changed or scrapped? _______________
What are these rules, policies and procedures? __________________________________________________
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