Basic Client Information Clients file number: 2.

0 Personal identifying information Last Name: Escolano First Name: Catherine Age: 18 Initial: F

Date of Birth: September 15, 1993 Citizenship: Filipino

2.1 Address Mailing Address: 13 Domingo St. Tuktukan Taguig City 2.2 Telephone Home: 4914045 Leave Message: Yes Cellular: 0999805297 2.3 Living Arrangement (have the client rate) Poor: Fair: Good: Excellent: No:

Comments: 2.4 Education High school: Camarines Sur National High School Technical/ College/ University: Datamex Institute of Information Technology Grade point Average: 85 Future educational plans: to continue my studies and to hopefully graduate with flying colors Have you ever been diagnosed with any type of learning disability? Yes If yes: (a) when? (b) by whom? (c) Any medication? No

What are your present learning strategies?

2.5 Present employment / last employer: None 2,6 Basic multicultural information Gender: Male Religion: Catholic Race: Asian Cultural Identity: Filipino Is there anything you could teach me right now about your culture that may help facilitate this interview? None, because youre a Filipino too like me. Female: Preferred language: Tagalog Sexuality: Straight

2.7 Spiritual Information Religion: Catholic Are you a spiritual person? Yes Briefly explain youre position: No

2.8 Legal status Do you have a criminal record? Yes If yes: what is your current legal status? What is our criminal record for the last ten years? Clean Have you ever been incarcerated? Yes If yes: when, where, and for how long? 3.0 Reason for assessment What is your major reason for seeking counseling? (self or external, e.g., court)? No: No:

3.1 How long have you felt like this? 3.2 To date, what have you tried to do in an attempt to feel better? 3.3 Have you tried counseling for this concern? 3.4 have you ever tried counseling before? Yes No

If yes: When, with whom, and what did you do in counseling? 3.5 What happened that led you to counseling? When was the last time you felt pain similar to this? 3.6 Do you ever think/see/feel (use the term that best matches the clients modality) a time when you will feel better? What is your perception? 3. 7 Are you motivated to work to improve your current circumstances? Yes If no: what are you wanting to obtain through counselling? 3.8 Pretend that counseling went perfectly for you; what do you want in your life to be like after finish counseling? (Please do not base your answer on your current circumstances)? 3.9 If you were to draw a metaphorical picture that best describe you current situation, what would you draw? (Give the client an example of metaphor. After the picture is drawn, ask the client to describe what all the different parts represent and what role the counsellor takes in this metaphor.) No

How You Picture Your Life Today (Draw your current situation metaphor on this page)