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Republic of the Philippines

Department of Education
Region III- Central Luzon
Tarlac City Schools Division
STO CRISTO INTEGRATED SCHOOL
High School Department
Sto. Cristo, Tarlac City

INCIDENT REPORT
Brief Description of the Incident:
______________________________________________________
Incident Date: ____________________________
Person/s involved:
Incident Time: ____________________________
____________________________________
Venue of Incident: ________________________
____________________________________
_________________________________________
____________________________________
____________________________________
____________________________________

Narration of the Incident:

By signing this document, you acknowledged that you have read and understood
the information contained herein.
Incident reported by: __________________________________

Date: _________________

signature over printed name

Incident reported to: __________________________________


_________________

Date:

signature over printed name

Noted/Witnesses:
Name: ________________________________________

Date: _________________

signature over printed name

Name: ________________________________________
signature over printed name

Date: _________________

Republic of the Philippines


Department of Education
Region III- Central Luzon
Tarlac City Schools Division
STO CRISTO INTEGRATED SCHOOL
High School Department
Sto. Cristo, Tarlac City

ANECDOTAL RECORD
NAME: ________________________________________ GR. & SEC.:
_________________________

DATE/ TIME/
SUBJECT

NARRATIVE

REPORTED BY

SIGNATURE

Republic of the Philippines


Department of Education
Region III- Central Luzon
Tarlac City Schools Division
STO CRISTO INTEGRATED SCHOOL
High School Department
Sto. Cristo, Tarlac City

DATE: __________________

This
is
to
______________________,

confirm

that

_________________________________________

(Name of student)

of

(Grade and

Section)

with his/her parent/guardian Mr/s. ____________________________________________, agreed that


the
(Name of parent/guardian)

student will be temporarily enrolled/under probation in this school for the school year 20___
- 20___
for
the
reason
____________________________________________________________________________.

of

(reason/violation)

Furthermore, the parties agreed that if the student will (again) violate any school
rules and
regulation, he/she will be suspended/dismissed from this institution subject to the approval
of the
school authority/ies.
Signed:
________________________________________
________________________________________
STUDENT

PARENT/GUARDIAN

________________________________________
________________________________________
ADVISER

GUIDANCE COUNSELOR

Conforme:
________________________________________
SCHOOL HEAD/TEACHER-IN-CHARGE

HOME VISITATION FORM


S.Y 20__ - 20__
Date: ____________________
Name of Student_________________________________________ Grade & Section
__________________________
Address __________________________________________________________________________________________

Republic of the Philippines


Department of Education
Region III- Central Luzon
Tarlac City Schools Division
STO CRISTO INTEGRATED SCHOOL
High School Department
Sto. Cristo, Tarlac City

Name of Parent/Guardian_________________________________ Contact Number


__________________________
REASON FOR HOME VISITATION:

REMARKS/AGREEMENT:

_________________________________
____________________________________
PARENTS SIGNATURE OVER PRINTED NAME
OVER PRINTED NAME

STUDENTS SIGNATURE

Noted by:
__________________________________
Guidance Counselor
Prepared by:
__________________________________
Adviser

SIGNED:
_________________________________
School Head/Teacher-inCharge

D I S C I P L I N A RY

AC T I O N

Republic of the Philippines


Department of Education
Region III- Central Luzon
Tarlac City Schools Division
STO CRISTO INTEGRATED SCHOOL
High School Department
Sto. Cristo, Tarlac City

SCHOOL YEAR 20___ - 20 ___


_______________________
NAME OF STUDENT: ________________________________
___________________
ACTION TAKEN/AGREEMENT:

DATE:
GR&SEC:

[e.g Community Service, Home/Working Suspension (Specify Duration),

Dismissal]

REASON/VIOLATION:

Signed:
________________________________________
________________________________________
STUDENT

PARENT/GUARDIAN

________________________________________
________________________________________
ADVISER

GUIDANCE COUNSELOR

Conforme:
________________________________________
SCHOOL HEAD/TEACHER-IN-CHARGE

D I S C I P L I N A RY
SCHOOL YEAR 20___ - 20 ___
_______________________
NAME OF STUDENT: ________________________________
___________________
ACTION TAKEN/AGREEMENT:

AC T I O N
DATE:
GR&SEC:

[e.g Community Service, Home/Working Suspension (Specify Duration),

Dismissal]

REASON/VIOLATION:

Signed:
________________________________________
________________________________________
STUDENT

PARENT/GUARDIAN

Republic of the Philippines


Department of Education
Region III- Central Luzon
Tarlac City Schools Division
STO CRISTO INTEGRATED SCHOOL
High School Department
Sto. Cristo, Tarlac City

________________________________________
________________________________________
ADVISER

GUIDANCE COUNSELOR

Conforme:
________________________________________
SCHOOL HEAD/TEACHER-IN-CHARGE