Form 137-A

Republic of the Philippines

DEPARTMENT OF EDUCATION
NEGROS ISLAND REGION

____________________________________
School
____________________________________
Municipality

SECONDARY STUDENT'S PERMANENT RECORD

Date of Birth: Year______Month_____Day______Sex____

(Surname) (Given Name)
Place of Birth: Province Town Barrio
Parent Guardian:
(Name) (Address) (Occupation)
Elementary course completed School Level Gen. Ave
RECORD OF STANDARD INTELLIGENCE AND ACHIEVEMENT TEST
Score Percentile
Name and Form of Test Name and Form of Test Score Received Percentile Rank
Received Rank

School Level Section

Total number of years in school to date School Year 20_____ - 20 _____

PERIODICAL RATING
Averaging/Cumulative Action Units Extra-curricular
SUBJECT Final Rating Earned Activities
1 2 3 4 Taken
Filipino
English
Mathematics
Science
Araling Panlipunan
EsP
EPP/TLE
MAPEH
Music
Arts
PE
Health

Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May TOTAL
Days of School
Days Present
Has Advance Units in
Lacks Units in
To be Classified as Total number of years in School to date
(Cur. Year)
School School Year 20____ 20____ Section
PERIODICAL RATING
Averaging/Cumulative Action Units Extra-curricular
SUBJECT Final Rating Earned Activities
1 2 3 4 Taken
MTB-MLE (Grades 1 to 3)
Filipino
English
Mathematics
Science
Araling Panlipunan
EsP
EPP/TLE
MAPEH
Music
Arts
PE
Health

Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May TOTAL
Days of School
Days Present
Has Advance Units in
Lacks Units in
To be Classified as Total number of years in School to date
(Cur. Year)
NAME
(Surname) (First Name)
School School Year 20____ 20____ Section
PERIODICAL RATING
Averaging/Cumulative Action Units Extra-curricular
SUBJECT Final Rating Earned Activities
1 2 3 4 Taken
Filipino
English
Mathematics
Science
Araling Panlipunan
EsP
EPP/TLE
MAPEH
Music
Arts
PE
Health

Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May TOTAL
Days of School
Days Present
Has Advance Units in
Lacks Units in
To be Classified as Total number of years in School to date
(Cur. Year)
School School Year 20____ 20____ Section
PERIODICAL RATING
Averaging/Cumulative Action Units Extra-curricular
SUBJECT Final Rating Earned Activities
1 2 3 4 Taken
Filipino
English
Mathematics
Science
Araling Panlipunan
EsP
EPP/TLE
MAPEH
Music
Arts
PE
Health

Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May TOTAL
Days of School
Days Present
Has Advance Units in
Lacks Units in
To be Classified as Total number of years in School to date
(Cur. Year)
REPORT ON LEARNER'S OBSERVED VALUES
Quarter
Core Values Behavior Statements
1 2 3 4
Expresses one's spiritual beliefs while
1. MAKA-DIYOS respecting the spiritual beliefs of others
Shows adherence to ethical principles by upholding truth
Is sensitive to individual, social, and cultural differences
2. MAKATAO
Demonstrates contributions towards solidarity
Cares for the environment and utilizes resources wisely,
3. MAKAKALIKASAN
judiciously, and economically
Demonstrates pride in being a Filipino; exercises
the rights and responsibilities of a Filipino citizen
4. MAKABANSA
Demonstrates appropriate behavior in carrying out
activities in the school, community, and country

CERTIFICATE OF TRANSFER

To Whom It May Concern:

I certify that this is a true record of , the student is eligible, on this day of
, 20______, for admission to the year as a regular/an irregular and had no
money or property responsibility in this school.
Remarks

(Principal)

Copy of this record sent to principal of School

on , 20 .
(Principal)