Form 137-A

Republic of the Philippines

DEPARTMENT OF EDUCATION
National Central Region
Division of Caloocan City
Cielito Zamora High School Annex II
Mahogany St. Cristina Homes, Camarin, Caloocan City

SECONDARY STUDENT'S PERMANENT RECORD

Name 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
SECONDARY STUDENT PERMANENT RECORD

School Level Section

School Year 20_____ - 20 _____
PERIODICAL RATING
Action Units Extra-curricular
SUBJECT Averaging/Cumulative Final Rating
1 2 3 4 Taken Earned Activities
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
To be Classified as
(Cur. Year )
School School Year 20____ - 20____ Section
PERIODICAL RATING Action Units
SUBJECT Final Rating
1 2 3 4 Taken Earned
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)

(Surname) (First Name)

School Year 20____ - 20____ Section
School
 PERIODICAL RATING Action Units Extra-curricular
SUBJECT Final Rating
SUBJECT Final Rating
1 2 3 4 Taken Earned Activities
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 A 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 Action Units Extra-curricular
SUBJECT Final Rating
1 2 3 4 Taken Earned Activities
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 respecting
1. MAKA-DIYOS 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:
, the student is eligible, on this
, 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)
I certify that this is a true record of day of