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School Form 1 (SF 1) School Register

(This replace Form 1, Master List & STS Form 2-Family Background and Profile)

School ID School Name

136439

Region NCR
Isabelo delos Reyes Elementary School AGE as of

Division

Manila

District
2013-2014

School Year

Grade Level

Three

SECTION

ADDRESS

NAME OF PARENTS

LRN

NAME (Last Name, First Name, Middle Name)

BIRTH DATE Sex (M/F) (mm/ dd/yy) (nos. of years as per last birthday)
Male Male Male Male Male Male Male Male Male Male Male Male Male Male Male Male Male Male Male Male Male Male Male Female Female Female 10/1/04 11/25/04 10/26/03 10/22/04 5/5/05 1/29/05 3/29/05 10/19/02 10/23/04 8/19/04 1/23/05 6/28/05 8/19/00 7/1/04 7/6/03 8/31/04 7/23/05 7/3/04 4/11/04 6/24/05 10/14/04 5/30/05 10/17/05 5/7/04 5/27/05 11/18/04 8 8 9 8 8 8 8 10 8 8 8 8 13 9 9 9 8 9 9 8 8 8 7 9 8 8

BIRTH PLACE (Province)

MOTHER TONGUE

IP (Specify Ethnic Group)

RELIGION

House # / Street/Sitio/ Purok


313 Balagtas 1151 Asuncion 775 A Pavia 1207 J. Abad Santos 192 Tayuman 1329 A. Buro 1318 C.P.Garcia 374 Matiisin 920 K. San Antonio 1211 Tagumpay 864 Prudencia 355 Lakandula 659 Raja Matanda 358 K Sta. Margarita 293 Ibarra 1050 Carmen Planas 225 Sandico 1232 Mithi 392 B. Lakandula 1216 Wagas 309 Zabala 1033 Carmen 1238 Kagitingan 1192 Kasipagan 1329 B. Abad Santos Bldg.D Rm. 206 Sambahayan

Barangay

Municipality/ City

Province

Father (1st name only if family name identical to learner)


Luis Jr. Alejandro Romel

Mother (Maiden)

1 136439100349 2 136439100344 3 136439100375 4 136439100379 5 136439100408 6 136439100383 7 136439100493 8 136439100404 9 136439100414 10 136439100421 11 136439100441 12 136439100443 13 136439100445 14 136439100464 15 136439100478 16 136439100504 17 136439100515 18 136439100498 19 136439100532 20 136439100537 21 136439100544 22 136439100592 23 136439100548 24 136439100251 25 13643912175 26 136439100261

De-Juras, Luis III Quiton de Vera, Allen Andrei Moquia Diaz, Gokienick Dimaranan,Christian Jarwin Santos Dia, Jaden Kyler Buensalida Discar, Carl John Jurilla Divinagracia, Axcelle Calixtro Enciso, Ron Jayson De Guzman Espaola, Jade Marco Sacdalan Espinosa, Ace Bernard Casas Fajardo, Dave Pleno Fajardo, Maurice Jay Lim Farrer, Orlando Jr. Adan Francia, Victor Umpacan Fuerte, Noel Christopher Salapi Gannaban, Rhedd Balatbat Garcia, Joaquin Flores Gelves, Lawrence Dela Cruz Golez, Mike Placencia Gonzaga, John Vincent Ramos Guanzon, Reylour Alcantara Guelas, Dhel Elieser Raquio Guevara, Jenicis Valiente Catacutan, Mary Joy Silvestre Celestino, Johanna Maris Brozo Cervantes, Norena Leonardo

Manila Manila Manila Manila Manila Manila Manila Manila Manila Manila Manila Manila Manila Manila Manila Manila Manila Manila Manila Manila Manila Ilocos Sur Manila Manila Manila Manila

Tagalog Tagalog Tagalog Tagalog Tagalog Ilonga Tagalog Tagalog Tagalog Tagalog Tagalog Tagalog Tagalog Tagalog Tagalog Tagalog Tagalog Tagalog Tagalog Tagalog Tagalog Tagalog Tagalog Tagalog Tagalog Tagalog

Catholic Catholic Catholic Catholic Iglesia Catholic Jehovah Catholic Catholic Catholic Catholic Catholic Catholic Catholic Catholic Catholic Catholic Catholic Catholic Catholic Catholic Catholic Catholic Catholic Catholic Catholic

31 35

Manila Manila Manila

Jasmin S. Quiton Teresita Moquia Catalina Diaz

36

Manila Manila Manila Manila Manila Bulacan Joseph Bernardo Alberto Ricardo Pangasinan Orlando Sr. Hipolito Noel Edgardo Ildefonso Jr. Cyril Joseph Renato Russ Rodel Francis Pedro Jonathan Noli Iloilo Allan Isidro Fleurdeliz S. Buensalida Rubylyn Jurilla Annalee Calixtro Susana D. Enciso Marites F. Sacdalan Marilou C. Casas Maria Noulida Pleno Jamie A. Lim Violeta Adan Sally Umpacan Luciana D. Salapi Joana Balatbat Eleonor Flores Ma. Christina Dela Cruz Evelyn T. Placencia Arlene Ramos Glenda L. Alcantara Marilyn A. Raquio Jennifer D. Valiente Marivic C. Silvestre Maristella Brozo Annabelle Leonardo

13

Manila Manila

51 35 7

Manila Manila Manila Manila Manila Manila Manila

41

Manila Manila Manila

31

Manila Manila Manila Manila

72

Manila Manila

AGE as of ADDRESS NAME OF PARENTS NAME (Last Name, First Name, Middle Name) BIRTH DATE Sex (M/F) (mm/ dd/yy) (nos. of years as per last birthday)
Female Female 4/17/05 5/21/05 8 8

LRN

BIRTH PLACE (Province)

MOTHER TONGUE

IP (Specify Ethnic Group)

RELIGION

House # / Street/Sitio/ Purok


1121 Juan Luna 106 JV Paz Comp.

Barangay

Municipality/ City

Province

Father (1st name only if family name identical to learner)

Mother (Maiden)

27 136439100265 28 136439100275

Clavines, Ira Marie Yape Corpuz, Elyssa Cortes

Manila Quezon

Tagalog Tagalog

Catholic Catholic

6 123

Manila Manila

Samar

Efren Arnel

Ana Marie Yape Carren G. Cortes

29 136439100306 30 136439100306 31 136439100329 32 136439100311 33 136439100312 34 136439100329 35 136439100333 36 136439100334 37 136439100372 38 131279120319 39 136439100377 40 136439121576 41 136439121577 42 136439100396 43 136439100409

Crisostomo, Marian Gail Tornea Daguman, Alexsandra Libanan Dapoc, Khyla Cuerdo Dasigan, Rachelle Dataro, Althea Bianca Escao De Guzman, Danna Aolivienn Bartolome De Guzman, Shiela Mae Reyes De Guzman, Uriah Grace Nono Derejino, Manilyn Padual Diaz, Mary Ann Baricuatro Dignos, Sandra Nicole Garcia Dimafelix, Jaira Kyla San Juan Dula, Mhiles Thrixie Ojales Dumiigpi, Eunice Casiedo Escober, Allysa Jermaine Teodoro

Female Female Female Female Female Female Female Female Female Female Female Female Female Female Female

12/31/04 4/17/05 8/21/05 10/20/01 12/22/04 10/29/04 12/29/03 8/28/04 8/23/04 12/28/04 3/3/05 11/6/04 10/13/05 9/25/05 8/23/05

8 8 8 11 8 8 9 8 8 8 8 8 8 7 7

Manila Manila Batangas Manila Manila Manila Pangasinan Manila Manila

Tagalog Tagalog Tagalog Tagalog Tagalog Tagalog Tagalog Tagalog Tagalog

Catholic Catholic Catholic Iglesia Catholic Catholic Catholic Catholic Catholic Catholic Catholic Catholic Catholic Catholic Catholic

Blk.2 l.4 Model Comp. 331 Ibarra 309 Lallana 322 P. Ortega 335 CM Recto 770 Coral 882 Yangco Mrkt. Tabora 524 N. Zamora 1201 Sandico 1374 Madrid Blk.8 L.13 Model Comp. 1146 Camba 1153 P. Soriano 352 B. Matiisin 291 Matimtiman 35 35 33 33

Manila Manila Manila Manila Manila Manila Manila Manila Manila Manila Manila Manila Manila Manila Manila

Aklan

Adrian Sheigfred Jojo Francisco Edwin C. Llusala Randy Lou Ricardo Eduardo Dennis Milvin Leonardo Joel

Martha T. Tornea Joan C. Libanan Nelsa P. Cuerdo Imelda R. Dasigan Jeanilyn M. Escao Eloisa Bartolome Araceli G. Reyes Dorcas I. Nono Janet A. Padual Nancy D. Baricuatro Julie Ann B. Garcia Joan San Juan Mariecris J. Ojales Bea T. Casiedo Ricsan Jessica A. Teodoro

General Santos City Tagalog Manila Manila Manila Manila Manila Tagalog Tagalog Tagalog Tagalog Tagalog

Bulacan Samar

Jessie Jr. Eleazar Alejandro Fil Anton

List and code of Indicators under REMARK column


Indicator
Transferred Out Transferred IN Dropped

Code
T/O T/I DRP

Required Information
Name of Public (P) Private (PR) School & Effectivity Date Name of Public (P) Private (PR) School & Effectivity Date Reason and Effectivity Date

Indicator
CCT Recipient

Code
CCT B/A LWD ACL

Required Information
CCT Control/reference number & Effectivity Date Name of school last attended & Year
MALE FEMALE TOTAL

BoSY
23 20 43

EoSY
23

Prepared by:

RUTH T. LUCINA 20 43
(Signature of Adviser over Printed Name)

Balik-Aral Learner With Dissability Accelarated

Date: August 9, 2013

Camachille

GUARDIAN (If not Parent)

REMARK/S

Name

Relationship

Contact Number

(Please refer to the legend on last page)

9453903

Esmeralda R. Santos

grandmother

9156562223

9288712442 9224601084 9199635385 9305756929

9071416692 9287922375 9238912318

9168277115

Erlinda Guanzon

Auntie

9156883921 9496569761 2428486

Alma S. Mangalos

Auntie

9097237205 9478430231

GUARDIAN (If not Parent)

REMARK/S

Name

Relationship

Contact Number

(Please refer to the legend on last page)

9235368369 9981652523

Marlon Libanan

Uncle

9198909239 9187333099 9485723713

Lita Escao

Grandmother

9487821709 9234686170

9996655831

9072272541 9225275450

d by:

Certified Correct:

T. LUCINA

TRINIDAD R. GALANG
(Signature of School Head over Printed Name)

ture of Adviser over Printed Name)

ust 9, 2013

Date: August 9, 2013

School Form 2 (SF2) Daily Attendance Report for learner


(This cancel Form 1, Form 2 & STS Form 4 - Absenteeism and Dropout Profile)

School ID Name of School


*LEARNER'S NAME (Last Name, First Name, Middle Name)
1
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

School Year

Month Reporting
Grade Level
DATE (1st row for date, 2nd row for Day: M,T,W,TH,F)

Section
29
M

1
M

2
T

3
W

4
TH

5
F

8
M

9
T

10
W

11
TH

12
F

15
M

16
T

17
W

18
TH

19
F

22
M

23
T

24
W

25
TH

26
F

30
T

31
W

Total for the Month ABSENT TARDY

REMARK/S (If DROPPED OUT, state reason, please refer to legend number 2. If TRANSFERRED IN/OUT, write the name of School.)

MALE | TOTAL Per Day

TH

TH

TH

TH

1
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

FEMALE | DAILY TOTAL

Combined TOTAL PER DAY

*LEARNER'S NAME (Last Name, First Name, Middle Name)

DATE (1st row for date, 2nd row for Day: M,T,W,TH,F) 1 2 3 4 5 8 9 10 11 12 15 16 17 18 19 22 23 24 25 26 29 30 31

Total for the Month ABSENT TARDY

REMARK/S (If DROPPED OUT, state reason, please refer to legend number 2. If TRANSFERRED IN/OUT, write the name of School.)

TH

TH

TH

TH

* Automatic Generation thru LIS

*LEARNER'S NAME (Last Name, First Name, Middle Name)


GUIDELINES:

DATE (1st row for date, 2nd row for Day: M,T,W,TH,F) 1 2 3 4 5 8 9 10 11 12 15 16 17 18 19 22 23 24 25 26 29 30 31

Total for the Month ABSENT TARDY


Month:

REMARK/S (If DROPPED OUT, state reason, please refer to legend number 2. If TRANSFERRED IN/OUT, write the name of School.)
No. of Days of Classes:

1. CODES FOR CHECKING ATTENDANCE blank- Present; (x)- Absent; Tardy (half shaded= Upper for Late Commer, Lower for Cutting Classes)

Summary for the Month


M F TOTAL

1. The attendance shall be accomplished daily. Refer to the codes for checking learners' attendance. 2. Dates shall be written in the preceding columns beside Learner's Name. 3. To compute the following: Registered Learner as of End of the Month a. Percentage of Enrolment = Enrolment as of July Total Daily Attendance b. Average Daily Attendance = Number of School Days Average daily attendance Percentage of Attendance for the month = c. Registered Learner as of End of the month 4. Every End of the month, the teacher/adviser submit this form to the office of the principal for recording of summary table into the Form 3. Once signed by the principal, this form should be returned to the adviser. 5. Attendance performance of learner is expected to reflect in Form 137 and Form 138 every grading period * Beginning of School Year cut-off report is every 1st Friday of School Calendar Days

* Enrolment as of Registered Learner as of end of the month *Percentage of Enrolment as of

x 100

x 100

School Form 2: Page 2 of ________

2. REASONS/CAUSES OF DROP-OUTS a. Domestic-Related Factors a.1. Had to take care of siblings a.2. Early marriage/pregnancy a.3. Parents' attitude toward schooling a.4. Family problems b. Individual-Related Factors b.1. Illness b.2. Overage b.3. Death b.4. Drug Abuse b.5. Poor academic performance b.6. Lack of interest/Distractions b.7. Hunger/Malnutrition c. School-Related Factors c.1. Teacher Factor c.2. Physical condition of classroom c.3. Peer influence d. Geographic/Environmental d.1. Distance between home and school d.2. Armed conflict (incl. Tribal wars & clan feuds) d.3. Calamities/Disasters e. Financial-Related e.1. Child labor, work f. Others

Average Daily Attendance Percentage of Attendance for the month Number of students with 5 consecutive days of absences:
Drop out Transferred out Transferred in I certify that this is a true and correct report. RUTH T. LUCINA (Signature of Teacher over Printed Name) Attested by: TRINIDAD R. GALANG (Signature of School Head over Printed Name)

School Form 3 (SF3) Books Issued and Returned


(This replace Form 1 & Inventory of Text Book)

School ID School Name

136439 Isabelo delos Reyes Elementary School


Subject Area & Title Filipino / Bagong Filipino (pagbasa) Date: 6-3-13 Issued Returned

School Year

2013-2014

Grade Level Three


Subject Area & Title Filipino / Bagong Filipino (wika) Date: 6-3-13 Issued Returned

Section

Camachille
Subject Area & Title English / English for All Times (language) Date: 6-3-13 Issued Returned Subject Area & Title Developmental Reading Power Date: 6-3-13 Issued Returned

NO.

*LEARNER'S NAME (Last Name, First Name, Middle Name)

Subject Area & Title Subject Area & Title Subject Area & Title Subject Area & Title Math / Mathematics for GMRC / Ugali at Asal Makabayan / Masipag Science / Science and Everyday Use na Pilipino Health Date: 6-3-13 Issued Returned Date: 6-3-13 Issued Returned Date: 6-3-13 Issued Returned Date: 6-3-13 Issued Returned

1 2 3 4 5 6 7 8 9

De-Juras, Luis III Quiton de Vera, Allen Andrei Moquia Diaz, Gokienick Dimaranan,Christian Jarwin Santos Dia, Jaden Kyler Buensalida Discar, Carl John Jurilla Divinagracia, Axcelle Calixtro Enciso, Ron Jayson De Guzman Espaola, Jade Marco Sacdalan

10 Espinosa, Ace Bernard Casas 11 Fajardo, Dave Pleno 12 Fajardo, Maurice Jay Lim 13 Farrer, Orlando Jr. Adan 14 Francia, Victor Umpacan 15 Fuerte, Noel Christopher Salapi 16 Gannaban, Rhedd Balatbat 17 Garcia, Joaquin Flores 18 Gelves, Lawrence Dela Cruz 19 Golez, Mike Placencia 20 Gonzaga, John Vincent Ramos 21 Guanzon, Reylour Alcantara 22 Guelas, Dhel Elieser Raquio

NO.

*LEARNER'S NAME (Last Name, First Name, Middle Name)

Subject Area & Title Filipino / Bagong Filipino (pagbasa) Date: 6-3-13 Issued Returned

Subject Area & Title Filipino / Bagong Filipino (wika) Date: 6-3-13 Issued Returned

Subject Area & Title Subject Area & Title Subject Area & Title Subject Area & Title Math / Mathematics for GMRC / Ugali at Asal Makabayan / Masipag Science / Science and Everyday Use na Pilipino Health Date: 6-3-13 Issued Returned Date: 6-3-13 Issued Returned Date: 6-3-13 Issued Returned Date: 6-3-13 Issued Returned

Subject Area & Title English / English for All Times (language) Date: 6-3-13 Issued Returned

Subject Area & Title Developmental Reading Power Date: 6-3-13 Issued Returned

De-Juras, Jenicis Luis IIIValiente Quiton 23 Guevara, TOTAL FOR MALE 1 2 3 4 5 6 7 8 9 Catacutan, Mary Joy Silvestre Celestino, Johanna Maris Brozo Cervantes, Norena Leonardo Clavines, Ira Marie Yape Corpuz, Elyssa Cortes Crisostomo, Marian Gail Tornea Daguman, Alexsandra Libanan Dapoc, Khyla Cuerdo Dasigan, Rachelle | TOTAL COPIES

10 Dataro, Althea Bianca Escao 11 De Guzman, Danna Aolivienn Bartolome 12 De Guzman, Shiela Mae Reyes 13 De Guzman, Uriah Grace Nono 14 Derejino, Manilyn Padual 15 Diaz, Mary Ann Baricuatro 16 Dignos, Sandra Nicole Garcia 17 18 19 20 Dimafelix, Jaira Kyla San Juan Dula, Mhiles Thrixie Ojales Dumiigpi, Eunice Casiedo Escober, Allysa Jermaine Teodoro TOTAL FOR FEMALE TOTAL LEARNERS | TOTAL COPIES | TOTAL COPIES
Prepared By: RUTH T. LUCINA (Signature over printed name)

* Automatic Generation thru LIS

GUIDELINES: 1. Title of Books Issued to each learner must be recorded by the class adviser. 2. The Date of Issuance and the Date of Return shall be reflected in the form. 3. The Total Number of Copies issued at BoSY shall be reflected in the form. 4. The Total Number of Copies of Books Returned at the EoSYshall be reflected in the form.

School Form 3: Page 2 of ________

Region:

Division:

District

School Form 4 (SF4) Monthly Learner's Movement and Attendance


(This replace Form 3 & STS Form 4-Absenteeism and Dropout Profile) Region Division District

School ID School Name


REGISTERED LEARNER (As of End of the Month) M F T M ATTENDANCE DROPPED OUT (A) Cumulative as (B) For the Month of Previous Month T M F T M F T

School Year
TRANSFERRED OUT

Month Reporting
TRANSFERRED IN

NAME OF ADVISER

GRADE/ YEAR LEVEL

SECTION

Average
F T

Percentage M F

(A+B) Cumulative (A+B) Cumulative (A+B) (A) Cumulative as (A) Cumulative as as of End of the (B) For the Month as of End of the (B) For the Month Cumulative as of of Previous Month of Previous Month Month Month End of the Month M F T M F T M F T M F T M F T M F T M F T

ELEMENTARY/SECONDARY: KINDER GRADE 1/GRADE 7 GRADE 2/GRADE 8 GRADE 3/GRADE 9 GRADE 4/GRADE 10 GRADE 5/GRADE 11 GRADE 6/GRADE 12 TOTAL FOR NON-GRADED TOTAL # Need home visitation as per DECS Service Manual (page, section) GUIDELINES: 1. This forms shall be accomplished every end of the month using the summary box of Form 1 submitted by the teachers/advisers to update figures for the month. Columns for "Cumulative as of Previous Month" require the figures in "cumulative total reported from previous month". 2. Furnish copy to Division Office: a week after July 31, October 30 & March 31 3. Teachers who are handling advisory class shall be reported. 4. Small school that has one section per grade/year level are not required to fill the columns "Name of Adviser, Grade/Year Level & Section". Instead, they will only accomplish the summary column per grade/year level. Prepared and Submitted by:

(Signature of School Head over Printed Name)

School Form 5 (SF 5) Report on Promotion & Level of Proficiency


(This replace Forms 18-E1, 18-E2, 18A)

Region
School ID School Name

Division School Year

District Curriculum
Grade Level Section

LRN

LEARNER'S NAME (Last Name, First Name, Middle Name)

GENERAL AVERAGE (Numerical Value in 3 decimal places)

ACTION TAKEN: PROMOTED or RETAINED (RBEC only)

INCOMPLETE SUBJECT/S (This column is for K to 12 Curriculum and remaining RBEC in High School. Elementary grades level that still implementing RBEC need not to fill up this column) Completed as of end of current SY as of End of the current SY

SUMMARY TABLE
MALE FEMALE TOTAL

PROMOTED

RETAINED

LEVEL OF PROFICIENCY
MALE FEMALE TOTAL

BEGINNNING (B: 74% and below) DEVELOPING (D: 75%-79%)

APPROACHING PROFICIENCY (AP: 80%-84%)

PROFICIENT (P: 85% -89%) ADVANCED (A: 90% and above)

LRN

LEARNER'S NAME (Last Name, First Name, Middle Name)

GENERAL AVERAGE (Numerical Value in 3 decimal places)

ACTION TAKEN: PROMOTED or RETAINED (RBEC only)

INCOMPLETE SUBJECT/S (This column is for K to 12 Curriculum and remaining RBEC in High School. Elementary grades level that still implementing RBEC need not to fill up this column) Completed as of end of current SY as of End of the current SY

TOTAL MALE

PREPARED BY:

DANALYN V. SERVILLON Class Adviser (Name and Signature)

CERTIFIED CORRECT & SUBMITTED:

School Head (Name and Signature)

GUIDELINES: 1. For All Grades Level 2. To be prepared by the Adviser. Final rating per subject area should be taken from the record of subject teacher. The class adviser should make the computation of General Average. 2. On the summary table, reflect the total number of learners promoted, retained and the level of proficiency according to the individual general average TOTAL FEMALE COMBINED 3. Must tallied with the total enrollment report as of End of School Year GESP /GSSP (BEIS)

LRN

LEARNER'S NAME (Last Name, First Name, Middle Name)

GENERAL AVERAGE (Numerical Value in 3 decimal places)

ACTION TAKEN: PROMOTED or RETAINED (RBEC only)

INCOMPLETE SUBJECT/S (This column is for K to 12 Curriculum and remaining RBEC in High School. Elementary grades level that still implementing RBEC need not to fill up this column) Completed as of end of current SY as of End of the current SY

* May generate thru Learner's Information System or may lift from Master List of Learners.
School Form 5: Page 2 of ________

School Form 6 (SF6) Summarized Report on Promotion and Level of Proficiency


(This cancel Form 20)

School ID School Name


GRADE 1 / GRADE 7 GRADE 2 / GRADE 8

Region

Division District
School Year
GRADE 5 / GRADE 11 GRADE 6 / GRADE 12 TOTAL

SUMMARY TABLE

GRADE 3 / GRADE 9

GRADE 4 / GRADE 10

MALE PROMOTED RETAINED (RBEC) LEVEL OF PROFICIENCY MALE

FEMALE

TOTAL

MALE

FEMALE

TOTAL

MALE

FEMALE

TOTAL

MALE FEMALE

TOTAL MALE

FEMALE

TOTAL

MALE

FEMALE

TOTAL

MALE

FEMALE

TOTAL

FEMALE

TOTAL

MALE

FEMALE

TOTAL

MALE

FEMALE

TOTAL

MALE FEMALE

TOTAL MALE

FEMALE

TOTAL

MALE

FEMALE

TOTAL

MALE

FEMALE

TOTAL

Nos. of BEGINNNING (B: 74% and below) Nos. of DEVELOPING (D: 75%-79%) Nos. of APPROACHING PROFICIENCY (AP: 80%-84%) Nos. of PROFICIENT (P: 85% -89%) Nos. of ADVANCED (A: 90% and above)
TOTAL

Prepared and Submitted by: SCHOOL HEAD

Reviewed & Validated by: DPO/EPS

Noted by: SCHOOLS DIVISION SUPERINTENDENT

GUIDELINES: 1. After receiving and validating the Report for Promotion submitted by the class adviser, the School Head shall compute the Total for Grade Level in order to reflect the result in each data field. 2. This report together with the copy of Report for Promotion submitted by the class adviser shall be forwarded to the Division Office by the end of the school year. 3. The Report on Promotion per Grade Level is reflected in the End of School Year Report of GESP/GSSP

School Form 7 (SF7) School Personnel Assignment List and Basic Profile
(This replace Form 12-Monthly Status Report for Teachers, Form 19-Assignment List, Form 29-Teacher Program and Form 31-Summary Information of Teachers)

School ID School Name


(A) Nationally-Funded Teaching Related Items Title of Plantilla Position (as appeared in the appointment document) Number of Incumbent

Region

Division District
Number of Incumbent Nature of Appointment and Designation (Contractual, Substitute, Volunteer & others) KINDER

School Year
(C ) Other Appointments Fund Source LOCALLY FUNDED Number of Incumbent NonTeaching Teaching 1

(B) Nationally-Funded Non Teaching Items Title of Plantilla Position (as appeared in the appointment document)

EDUCATIONAL QUALIFICATION Name of School Personnel No. (Arrange by Position, Descending) Sex Fund Source Position/ Designation Nature of Appointment

Degree / Post Graduate

Major/ Specialization

Minor

Subject Taught (include Grade & Section) & Other Ancillary Assignment (Please Specify)

* Daily Program (time duration) Actual Teaching/ Service Render (Mins/Day) Remark/s (For Detailed Items, Indicate name of school/office, For IP's Ethnicity)

DAY

From

To

Ave. Minutes per Day

Ave. Minutes per Day

EDUCATIONAL QUALIFICATION Name of School Personnel No. (Arrange by Position, Descending) Sex Fund Source Position/ Designation Nature of Appointment

Degree / Post Graduate

Major/ Specialization

Minor

Subject Taught (include Grade & Section) & Other Ancillary Assignment (Please Specify)

* Daily Program (time duration) Actual Teaching/ Service Render (Mins/Day) Remark/s (For Detailed Items, Indicate name of school/office, For IP's Ethnicity)

DAY

From

To

Ave. Minutes per Day

Ave. Minutes per Day

Ave. Minutes per Day

Ave. Minutes per Day

Ave. Minutes per Day

Ave. Minutes per Day GUIDELINES: 1. This form shall be accomplished at the beginning of the school year by the school head. In case of movement of teachers and other personnel during SY, updated Form 19 must submit to the Division Office . 2. All school personnel, regardless of position/nature of appointment should be included in this form and should be listed from the highest rank down to the lowest. This form shall also serve as inventory list of school personnel. 3. * Daily Program Column is for teaching personnel only Submitted by:

(Signature of School Head over Printed Name) School Form 7, Page 2 of ________

Republic of the Philippines Department of Education Region: _____________________________ Division : ____________________________ School: _______________________________ LEARNER DATA SHEET Pls. Check: ( ) Transferee ( ) Balik-Aral ( ) Private ( ) Public Name of Previous School: _________________________________________________________ Division: ______________________________ Province/Region : ______________________________ A. PERSONAL DATA (to be accomplished by the parent/pupil during enrolment) Name of Learner: ______________________________________ LRN: __________________ Date of Birth : _________________________________ Place of Birth : ____________________ Sex: ___________ Current Address/Residence: SY House #/Street Barangay SY SY SY SY SY Nationality: __________________________ Religion: ______________ Name of Father: _______________________________ Occupation : ___________________ Highest Educational Attainment of Father: ______________________________ Name of Mother: _______________________________ Occupation : ______________________ Highest Educational Attainment of Mother: ______________________________ Name of Guardian (if Guardian is not the parent): ______________________________________ Relationship to Guardian: ________________________________ Contact Number of Parents/Guardian: _________________________________ Currently living with at least one of the parents : ( ) yes ( ) no Dialect use to communicate within the family: ______________________ Recipient of 4P's* : Yes/ No SY SY SY SY *Programang Pantawid ng Pamilyang Pilipino SY SY B. MEDICAL / HEALTH RECORD (annual updating by the health officer/teacher) b.1 Nutritional Status SY_____ SY_____ SY_____ SY_____ SY_____ Weight (kg) Height (m) Body Mass Index (BMI) Nutritional Status (e.g.Normal,Below Normal,Above Normal,Severely Wasted) b.2 Learner's record of ailments: (pls. check) (to be examined by the nurse) SY_____ SY_____ SY_____ SY_____ SY_____ ( ) Pediculosis ( ) Tinea Flava ( ) Scabies ( ) Eye infection ( ) Squinting eyes ( ) Otitis Media ( ) Impacted Cerumen ( ) Colds/Cough ( ) Sinusitis ( ) Ringworm ( ) Nosebleed ( ) Decayed Tooth ( ) defective speech ( ) Sore Throat ( ) Tonsilitis ( ) Asthma ( ) Allergy ( ) Bronchitis ( ) Primary Complex ( ) Convulsions ( ) Frequent headache ( ) Heart problem ( ) Frequent Stomach Ache Other illness(specify):

Municipality/Province

SY_____

SY_____

SY_____

SY_____

*Order of ailments (eyes, ears, etc.)

b.3 Immunization

Learner's immunization shots are complete and current: yes /no SY b.4 Physical Fitness and Sports Talent Test (PFSTT) SY_____ SY_____ SY_____ b.4.1. Muscular Fitness Partial: Curl Ups Trunk: Lift (cm) 90-Degrees push- ups b.4.2. Flexibility Fitness Sit and Reach Left leg bent (cm) Right leg bent (cm) Shoulder Flexibility Right arm up (cm) Left arm up (cm) b.4.3. Physiological Fitness 1km run - Time: (min/sec) b.5. Sports Talents b.5.1 Anthropometrics Sitting Height (cm) Arm Span (cm) b.5.2. Muscular Power Standing Long Jump (m) Basketball Pass (m) b.5.3 Speed 40-meter sprint (sec.) C. FAMILY& COMMUNITY PROFILE

SY SY_____

SY_____

SY_____

SY_____

*to be commented by PE Teachers

Type of community ( ) Residential ( ) Commercial ( )Agricultural ( ) Industrial ( ) Fishing Disaster Prone/ Armmed Conflict ( ) Yes ( ) No Identified as IP Community? If yes, specify: _____________________________________________ With electrical services (Home) ( ) Yes ( ) No With water services (Home) ( ) Yes ( ) No Distance of Home from/to school: ___________ (km) Estimated time in going to school : ______ (hour) Means of going to school: ( ) walking ( ) by boat ( ) vehicles D. EDUCATIONAL PROFILE (see attached Form 137)

( ) Mining

GUIDELINE: The Learner Data Sheet shall be accomplish by the parent/pupil during enrolment. While, the medical/health record shall be accomplish by the