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FORM 137-E

Republika ng Pilipinas
(Republic of the Philippines)

Kagawaran ng Edukasyon
(Department of Education)

KAWANIHAN NG EDUKASYON ELEMENTARYA


(BUREAU OF ELEMENTARY EDUCATION)

Rehiyon: ________

(Region)

PALAGIANG TALAAN SA MABABANG PAARALAN


(Elementary School Permanent Record)
LRN:_______________________
Pangalan ___________________________________________________________________
Sangay__________________Paaralan______________________________ (Name)
Unang Pangalan

M.I.

(Division)

Apelyido

(School)

Kasarian__________Petsa ng Kapanganakan__________________Pook___________________________________Petsa
ng Pagpasok__________________
(Sex)
Entrance)

(Date of Birth)

(Place)

Bayan/lalawigan/Lunsod

(Date of

(Town/Province/City)

Magulang/Tagapagalaga______________________________________________________________________________________________________
______________
(Parent/Guardian)
Hanapbuhay

Pangalan

Tirahan

(Name)

(Address)

(Occupation)

PAG-UNLAD SA MABABANG PAARALAN


(Elementary School Progress)
Eligible for Admission to
Grade______________________________________________
Grade
ISchool_______________________________________________________
__________
School
Year__________________________________________________________
________
LEARNING AREAS
1

Periodic
Rating
2
3

Remarks
4

Mother Tongue
Filipino
English
Mathematics
Araling Panlipunan
MAPEH
Music
Art
Physical Education
Health
Edukasyon sa
Pagpapakatao (EsP)

Gener
al Average
Eligible for Admission to
Grade______________________________________________
Grade
VSchool_______________________________________________________
________
School
Year__________________________________________________________
________
LEARNING AREAS
1

Gener
al Average
Eligible for Admission to
Grade______________________________________________
Grade
IIISchool_______________________________________________________
_______
School
Year__________________________________________________________
________
LEARNING AREAS
1

Periodic
Rating
2
3

Remarks
4

Periodic
Rating
2
3

Gener
al Average
Eligible
for
admission
_________________________________

Remarks
4

to

Grade

Grade
IISchool_______________________________________________________
_________
School
Year__________________________________________________________
________
LEARNING AREAS
1
Mother Tongue
Filipino
English
Mathematics
Araling Panlipunan
MAPEH
Music
Art

Periodic
Rating
2
3

Remarks
4

Physical Education
Health
Edukasyon sa
Pagpapakatao (EsP)
Gener
al Average
Eligible for Admission to
Grade______________________________________________
Grade
IVSchool_______________________________________________________
________
School
Year__________________________________________________________
________
LEARNING AREAS
1

Periodic
Rating
2
3

Remarks
4

Gener
al Average
Eligible for Admission to
Grade______________________________________________
Grade
VISchool_______________________________________________________
________
School
Year__________________________________________________________
________
LEARNING AREAS
1

Gener
al Average
Eligible for admission to Grade
_________________________________

Periodic
Rating
2
3

Remarks
4

III.

REPORT ON LEARNERS OBSERVED VALUES

Core
Values
1. MakaDiyos
2. Makatao
3. Makakalikasan

4.Makaban
sa

Core
Values
1. MakaDiyos
2. Makatao
3. Makakalikasan

4.Makaban
sa

Behavior Statements

Gr. 1 S.Y.
________________
Quarter
1
2
3
4

Gr. 2 S.Y.
________________
Quarter
1
2
3
4

Gr. 3 S.Y.
________________
Quarter
1
2
3
4

Gr. 4 S.Y.
_______________
Quarter
1
2
3
4

Gr. 5 S.Y.
________________
Quarter
1
2
3
4

Gr. 6 S.Y.
________________
Quarter
1
2
3
4

Expresses ones
spiritual beliefs while
respecting the spiritual
beliefs of others
Shows adherence to
ethical principles by
upholding truth
Cares for the
environment and
utilizes resources
wisely, judiciously, and
economically
Demonstrates pride in
being a Filipino;
exercises the rights
and responsibi-lities of
a Filipino citizen.
Demonstrates
appropriate behavior in
carrying out activities
in the school,
community, and
country

Behavior Statements
Expresses ones
spiritual beliefs while
respecting the spiritual
beliefs of others
Shows adherence to
ethical principles by
upholding truth
Cares for the
environment and
utilizes resources
wisely, judiciously, and
economically
Demonstrates pride in
being a Filipino;
exercises the rights
and responsibi-lities of
a Filipino citizen.
Demonstrates
appropriate behavior in
carrying out activities
in the school,
community, and
country

AO Always Observed
Not Observed

IV.

SO Sometimes Observed

RO Rarely Observed

NO

ATTENDANCE RECORD

Grade

No. of
Schoo
l
Days

No. of
School
Days
Absent

Cause

No. of
Times
Tardy

Cause

No. of
School
Days
Present

CERTIFICATE OF TRANSFER
TO WHOM IT MAY CONCERN:
This is to certify that this is a true record of the Elementary School Permanent Record of
_____________________________________________________. He/She is eligible for transfer and admission of
Grade/Year_____________________.
_____________________________________________
Signature
___________________________________________
____________________________________________
Date
Designation