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FORM 137-E

Republika ng Pilipinas
(Republic of the Philippines)
Kagawaran ng Edukasyon
(Department of Education)
Rehiyon: IV-A

PALAGIANG TALAAN SA MABABANG PAARALAN


(Elementary School Permanent Record) LRN:_______________________

Pangalan ___________________________________________________________________ Sangay__________________Paaralan______________________________


(Name) Apelyido Unang Pangalan M.I. (Division) (School)

Kasarian__________Petsa ng Kapanganakan__________________Pook___________________________________Petsa ng Pagpasok__________________


(Sex) (Date of Birth) (Place) Bayan/lalawigan/Lunsod (Date of Entrance)
(Town/Province/City)
Magulang/Tagapag-alaga____________________________________________________________________________________________________________________
(Parent/Guardian) Pangalan Tirahan Hanapbuhay
(Name) (Address) (Occupation)

PAG-UNLAD SA MABABANG PAARALAN


(Elementary School Progress)

Eligible for Admission to Grade______________________________________________ Grade II-School________________________________________________________________


Grade I-School_________________________________________________________________ School Year__________________________________________________________________
School Year__________________________________________________________________
Periodic Rating
LEARNING AREAS Remarks
Periodic Rating 1 2 3 4
LEARNING AREAS Remarks
1 2 3 4 Mother Tongue
Mother Tongue Filipino
Filipino English
English Mathematics
Mathematics Araling Panlipunan
Araling Panlipunan MAPEH
MAPEH Music
Music Art
Art Physical Education
Physical Education Health
Health Edukasyon sa Pagpapakatao (EsP)
Edukasyon sa Pagpapakatao (EsP) General Average
General Average Eligible for Admission to Grade______________________________________________
Eligible for Admission to Grade______________________________________________
Grade IV-School_______________________________________________________________
Grade III-School______________________________________________________________ School Year__________________________________________________________________
School Year__________________________________________________________________ Periodic Rating
Periodic Rating LEARNING AREAS Remarks
LEARNING AREAS Remarks 1 2 3 4
1 2 3 4

General Average
General Average Eligible for Admission to Grade______________________________________________
Eligible for Admission to Grade______________________________________________
Grade VI-School_______________________________________________________________
Grade V-School_______________________________________________________________ School Year__________________________________________________________________
School Year__________________________________________________________________
Periodic Rating
LEARNING AREAS Remarks
Periodic Rating 1 2 3 4
LEARNING AREAS Remarks
1 2 3 4

General Average
General Average Eligible for admission to Grade _________________________________
Eligible for admission to Grade _________________________________
III. REPORT ON LEARNER’S OBSERVED VALUES
Gr. 1 S.Y. ________________ Gr. 2 S.Y. ________________ Gr. 3 S.Y. ________________
Core Values Quarter Quarter Quarter
Behavior Statements
1 2 3 4 1 2 3 4 1 2 3 4
Expresses one’s spiritual
1. Maka- beliefs while respecting the
Diyos spiritual beliefs of others
Shows adherence to ethical
2. Makatao principles by upholding
truth
Cares for the environment
3. Maka- and utilizes resources
kalikasan wisely, judiciously, and
economically
Demonstrates pride in
being a Filipino; exercises
the rights and responsibi-
4.Makabansa lities of a Filipino citizen.
Demonstrates appropriate
behavior in carrying out
activities in the school,
community, and country

Gr. 4 S.Y. _______________ Gr. 5 S.Y. ________________ Gr. 6 S.Y. ________________


Core Values Quarter Quarter Quarter
Behavior Statements
1 2 3 4 1 2 3 4 1 2 3 4
Expresses one’s spiritual
1. Maka- beliefs while respecting the
Diyos spiritual beliefs of others
Shows adherence to ethical
2. Makatao principles by upholding
truth
Cares for the environment
3. Maka- and utilizes resources
kalikasan wisely, judiciously, and
economically
Demonstrates pride in
being a Filipino; exercises
the rights and responsibi-
4.Makabansa lities of a Filipino citizen.
Demonstrates appropriate
behavior in carrying out
activities in the school,
community, and country

AO – Always Observed SO – Sometimes Observed RO – Rarely Observed NO – Not Observed

IV. ATTENDANCE RECORD


Grade No. of No. of Cause No. of Cause No. of
School School Days Times School Days
Days Absent Tardy 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