School Forms 1 To 10 Spread Sheet

School ID Re
School Name
BIRTH
NAME Sex
LRN DATE
(Last Name, First Name, Middle Name) (M/F)
(mm/ dd/yy)
BIRTH
NAME Sex
LRN DATE
(Last Name, First Name, Middle Name) (M/F)
(mm/ dd/yy)
List and code of I

Indicator Code Required Information
Transferred Out T/O Name of Public (P) Private (PR) School & Effect
Transferred IN T/I Name of Public (P) Private (PR) School & E

Dropped DRP Reason and Effectivity Date
Late Enrollment LE Reason (Enrollment beyond 1st Friday of Jun
School Form 1
(This replaced Form 1, Master L
Region Division
School Yea
AGE as of
1st Friday
of June
BIRTH IP
MOTHER
PLACE (Specify RELIGION
TONGUE
( Province) Ethnic Group)
(nos. of
years as
per last
birthday)
AGE as of
1st Friday
of June
BIRTH IP
MOTHER
PLACE (Specify RELIGION
TONGUE
( Province) Ethnic Group)
(nos. of
years as
per last
birthday)
ode of Indicators under REMARK column

Indicator Code Required Information
& Effectivity D CCT Recipient CCT CCT Control/reference numb
hool & EffectivBalik-Aral B/A Name of school last attende

Learner With Disability LWD Specify
ay of June) Accelarated ACL Specify Level & Effectivity D
School Form 1 (SF 1) School Register
is replaced Form 1, Master List & STS Form 2-Family Background and Profile)
District
School Year Grade Level
ADDRESS NA
House # / Father (1st name o

Street/Sitio/ Barangay Municipality/ City Province family name identic
Purok learner)
ADDRESS NA
House # / Father (1st name o

Street/Sitio/ Barangay Municipality/ City Province family name identic
Purok learner)
d Information BoSY
trol/reference number & Effectivity Date MALE
school last attended & Year FEMALE
TOTAL
evel & Effectivity Data
Section
NAME OF PARENTS GUARDIAN (If not Parent)
(1st name only if

Mother (Maiden: 1st Name,
name identical to Name Relationship
Middle & Last Name)
earner)
NAME OF PARENTS GUARDIAN (If not Parent)
(1st name only if

Mother (Maiden: 1st Name,
name identical to Name Relationship
Middle & Last Name)
earner)
Prepared by:
EoSY
(Signature of Adviser over Printed Name)
BoSY Date: EoSYDate:

REMARK/S
Contact Number
(Parent
/Guardian)
(Please refer to the

legend on last page)
REMARK/S
Contact Number
(Parent
/Guardian)

legend on last page)
Certified Correct:
(Signature of School Head over Printed Name)
BoSY Date: EoSYDate:

School Form 2 (SF2) Daily A
(This replaced Form 1, Form 2 & STS F
School ID School Year
Name of School
LEARNER'S NAME (1st row for date, 2nd row

(Last 5 6 7 8 9 12 13 14 15 16 19 20
Name, First Name, Middle Name)
TH
TH
W
W
M
M
T
T
1 DELA CRUZ, JUAN, P.
MALE | TOTAL Per Day

(Last 5 6 7 8 9 12 13 14 15 16 19 20
TH
TH
W
W
M
M
T
T
FEMALE | TOTAL Per Day
Combined TOTAL PER DAY
GUIDELINES:
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 = x 100
Enrolment as of 1st Friday of June
Total Daily Attendance
b. Average Daily Attendance =
Number of School Days in reporting month
Average daily attendance
c. Percentage of Attendance for the month = x 100
Registered Learner as of End of the month
4. Every End of the month, the class adviser will submit this form to the office of the principal for recording of
summary table into the School Form 4. Once signed by the principal, this form should be returned to the adviser.
5. The adviser will extend neccessary intervention including but not limited to home visitation to learner/s that committed 5
consecutive days of absences or those with potentials of dropping out
6. 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
(Last 5 6 7 8 9 12 13 14 15 16 19 20
TH
TH
W
W
M
M
T
T
School Form 2: Page 2 of ________
ily Attendance Report of Learners
& STS Form 4 - Absenteeism and Dropout Profile)
Report for the Month of Jun-16
Grade Level Section
2nd row for Day: M,T,W,TH,F) Total for the

REMARK/S (If DROPPED OUT, state
Month
21 22 23 26 27 28 29 30 please refer to legend number 2.
If TRANSFERRED IN/OUT, write the n
TH
TH
W
ABSENT TARDY
M
School.)
F
F
Month
TH
TH
W
W
ABSENT TARDY
M
F School.)
Summary f
1. CODES FOR CHECKING ATTENDANCE Month: No. of Days of
Month
Classes:
M
blank- Present; (x)- Absent; Tardy (half shaded= Upper
for Late Commer, Lower for Cutting Classes) * Enrolment as of (1st Friday of June)
2. REASONS/CAUSES OF DROP-OUTS Late Enrollment during the month
a. Domestic-Related Factors (beyond cut-off)
a.1. Had to take care of siblings
Registered Learner as of end of the month
a.2. Early marriage/pregnancy
a.3. Parents' attitude toward schooling Percentage of Enrolment as of end of the month
a.4. Family problems
b. Individual-Related Factors Average Daily Attendance

b.1. Illness
Percentage of Attendance for the month
b.2. Overage
b.3. Death Number of students with 5 consecutive days of
b.4. Drug Abuse absences:
b.5. Poor academic performance
Drop out
b.6. Lack of interest/Distractions
b.7. Hunger/Malnutrition
Transferred out
c. School-Related Factors
c.1. Teacher Factor
Transferred in
c.2. Physical condition of classroom
Month
TH
TH
W
W
ABSENT TARDY
M
F School.)
F
c.3. Peer influence
d. Geographic/Environmental I certify that this is a true and correct report.
d.1. Distance between home and school
d.2. Armed conflict (incl. Tribal wars & clanfeuds)

(Signature of Teacher over Printed Name)
d.3. Calamities/Disasters
e. Financial-Related Attested by:
e.1. Child labor, work
f. Others (Signature of School Head over Printed Name)
UT, state reason,
number 2.
write the name of
UT, state reason,
number 2.
write the name of
ummary for the

Month
F TOTAL
UT, state reason,
number 2.
write the name of
Name)
School Form 3 (SF3) Books Issued and Returned
(This replaced Form 1 & Inventory of Text Book)
School ID School Year
School Name Grade Level Section

Subject Area & Title Subject Area & Title Subject Area & Title Subject Area & Title Subject Area & Title Subject Area & Title
LEARNER'S NAME
NO. (Last Name, First
Name, Middle Name) Date Date Date Date Date Date
Issued Returned Issued Returned Issued Returned Issued Returned Issued Returned Issued
LEARNER'S NAME
TOTAL FOR MALE | TOTAL COPIES

LEARNER'S NAME
LEARNER'S NAME
TOTAL FOR FEMALE | TOTAL COPIES
TOTAL LEARNERS | TOTAL COPIES

GUIDELINES: In case of losses/unreturned, please provide information with the following code:
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. A. In Column Date Returned, codes are: FM=Force Majeure, TDO: Transferred/Dropout, NE
3. The Total Number of Copies issued at BoSY shall be reflected in the form. B. In Column Remark/Action Taken, codes are: LLTR=Secured Letter from Learner duly signed
(for code FM), TLTR=Teacher prepared letter/report duly noted by School Head for submission
4. The Total Number of Copies of Books Returned at the EoSYshall be reflected in the form. Custodian (for code TDO), PTL=Paid by the Learner (for code NEG). References: DO#23, s.2
DO#14, 2.2012.
5. All textbooks being used must be included. Additional copy/ies of this form may use if needed.
ned
ct Area & Title Subject Area & Title Subject Area & Title
REMARK/ACTION TAKEN
Date Date Date legend on last page)
Returned Issued Returned Issued Returned
REMARK/ACTION TAKEN
REMARK/ACTION TAKEN
REMARK/ACTION TAKEN
ing code: Prepared By:
ed/Dropout, NEG=Negligence
rner duly signed by parent/guardian (Signature over printed name)
for submission to School Property
ces: DO#23, s.2001, DO#25, s.2003, Date BoSY:____________ Date EoSY: ___________

School Form 4 (SF4) Monthly Learner's Movement and A
(This replaced Form 3 & STS Form 4-Absenteeism and Dropout Profile)
Region Division District

School ID
School Name School Year
ATTENDANCE DROPPED OUT

REGISTERED
GRADE/ LEARNER
POSITIO (A+B) Cumulative
NAME OF ADVISER YEAR SECTION (As of End of the Percentage for (A) Cumulative as (A) Cumulat
N TITLE Month) Daily Average (B) For the Month as of End of the
LEVEL the Month of Previous Month of Previous M
Month
M F T M F T M F T M F T M F T M F T M
SUBJECT TEACHERS
NON-TEACHING PERSONNEL
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
GUIDELINES:
1. This forms shall be accomplished every end of the month using the summary box of SF2 submitted by the teachers/advisers to update figures for the month.
2. Furnish copy to Division Office: a week after June 30, October 30 & March 31
3. Only teachers who are handling advisory class shall be reported. May use additional copy/ies of this form if needed.
4. Small school that has one section per grade/year level is 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.
t and Attendance
District
School Year Report for the Month of
TRANSFERRED OUT TRANSFERRED IN
(A+B) Cumulative (A+B)

(A) Cumulative as (A) Cumulative as
(B) For the Month as of End of the (B) For the Month Cumulative as of
of Previous Month of Previous Month
Month End of the Month
F T M F T M F T M F T M F T M F T
Prepared and Submitted by:
(Signature of School Head over Printed Name)

School Form 5 (SF 5) Report on Promotion & Level of Proficiency
(This replaced Forms 18-E1, 18-E2, 18A and List of Graduates)
Region Division District
School ID School Year Curriculum
School Name Grade Level
INCOMPLETE SUBJECT/S
(This column is for K to 12 Curriculum
GENERAL remaining RBEC in High School. Elementary grades leve
AVERAGE
ACTION TAKEN:
still implementing RBEC need not to fill up this colum
(Numerical Value in 3
LEARNER'S NAME PROMOTED,
LRN decimal places for
(Last Name, First Name, Middle Name) honor learner, 2 for
*IRREGULAR or
RETAINED
non-honor & Completed as of end of current
Descriptive Letter) as of End of the curren
SY
AVERAGE
ACTION TAKEN:
(Last Name, First Name, Middle Name) *IRREGULAR or
honor learner, 2 for
RETAINED
SY
TOTAL MALE
AVERAGE
ACTION TAKEN:
RETAINED
SY
AVERAGE
ACTION TAKEN:
RETAINED
SY
TOTAL FEMALE
COMBINED
iciency
Section
Curriculum and
grades level that
p this column)
of the current SY
SUMMARY TABLE
STATUS MALE FEMALE TOTAL
PROMOTED
*IRREGULAR
RETAINED
Curriculum and
grades level that
p this column)
of the current SY
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)
PREPARED BY:
Curriculum and
grades level that
p this column)
of the current SY
Class Adviser
(Name and Signature)
CERTIFIED CORRECT & SUBMITTED:
School Head
REVIEWED BY:
Division Representative
GUIDELINES:
1. For All Grade/Year Levels

Curriculum and
grades level that
p this column)
of the current SY
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.
3. On the summary table, reflect the total number of

learners promoted, retained and irregular ( *for grade
7 onwards only) and the level of proficiency according
to the individual general average
4. Must tallied with the total enrollment report as of

End of School Year GESP /GSSP (BEIS)
5. Protocols of validation & submission will remain

under the discretion of the Schools Division
Superintendent

School Form 5 Report on Promotion & Level of Proficiency For Kinder (SF5
End of School Year Kindergarten Appraisal Report
School Name District Division
School ID Section School Year
SUMMATIVE APPRAISED
NAME OF LEARNER
No. LRN ASSESSMENT INTERPRETATION (Grade One Ready or
(Last Name, First Name, Name Extension, Middle Name)
STANDARD SCORE Needs Further Intervention)
MALE
der (SF5-K)
Region
SUMMARY TABLE
STATUS MALE FEMALE TOTAL
GRADE ONE (1)

READY
NEEDS FURTHER
INTERVENTION
LEVEL OF PROGRESS AND ACHIEVEMENT
INTERPRETATION MALE FEMALE TOTAL
Suggest Highly Advanced Development -

S.H.A.D. (130 and above)
Suggest Slight Advanced Development

- S.S.A.D. (120-129)
Average Development - A.D. (80-119)
Suggest Slight Delay in Overall

Development -
S.Sl.D.O.D (70-79)
Suggest Significant Delay in Overall

Development -
S.S.D.O.D (69 and below)
<=== TOTAL MALE
LEARNER'S NAME SUMMATIVE ACTION TAKEN (Grade One

No. LRN (Last Name, First Name, Name Extension, Middle ASSESSMENT INTERPRETATION Ready or Needs Further
Name) STANDARD SCORE Intervention)
FEMALE
Suggest Significant Delay in Overall
Development -
S.S.D.O.D (69 and below)
TOTAL BY GENDER
Prepared By:
Signature of Class Adviser over Printed Name
Certified Correct & Submitted By:
Signature of School Head over Printed Name

1. Do not in
2014)
2. This shou
Score shoul
Division Off
3. The sum
learners. Fo
Standard Sc
FURTHER I
<=== TOTAL FEMALE

<=== COMBINED
SFRT 2017
Reviewed By:
Signature of Public Schools District

Supervisor/Representative over Printed Name
Checked & Validated By:
Signature of Division Representative over Printed Name
GUIDELINES:
1. Do not include Dropouts and Transferred Out (DO 4, s.

2014)
2. This should be prepared by the Adviser. Post Test Standard
Score should be taken from the record submitted to the
Division Office.
3. The summary table should reflect the total number of
learners. For GRADE ONE READY, Summative Assessment
Standard Score must be 80 and above, while NEEDS
FURTHER INTERVENTION must be 79 and below.
School Form 6 (SF6) Summarized Report on Promotion
and Level of Proficiency
(This replaced Form 20)
School ID Region Division
School Name District
GRADE 1 /GRADE 7 GRADE 2 / GRADE 8 GRADE 3 / GRADE 9 GRADE 4 / GRADE 10 GRADE 5 / GRADE 11 GRADE 6 / GR
SUMMARY TABLE
MALE FEMALE TOTAL MALE FEMALE TOTAL MALE FEMALE TOTAL MALE FEMALE TOTAL MALE FEMALE TOTAL MALE
PROMOTED
IRREGULAR
RETAINED
LEVEL OF PROFICIENCYMALE FEMALE TOTAL MALE FEMALE TOTAL MALE FEMALE TOTAL MALE FEMALE TOTAL MALE FEMALE TOTAL MALE
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: Reviewed & Validated by: Noted by:
SCHOOL HEAD DIVISION REPRESENTATIVE SCHOOLS DIVISION SUPERI
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
4. Protocols of validation & submission will remain under the discretion of the Schools Division Superintendent
School Year
RADE 6 / GRADE 12 TOTAL
FEMALE TOTAL MALE FEMALE TOTAL
FEMALE TOTAL MALE FEMALE TOTAL

SION SUPERINTENDENT
eld.
School Form 7 (SF7) School Personnel Assignment List and Basic Profile
(This replaced Form 12-Monthly Status Report for Teachers, Form 19-Assignment List,
Form 29-Teacher Program and Form 31-Summary Information of Teachers)
School ID Region Division

School Name District Scho
(A) Nationally-Funded Teaching & Teaching Related Items (B) Nationally-Funded Non Teaching Items (C ) Other Appointments and Funding Sou
Title of Designation
(Designation Appointment:
Title of Plantilla Position Title of Plantilla Position (Contractual, Fund Source
Number of Number of as appeared in the
(as appeared in the appointment (as appeared in the appointment Substitute, (SE
Incumbent Incumbent contract/document: Teacher, Clerk, Volunteer, others
document/PSIPOP) document/PSIPOP) NGO's
Security Guard, Driver etc.) specify)
EDUCATIONAL QUALIFICATION * Daily Program (time durat

Employee Subject Taught
Nature of
No. (or Tax Name of School Personnel Fund Position/ Appointment/
(include Grade &
Identification (Arrange by Sex Section), Advisory Class DAY
Source Designation Employment Degree / Post Major/
Number Position, Descending) Minor & Other Ancillary (M/T/W/ From To
-T.I.N.) Status Graduate Specialization (00:00) (00:00)
Assignment TH/F)
Ave. Minutes per Day

Nature of
(include Grade &
Assignment TH/F)

Nature of
(include Grade &
Assignment TH/F)
GUIDELINES: Submitted by:

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 (Signature of Sch
shall also serve as inventory list of school personnel.
3. Please reflect subjects being taught and if teacher handling advisory class or Ancillary Assignment. Other administrative duties must also reported. Updated as of: _______
4. * Daily Program Column is for teaching personnel only.
Scho
School Year
ing Sources
Number of
Source Incumbent
(SEF, PTA,
NGO's etc.) Teaching Non-
Teaching
me duration)
Remark/s (For
Total Actual Detailed Items,
Teaching Indicate name of
Minutes school/office, For
Assignment IP's -Ethnicity)
per Week
me duration)
Remark/s (For
per Week
me duration)
Remark/s (For
per Week
e of School Head over Printed Name)
___________________________
School Form 7, Page 2 of ________

SF 8
Department of Education
School Form 8 Learner's Basic Health and Nutrition Report (SF8)
(For All Grade Levels)
School Name District Division
School ID Grade Section Track/Strand (SHS)
Learner's Name Nutritiona

Birthdate Weight Height Height²
No. LRN (Last Name, First Name, Age BMI
(MM/DD/YYYY) (kg) (m) (m²)
Name Extension, Middle Name) (kg/m²)
MALE
FEMALE
SUMMARY TABLE
Nutritional Status He
Summary Table
SEX Severely Severely
Wasted Normal Overweight Obese TOTAL Stunted Normal
Wasted Stunted
MALE
FEMALE
TOTAL
Date of Assessment: Conducted/Assessed By: Certified Correct By:

Region
School Year
ional Status
Height for
BMI Remarks
Age (HFA)
Category
ional Status
Height for
BMI Remarks
Age (HFA)
Category
ional Status
Height for
BMI Remarks
Age (HFA)
Category
Height for Age (HFA)

Summary Table
Tall Total
Reviewed By:
SFRT 2017
SF10-ES Republic of the Philippines
Learner's Permanent Academic Record for
(SF10-ES)
(Formerly Form 137)
LEARNER'S PERSONAL INFORMA
LAST NAME: FIRST NAME:
Learner Reference Number (LRN): ______________ Birthdate (mm/dd/yyyy):

ELIGIBILITY FOR ELEMENTARY SCHOOL E
Credential Presented for Grade 1: Kinder Progress Report
Name of School: School ID:
Other Credential Presented
PEPT Passer Rating: _________ Date of Examination/Assessment (mm/dd/yyyy): ___________
Name and Address of Testing Center:_______________________________________________
SCHOLASTIC RECORD
School: ____________________________________ School ID:

District: ______________________ Division: _______________ Region:
Classified as Grade: ______ Section: __________ School Year:
Name of Adviser/Teacher: ______________________Signature:
Quarterly Rating Final
LEARNING AREAS Remarks
1 2 3 4 Rating
Mother Tongue
Filipino
English
Mathematics
Science
Araling Panlipunan
EPP / TLE
MAPEH
Music
Arts
Physical Education
Health
Eduk. sa Pagpapakatao
*Arabic Language
*Islamic Values Education
General Average
Remedial Classes Conducted from: to
Remedial Class Recomputed
Learning Areas Final Rating Remarks
Mark Final Grade
School: ____________________________________ School ID:

District: ______________________ Division: _______________ Region:

Learning Areas Remarks
1 2 3 4 Rating
Mother Tongue
Filipino
English
Mathematics
Science
Araling Panlipunan
EPP / TLE
MAPEH
Music
Arts
Physical Education
Health
*Arabic Language
General Average
Remedial Classes Date Conducted: to
Mark Final Grade
epublic of the Philippines
cademic Record for Elementary School
(SF10-ES)
(Formerly Form 137)
EARNER'S PERSONAL INFORMATION
NAME EXTN. (Jr,I,II) MIDDLE NAME:
Sex:
Y FOR ELEMENTARY SCHOOL ENROLMENT
ECCD Checklist Kindergarten Certificate of Completion
Address of School:
essment (mm/dd/yyyy): ____________ Others (Pls. Specify): _________________________

_________________________________ Remark:____________________________________
SCHOLASTIC RECORD
School: _____________________________ School ID:

District: ______________________ Division: ____________ Region:
Classified as Grade: ______ Section: ____ School Year:
Name of Adviser/Teacher: ______________ Signature:
1 2 3 4 Rating
Mother Tongue
Filipino
English
Mathematics
Science
Araling Panlipunan
EPP / TLE
MAPEH
Music
Arts
Physical Education
Health
*Arabic Language
General Average
Remedial Classes Conducted from: to
Mark Final Grade
School: _____________________________ School ID:

District: ______________________ Division: ____________ Region:

1 2 3 4 Rating
Mother Tongue
Filipino
English
Mathematics
Science
Araling Panlipunan
EPP / TLE
MAPEH
Music
Arts
Physical Education
Health
*Arabic Language
General Average
Mark Final Grade
SFRT 2017
SF10-ES
SCHOLASTIC RECORD
School: _____________________________________ School ID:
District: ______________________ Division: ________________Region:

LEARNING AREAS Remarks
1 2 3 4 Rating
Mother Tongue
Filipino
English
Mathematics
Science
Araling Panlipunan
EPP / TLE
MAPEH
Music
Arts
Physical Education
Health
*Arabic Language
General Average
Mark Final Grade
School: _____________________________________ School ID:

District: ______________________ Division: ________________Region:

1 2 3 4 Rating
Mother Tongue
Filipino
English
Mathematics
Science
Araling Panlipunan
EPP / TLE
MAPEH
Music
Arts
Physical Education
Health
*Arabic Language
General Average
Mark Final Grade
For Transfer Out /Elementary School Completer Only

CERTIFICATION
I CERTIFY that this is a true record of ___________________________________ with LRN _______________
School Name: __________________________________ School ID ________________ Division: __________
____________________________________
Date Name of Principal/School Head over Printed Nam
CERTIFICATION
____________________________________
CERTIFICATION
____________________________________
May add Certification Box if needed
Page 2 of ________
SCHOLASTIC RECORD
School: _____________________________ School ID:
District: ______________________ Division: ________ Region:

1 2 3 4 Rating
Mother Tongue
Filipino
English
Mathematics
Science
Araling Panlipunan
EPP / TLE
MAPEH
Music
Arts
Physical Education
Health
*Arabic Language
General Average
Remedial Recomputed
Class Mark Final Grade
School: _____________________________ School ID:

District: ______________________ Division: ________ Region:

1 2 3 4 Rating
Mother Tongue
Filipino
English
Mathematics
Science
Araling Panlipunan
EPP / TLE
MAPEH
Music
Arts
Physical Education
Health
*Arabic Language
General Average
Remedial Recomputed
Class Mark Final Grade
CERTIFICATION
_____ with LRN ___________________ and that he/she is eligible for admission to Grade ________.
__________ Division: ___________ Last School Year Attended: _________________________
ipal/School Head over Printed Name (Affix School Seal here)
CERTIFICATION
CERTIFICATION

SFRT Revised 2017
SF 10 -JHS
Republic of the Philippines
Learner's Permanent Academic Record for Junior High School (SF10-JHS)
(Formerly Form 137)
LEARNER'S INFORMATION
LAST NAME: ________________________FIRST NAME: ____________________ NAME EXTN. (Jr,I,II): _______ MIDDLE NAME: ___
Learner Reference Number (LRN): ______________ Birthdate (mm/dd/yyyy): _____________________ Sex: _____________
ELIGIBILITY FOR JHS ENROLMENT

Elementary School Completer General Average: ________ Citation: (If Any)
Name of Elementary School: School ID: Adress of School:
Other Credential Presented
PEPT Passer Rating: _________ ALS A & E Passer Rating: _____________ Others (Pls. Specify):
Date of Examination/Assessment (mm/dd/yyyy): ____________ Name and Address of Testing Center: ______________________
SCHOLASTIC RECORD
School: ______________________ School ID: ________ District: ___________________ Division: _______________
Classified as Grade: ____ Section: ___ School Year: _____ Name of Adviser/Teacher: ________________ Signa
Quarterly Rating FINAL
LEARNING AREAS REM
1 2 3 4 RATING
Filipino
English
Mathematics
Science
Araling Panlipunan (AP)
Edukasyon sa Pagpapakatao (EsP)
Technology and Livelihood Education (TLE)
MAPEH
Music
Arts
Physical Education
Health
General Average
Remedial Classes Conducted from (mm/dd/yyyy) ____________________ to (mm/dd/yyyy) __________________
Recomputed Final
Learning Areas Final Rating Remedial Class Mark Rem
Grade

Classified as Grade: ____ Section: ___ School Year: _____ Name of Adviser/Teacher: ________________ Signatu
QUARTER FINAL
LEARNING AREAS REM
1 2 3 4 RATING
Filipino
English
Mathematics
Science
MAPEH
Music
Arts
Physical Education
Health
General Average
Remedial Classes Conducted from (mm/dd/yyyy) ____________________ to (mm/dd/yyyy) __________________

Recomputed Final
Learning Areas Final Rating Remedial Class Mark Rem
Grade
CERTIFICATION
I CERTIFY that this is a true record of _________________________with LRN ______________ and that he/she is eligible for admissi
Name of School: ____________________________________ School ID: __________________ Last School Year Attended: ________
________________________
Date Name of Principal/School Head over Printed Name (Affix School Seal he
SF10-JHS)
DDLE NAME: ___________________

: _____________________________
rs (Pls. Specify): ___________

___________________________
________________ Region: ____

_______ Signature: __________
REMARKS
____________
Remarks
________________ Region: ____

______ Signature: __________
REMARKS
___________
Remarks
gible for admission to Grade ____.

nded: _________________________
ffix School Seal here)

SF 10-JHS
LEARNING AREAS QUARTER FINAL REMAR

1 2 3 4 RATING
Filipino
English
Mathematics
Science
MAPEH
Music
Arts
Physical Education
Health
General Average
Remedial Classes Conducted from (mm/dd/yyyy) ____________________ to (mm/dd/yyyy) _______________
Recomputed Final
Subject Final Rating Remedial Class Mark Remark
Grade
LEARNING AREAS QUARTER FINAL REMAR
1 2 3 4 RATING
Filipino
English
Mathematics
Science
MAPEH
Music
Arts
Physical Education
Health
General Average
Remedial Classes Conducted from (mm/dd/yyyy) ____________________ to (mm/dd/yyyy) ______________
Recomputed Final
Learning Areas Final Rating Remedial Class Mark Remark
Grade
Quarterly Rating FINAL
LEARNING AREAS REMAR
1 2 3 4 RATING
Filipino
English
Mathematics
Science
MAPEH
Music
Arts
Physical Education
Health
General Average
Remedial Classes Conducted from (mm/dd/yyyy) ____________________ to (mm/dd/yyyy) ______________
Recomputed Final
Learning Areas Final Rating Remedial Class Mark Remark
Grade
For Transfer Out /JHS Completer Only

CERTIFICATION
I CERTIFY that this is a true record of _____________________________with LRN ________________ and that he/she is eligible for a
Name of School: ____________________________________ School ID __________________ Last School Year Attended: _________
_____________________
Date Name of Principal/School Head over Printed Name (Affix School Seal here)
(May add Certification box if needed)
Pag 2 of ________
__________________ Region: ____
_________ Signature: ________
REMARKS
____________
Remarks
__________________ Region: ____
_________ Signature: ________

REMARKS
y) _______________
Remarks
__________________ Region: ____
_________ Signature: ________
REMARKS
y) _______________
Remarks
he/she is eligible for admission to Grade ____.

Attended: _________________________
School Seal here)

SFRT Revised 2017
ALTERNATIVE LEARNING SYSTEM
MASTERLIST OF MAPPED AND POTENTIAL LEARNERS (AF1)
District Division: Region
COMPLETE HOME ADDRESS PARENTS
Contact
Sex (M/F)
NAME IP
Date of Birth Mother Number of
(Last Name, First Name, Name Age (Yes or Religion
(mm/dd/yyyy) Tongue House Father's Name (Last Mother's Maiden Name Learner
Extension, Middle Name) No)
No./Street/ Barangay Municipality/ City Province Name, First Name, Middle (Last Name, First (if available)
Sitio/ Purok Name) Name, Middle Name)
MAPPED LEARNERS as of (MM/DD/YY) ENROLLED LEARNERS as of Prepared By:
(MM/DD/YY)
Signature of Facilitator o
MALE MALE
FEMALE FEMALE
Certified Correct: Signature of PSDS ov

TOTAL TOTAL
Calendar Year
REMARKS
Last Grade
Level Date Mapped
If already enrolled
Completed in (mm/dd/yyyy) Interested in If Yes,
in ALS, provide date
Formal School ALS? Preferred
of first attendance
Yes or No Program
(DOFA) and LRN
Signature of Facilitator over Printed Name
Signature of PSDS over Printed Name

SFRT 2017
AF2 Republic of the Philippines
ALS ENROLMENT FORM (AF2)
Learner's Basic Profile
Date : LRN (if available) :
Personal Information (Part I)
Last Name First Name Middle Name Name Extension
• Address:
House No./Street/Sitio Barangay Municipality/City Province
• Birthdate (mm/dd/yyyy): _____/_____/________ Place of Birth (Municipality/City)
• Sex: □Male □Female • Civil Status: □Single □Married □Widow/er □Separated □Solo Parent
• Religion: ____________• IP (Specify ethnic group) : ______________ • Mother Tongue : _______________ PWD: □Yes □No
• Name of Father/Legal Guardian
Last Name First Name Middle Name Occupation

• Mother's Maiden Name
Last Name First Name Middle Name Occupation
Educational information (Part II)

• Last grade level completed
Elementary : □K □G-1 □G-2 □G-3 □G-4 □G-5 □G-6
Secondary : □G-7 □G-8 □G-9 □G-10
• Why did you drop out of school? (For OSY only)
□No school in Barangay □School too far from home □Needed to help family
□Unable to pay for miscellaneous and other expenses Others:
• Have you attended ALS learning sessions before? □YES □NO

If Yes:
Name of the Program: _____________________________________________ Level of Literacy: □Basic □Elem. □Sec. □InfEd
Year Attended: ___________ Have you completed the Program? (Yes/No) _______
If NO, state the reason:
Accessibility and Availability (Part III)

• How far is it from your home to your Learning Center? in kms in hours and mins.
• How do you get from your home to your Learning Center? □Walking □Motorcycle □Bicycle □Others (Pls. Specify) ___________
• When can you attend your Learning Session?
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
What specific time

can you be at your
Learning Center?
_______________________________________ _____________________________
Facilitator: Signature and Date Learner: Signature and Date
SFRT 2017
MASTERLIST OF ENROLLED LEARNERS WITH END OF PROGRAM/CY STATUS (A
District Division Region
Type of
Name of CLC Barangay
CLC
NON FORMAL E
PROGRAM ENROLLED Assessment for Basic
Functiona
Literacy (ABL)
PIS Score
Sex (M/F)
NAME
Birthdate First Date of
LRN (Last Name, First Name, Middle Age
(mmddyyyy) Attendance
Basic Literate
Post Literate
Neo Literate
Name, Name Extension)
Type of
Mode of Program Delivery Reading
Program
<=== TOTAL MALE

<=== TOTAL FEMALE
<=== COMBINED
Learners Enrolled
Learners Enrolled by Program Male Female Total
by Program Delivery
Male Female Total
BLP Face to Face

A&E Elem. Independent Learning
A&E Sec. Radio-based Instruction
InFED Computer-based Instruction
Learners Enrolled in BLP

by Level
Male Female Total Enrolled Learners Male Female Total
Basic Literate Number of 4P's Learners
Neo Literate Percent of Enrolled 4P's Learners
Post Literate
AF-3
TUS (AF-3)
Calendar Year
City/Municipality
N FORMAL EDUCATION
Functional Literacy Assessment (FLT) Score

End of
Program/ Remarks
CY Status
Listening & Overall
Numeracy Writing
Speaking Score
Prepared By:
Signature of Facilitator over Printed Name
Certified Correct By:
Signature of PSDS over Printed Name

MASTERLIST OF A&E REGISTRANTS (AF-4)
District Division Region
Place of Registration Center

(Name of School/Center, Barangay, Municipality)
(Testing Center) (Barangay) (Municipality/City)
NAME CLC DETAILS
Sex (M/F)
Birthdate
A&E Test Level Date
LRN CLC
(Last Name, First Name, Middle Registered Registered
CLC Name Barangay Municipal
Name, Ext) Type
<=== TOTAL MALE
<=== TOTAL FEMALE

<=== COMBINED
Registered Male Female Total Prepared By:

Elementary Signature of Facilitator over Printed Name
Secondary
Taker Male Female Total Certified Correct By:
Elementary
Secondary Signature of PSDS/DC over Printed Name
AF-4
y/City)
Date of
Examination
ed Name
ed Name
LEARNER'S PERMANENT RECORD (AF-5)

DISTRICT: DIVISION: REGION:
LEARNER'S INFORMATION LRN:_________________

___
LAST NAME: FIRST NAME: _____________________ NAME EXTENSION: ______ MIDDLE NAME: ___________
ADDRESS:
HOUSE NO./ SITIO / ST. BARANGAY MUNICIPALITY/CITY PROVINCE
BIRTHDATE: MONTH _____/ DATE__________ / YEAR______________ SEX: Male Female
LEARNER'S EDUCATIONAL STATUS

Program Enrolled : Program Enrolled :
Delivery Mode : Delivery Mode :
CLC Name : CLC Name :
CLC Address : CLC Address :
Name of Facilitator : Name of Facilitator :
Calendar Year : Calendar Year :
Score Score
ASSESSMENT RESULTS ASSESSMENT RESULTS
Pre Post Pre
PIS Score PIS Score
Assesment for Basic Literacy (ABL) Pre Post Assesment for Basic Literacy (ABL) Pre
Basic Literate Basic Literate
Neo Literate Neo Literate
Post Literate Post Literate
Functional Literacy Assessment Pre Post Functional Literacy Assessment Pre
FLT Score in Reading FLT Score in Reading
FLT Score in Numeracy FLT Score in Numeracy
FLT Score in Writing FLT Score in Writing
FLT Score in Listening & Speaking FLT Score in Listening & Speaking
Overall Score 0 0 Overall Score 0
InfEd Remarks InfEd Remark
A & E STATUS Remarks A & E STATUS

Program Status Program Status
Test Taken Test Taken
Date of Examination Date of Examination
Testing Center Testing Center
Location of Testing Center Location of Testing Center
Accreditation and Equivalency (A&E) Test Result Accreditation and Equivalency (A&E) Test Result
Certificate of Transfer Certificate of Transfer

Eligible for Admission to : Eligible for Admission to :
Certificate of Good Moral Character Certificate of Good Moral Character
This is to certify that the above-named is a learner of good moral character. This is to certify that the above-named is a learner of good moral charac
This certification is issued upon request of the concerned individual due to This certification is issued upon request of the concerned individual due
his/her desire to pursue formal schooling/other CLC or for employment. his/her desire to pursue formal schooling/other CLC or for employment.
Prepared By: Certified Correct By: Prepared By: Certified Correct By:
Facilitator PSDS/District Coordinator/EPSA Facilitator PSDS/District Coordinato

AF-5
______________
___________________
CE
Female
Score
Post
Post
Post
0
Remarks
Remarks
racter
moral character.
dividual due to
mployment.
Coordinator/EPSA

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School ID Re

List and code of I

Transferred IN T/I Name of Public (P) Private (PR) School & E

ode of Indicators under REMARK column

hool & EffectivBalik-Aral B/A Name of school last attende

School Year Grade Level

House # / Father (1st name o

House # / Father (1st name o

trol/reference number & Effectivity Date MALE

school last attended & Year FEMALE

NAME OF PARENTS GUARDIAN (If not Parent)

(1st name only if

(1st name only if

(Signature of Adviser over Printed Name)

BoSY Date: EoSYDate:

(Please refer to the

(Please refer to the

(Signature of School Head over Printed Name)

BoSY Date: EoSYDate:

School ID School Year

LEARNER'S NAME (1st row for date, 2nd row

MALE | TOTAL Per Day

Report for the Month of Jun-16

Grade Level Section

2nd row for Day: M,T,W,TH,F) Total for the

b. Individual-Related Factors Average Daily Attendance

d.2. Armed conflict (incl. Tribal wars & clanfeuds)

ummary for the

School ID School Year

School Name Grade Level Section

TOTAL FOR MALE | TOTAL COPIES

TOTAL FOR FEMALE | TOTAL COPIES

TOTAL LEARNERS | TOTAL COPIES

ing code: Prepared By:

School Form 3: Page 2 of ________

Region Division District

School Name School Year

ATTENDANCE DROPPED OUT

School Year Report for the Month of

TRANSFERRED OUT TRANSFERRED IN

(A+B) Cumulative (A+B)

(Signature of School Head over Printed Name)

Region Division District

School ID School Year Curriculum

School Name Grade Level

STATUS MALE FEMALE TOTAL

MALE FEMALE TOTAL

(Name and Signature)

CERTIFIED CORRECT & SUBMITTED:

(Name and Signature)

(Name and Signature)

1. For All Grade/Year Levels

2. To be prepared by the Adviser. Final rating per

3. On the summary table, reflect the total number of

4. Must tallied with the total enrollment report as of

5. Protocols of validation & submission will remain

School Form 5: Page 2 of ________

STATUS MALE FEMALE TOTAL

GRADE ONE (1)

LEVEL OF PROGRESS AND ACHIEVEMENT

INTERPRETATION MALE FEMALE TOTAL

Suggest Highly Advanced Development -

Suggest Slight Advanced Development

essment (mm/dd/yyyy): Others (Pls. Specify): _____________

School: ____________ School ID: District: _ Division: _______

Remedial Classes Conducted from (mm/dd/yyyy) __ to (mm/dd/yyyy)

____________ Region:

____________ Region:

School: ____________ School ID: District: _ Division: _______

_ Signature:

______________ Region:

_ Signature: