FORM 137-E

Republic of the Philippines

(Republika ng Pilipinas)
Department of Education
(Kagawaran ng Edukasyon)
BUREAU OF ELEMENTARY EDUCATION
(KAWANIHAN NG EDUKASYON ELEMENTARYA)
National Capital Region
(Pambansang Punong Rehiyon)
Division of City Schools
(Sangay ng mga Paaralang Lungsod)
Caloocan City
(Lungsod ng Caloocan)
ELEMENTARY SCHOOL PERMANENT RECORD
(PALAGIANG TALAAN SA MABABANG PAARALAN)

I. Name ___________________________________________________________________ Division__________________________ A. Mabini

School______________________
(Pangalan) Surname First Name M.I. (Sangay) (Paaralan)
Sex_______________ Date of Birth _____________________ Place______________________________________ Date of Entrance __________________
(Kasarian) (Kapanganakan) (Pook-Bayan/Lalawigan/Lungsod) (Petsa ng Pagpasok)
Parent/Guardian_____________________________________________ _______________________________________________ ____________________________
(Magulang/Tagapag-alaga) Name ( Pangalan) Address (Tirahan) Occupation (Hanapbuhay)

II. ELEMENTARY SCHOOL PROGRESS

(PAG-UNLAD SA PAARALANG ELEMENTARYA)

Learner’s Reference N. (LRN): _________________________________

Grade I-School__________________________________________________________________ Grade II-School________________________________________________________________
School Year__________________________________________________________________ School Year__________________________________________________________________
Periodic Rating Periodic Rating
LEARNING AREAS Remarks LEARNING AREAS Remarks
1 2 3 4 1 2 3 4
Mother Tongue Mother Tongue
Filipino Filipino
Promoted

English English

Promoted
Mathematics Mathematics
Araling Panlipunan Araling Panlipunan
MAPEH MAPEH
Music Music
Art Art
Physical Education Physical Education
Health Health
Edukasyon sa Pagpapakatao Edukasyon sa Pagpapakatao
General Average General Average
Eligible for Admission to Grade______________________________________________ Eligible for Admission to Grade______________________________________________

Grade III-School_______________________________________________________________ Grade IV-School_______________________________________________________________

School Year__________________________________________________________________ School Year__________________________________________________________________
Periodic Rating Periodic Rating
LEARNING AREAS Remarks LEARNING AREAS Remarks
1 2 3 4 1 2 3 4
Mother Tongue Filipino
Filipino English
English Mathematics
Mathematics
Promoted

Science
Science Araling Panlipunan
Araling Panlipunan Edukasyong Pantahanan at
MAPEH Pangkabuhayan (EPP)
Music MAPEH
Arts Music
Physical Education Arts
Health Physical Education
Edukasyon sa Pagpapakatao Health
Edukasyon sa Pagpapakatao
General Average General Average
Eligible for Admission to Grade______________________________________________ Eligible for Admission to Grade______________________________________________

Grade V-School_______________________________________________________________ Grade VI-School_______________________________________________________________

School Year__________________________________________________________________ School Year__________________________________________________________________
Periodic Rating Periodic Rating
LEARNING AREAS Remarks LEARNING AREAS Remarks
1 2 3 4 1 2 3 4
Filipino Filipino
English English
Mathematics Mathematics
Science Science
Araling Panlipunan Araling Panlipunan
Edukasyong Pantahanan at Edukasyong Pantahanan at
Pangkabuhayan (EPP) Pangkabuhayan (EPP)
MAPEH MAPEH
Music Music
Arts Arts
Physical Education Physical Education
Health Health
Edukasyon sa Pagpapakatao Edukasyon sa Pagpapakatao
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 beliefs
1. Maka-Diyos while respecting 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
3. Maka- utilizes resources wisely,
kalikasan 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

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 beliefs
1. Maka-Diyos while respecting 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
3. Maka- utilizes resources wisely,
kalikasan judiciously, and economically
Demonstrates pride in being a
Filipino; exercises the rights and
responsibi-lities of a Filipino
citizen.
4.Makabansa
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

___________________________________________ Principal
____________________________________________
Date Designation