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) 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 I-School_________________________________________________________________ Grade II-School________________________________________________________________
School Year__________________________________________________________________ School Year__________________________________________________________________
Periodic Rating Remarks
LEARNING AREAS Periodic Rating Remarks
1 2 3 4 LEARNING AREAS
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 III-School______________________________________________________________
Grade IV-School_______________________________________________________________
School Year__________________________________________________________________
School Year__________________________________________________________________
Periodic Rating Remarks
LEARNING AREAS Periodic Rating Remarks
1 2 3 4 LEARNING AREAS
1 2 3 4

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

General Average
Eligible for admission to Grade _________________________________ General Average
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