FORM 137-E

Republika ng Pilipinas
Kagawaran ng Edukasyon
Rehiyon IV - MIMAROPA
SANGAY NG PALAWAN

PALAGIANG TALAAN SA MABABANG PAARALAN

(ELEMENTARY SCHOOL PERMANENT RECORD)
DISTRITO (District) Roxas North District
PAARALAN (School) Tumarbong Elementary School

Pangalan ______________________________________________________________________________ Kasarian__________________LRN______________________________

(Name)) Apelyido Pangalan M.I. (Sex)

Petsa ng Kapanganakan________________________________Pook__________________________________________________Petsa ng Pagpasok_________________

(Date of Birth) (Place) Bayan/lalawigan/Lungsod (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)

Grade I-School_________________________________________________E ______________________ Grade II-School_________________________________________________E ______________________

School Year___________________________________________________L______________________ School Year___________________________________________________L______________________
Periodic Rating Periodic Rating Final
LEARNING AREAS Final Remarks LEARNING AREAS Remarks
1 2 3 4 Rating
1 2 3 4 Rating

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

Checked by: Date Checked by: Date

1. 1.
2. 2.
3. 3.
4. 4.
Eligible for Admission to Grade____________________________Gen. Ave.________________ Eligible for Admission to Grade____________________________Gen. Ave.________________
No. of Years in School ______________Adviser __________________________________________ No. of Years in School ______________Adviser __________________________________________

Grade III-School_________________________________________________E ______________________ Grade IV-School_________________________________________________E ______________________

School Year___________________________________________________L______________________ School Year_________________________________________________L_______________________

Periodic Rating Periodic Rating Final

LEARNING AREAS Final Remarks LEARNING AREAS Remarks
Rating 1 2 3 4 Rating
1 2 3 4
Filipino Filipino
English English
Science and Health Science and Health
Mathematics Mathematics
Araling Panlipunan Araling Panlipunan
MAPEH EPP/TLE
Music MAPEH
Art Music
Physical Education Art
Health Physical Education
Mother Tongue Health
Edukasyon sa Pagpapakatao Edukasyon sa Pagpapakatao

Checked by: Date Checked by: Date

1. 1.
2. 2.
3. 3.
4. 4.

Eligible for Admission to Grade____________________________Gen. Ave.________________ Eligible for Admission to Grade____________________________Gen. Ave.________________
No. of Years in School ______________Adviser __________________________________________ No. of Years in School ______________Adviser __________________________________________
 Grade V-School_________________________________________________E ______________________ Grade VI-School_________________________________________________E ______________________
School Year___________________________________________________L______________________ School Year___________________________________________________L______________________
Periodic Rating Final Periodic Rating
LEARNING AREAS Remarks LEARNING AREAS Final Remarks
1 2 3 4 Rating 1 2 3 4 Rating

Filipino Filipino
English English
Science and Health Science and Health
Mathematics Mathematics
Araling Panlipunan Araling Panlipunan
EPP/TLE EPP/TLE
MAPEH MAPEH
Music Music
Art Art
Physical Education Physical Education
Health Health
Edukasyon sa Pagpapakatao Edukasyon sa Pagpapakatao

Checked by: Date Checked by by: Date

1. 1.
2. 2.
3. 3.
4. 4.
Eligible for Admission to Grade____________________________Gen. Ave.________________ Eligible for Admission to Grade____________________________Gen. Ave.________________
No. of Years in School ______________Adviser __________________________________________ No. of Years in School ______________Adviser __________________________________________

II. CHARACTER BUILDING

Character Traits Gr.______________Sch. Yr.____________________ Gr.______________Sch. Yr.____________________ Gr.______________Sch. Yr.____________________

123 4 FR
1. Honesty
2. Courtesy
3. Helpfulness and Cooperation
4. Resourcefulness and Creativity
5. Consideration for Others
6. Sportsmanship
7. Obedience
8. Self-Reliance
9. Industry.
10. Cleanliness and Orderliness
11. Promptness and Punctuality
12. Sence of Responsibility
13. Love of God
14. Patriotism and Love of Country

Character Traits Gr.______________Sch. Yr.____________________ Gr.______________Sch. Yr.____________________ Gr.______________Sch. Yr.____________________

1. Honesty
2. Courtesy
3. Helpfulness and Cooperation
4. Resourcefulness and Creativity
5. Consideration for Others
6. Sportsmanship
7. Obedience
8. Self-Reliance
9. Industry.
10. Cleanliness and Orderliness
11. Promptness and Punctuality
12. Sense of Responsibility
13. Love of God
14. Patriotism and Love of Country

III. ATTENDANCE RECORD

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

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_____________________.

_____________________________________________________________ _______________ _____________________________________________

Date TIC/Head Teacher/Principal
Name: _____________________________________ LRN:____________________________

Tumarbong Elemetary School

School: _____________________________________

II. REPORT ON LEARNERS’ OBSERVED VALUE

CORE Gr.____Sch. Yr._________ Gr.____Sch. Yr._________ Gr.____Sch. Yr._________
VALUES BEHAVIOR STATEMENTS 1 2 3 4 1 2 3 4 1 2 3 4
Expresses one’s spiritual beliefs while
1. Maka- respecting the spiritual beliefs of others.
Diyos Shows adherence to ethical principles by
upholding truth.
Is sensitive to individual, social, and
2. Makatao cultural differences.
Demonstrate contributions toward
solidarity.
3. Maka Cares for the environment and utilizes
kalikasan resources wisely, judiciously, and
economically
Demonstrates pride in being a Filipino;
4. Maka exercise the rights and responsibilities of a
bansa Filipino citizen.
Demonstrate appropriate behavior in
carrying out activities in the school,
community, and country.

CORE Gr.____Sch. Yr._________ Gr.____Sch. Yr._________ Gr.____Sch. Yr._________

VALUES BEHAVIOR STATEMENTS 1 2 3 4 1 2 3 4 1 2 3 4
Expresses one’s spiritual beliefs while
1. Maka- respecting the spiritual beliefs of others.
Diyos Shows adherence to ethical principles by
upholding truth.
Is sensitive to individual, social, and
2. Makatao cultural differences.
Demonstrate contributions toward
solidarity.
3. Maka Cares for the environment and utilizes
kalikasan resources wisely, judiciously, and
economically
Demonstrates pride in being a Filipino;
4. Maka exercise the rights and responsibilities of a
bansa Filipino citizen.
Demonstrate appropriate behavior in
carrying out activities in the school,
community, and country.

Marking Non-Numerical Rating Marking Non-Numerical Rating

AO - Always Observed RO - Rarely Observed

SO - Sometimes Observed NO - Not Observed