STA.

ROSA ACADEMY OF SAN NICOLAS

ILOCOS NORTE INC.
SAN NICOLAS, ILOCOS NORTE

ANECDOTAL RECORD

STUDENT: ZYMON MATTHEW BUTAY

YR. & SECTION: GRADE 8- ST. FRANCIS XAVIER

Incident Action Taken

1. Involve in Students Fight Being called to Guidance Office for
Disciplinary Action
2. Usually misbehaving in class
3. Violated School Rules (Bringing and using Confiscated by the Adviser
Cellphone during Class hours)
4. Disrespectful to Classmates
5. Disrespectful to Teacher/s
6. Involve in Being called to the Guidance Office for
Disciplinary Action.
Will not be accepted to Sta. Rosa Academy of
San Nicolas, Inc.

I, ANNE BERNADETTE D. VOCAL the adviser of Grade 8- St. Francis Xavier of Sta. Rosa
Academy of San Nicolas Ilocos Norte Inc., School Year 2017-2018 declare that all aforementioned
incident taken by ZYMON MATTHEW BUTAY are correct and true as per teachers’ record.

ZYMON MATTHEW BUTAY _____________________________________

Student Parent

Prepared by: Attested by:

ANNE BERNADETTE D. VOCAL SR. MA. SONIA C. de GUZMAN, MCST

Class Adviser Guidance Counselor/ School Principal

STA. ROSA ACADEMY OF SAN NICOLAS

ILOCOS NORTE INC.
SAN NICOLAS, ILOCOS NORTE

ANECDOTAL RECORD

STUDENT: JULIUS CEASAR COLOMA

YR. & SECTION: GRADE 8- ST. FRANCIS XAVIER

Incident Action Taken

1. Involve in Students Fight Being called to Guidance Office for
Disciplinary Action
2. Usually misbehaving in class
3. Violated School Rules Confiscated by the Adviser
 Bringing and using Cellphone during
Class hours.
 Wearing earrings
4. Disrespectful to Classmates
5. Disrespectful/ Cursing a Teacher/s
6. Involve in Being called to the Guidance Office for
Disciplinary Action.
Will not be accepted to Sta. Rosa Academy of
San Nicolas, Inc.

I, ANNE BERNADETTE D. VOCAL the adviser of Grade 8- St. Francis Xavier of Sta. Rosa
Academy of San Nicolas Ilocos Norte Inc., School Year 2017-2018 declare that all aforementioned
incident taken by JULIUS CEASAR COLOMA are correct and true as per teachers’ record.

_______________________________ ____________________________________
Student Parent

Prepared by: Attested by:

ANNE BERNADETTE D. VOCAL SR. MA. SONIA C. de GUZMAN, MCST

Class Adviser Guidance Counselor/ School Principal

STA. ROSA ACADEMY OF SAN NICOLAS

ILOCOS NORTE INC.
SAN NICOLAS, ILOCOS NORTE

ANECDOTAL RECORD

STUDENT: WALEED S. DE LEON

YR. & SECTION: GRADE 8- ST. FRANCIS XAVIER

Incident Action Taken

1. Involve in Bullying (Louie Guillermo) Being called to Guidance Office for
Disciplinary Action
2. ALWAYS misbehaving in class
3. Violated School Rules (Bringing and using Confiscated by the Adviser
Cellphone during Class hours)
4. Disrespectful to Classmates
5. Disrespectful to Teacher/s
6. Not doing his Classroom Obligations
7. Threatened a Schoolmate (Giro Tenedor)
8. Broken a Chair
9. Dishonesty (Acted like he was being
possessed)
10. Involve in Being called to the Guidance Office for
Disciplinary Action.
Will not be accepted to Sta. Rosa Academy of
San Nicolas, Inc.

I, ANNE BERNADETTE D. VOCAL the adviser of Grade 8- St. Francis Xavier of Sta. Rosa
Academy of San Nicolas Ilocos Norte Inc., School Year 2017-2018 declare that all aforementioned
incident taken by WALEED DE LEON are correct and true as per teachers’ record.

________________________________ _____________________________________
Student Parent

Prepared by: Attested by:

ANNE BERNADETTE D. VOCAL SR. MA. SONIA C. de GUZMAN, MCST

Class Adviser Guidance Counselor/ School Principal

STA. ROSA ACADEMY OF SAN NICOLAS

ILOCOS NORTE INC.
SAN NICOLAS, ILOCOS NORTE
 ANECDOTAL RECORD

STUDENT: ZYMON MATTHEW BUTAY

YR. & SECTION: GRADE 8- ST. FRANCIS XAVIER

Incident Action Taken

1. Involve in Student Bullying (Louie Being called to Guidance Office for
Guillermo) Disciplinary Action
2. Usually misbehaving in class
3. Violated School Rules Confiscated by the Adviser
 (Bringing and using Cellphone during
Class hours)
 Proper Haircut
4. Disrespectful to Classmates / Teachers
6. Involve in Being called to the Guidance Office for
Disciplinary Action.
Will not be accepted to Sta. Rosa Academy of
San Nicolas, Inc.

I, ANNE BERNADETTE D. VOCAL the adviser of Grade 8- St. Francis Xavier of Sta. Rosa
Academy of San Nicolas Ilocos Norte Inc., School Year 2017-2018 declare that all aforementioned
incident taken by ERICK LENIN ESCAMILLA are correct and true as per teachers’ record.

_____________________________________ _____________________________________
Student Parent

Prepared by: Attested by:

ANNE BERNADETTE D. VOCAL SR. MA. SONIA C. de GUZMAN, MCST

Class Adviser Guidance Counselor/ School Principal

STA. ROSA ACADEMY OF SAN NICOLAS

ILOCOS NORTE INC.
SAN NICOLAS, ILOCOS NORTE
 ANECDOTAL RECORD

STUDENT:ERICK LENIN ESCAMILLA

YR. & SECTION: GRADE 8- ST. FRANCIS XAVIER

Incident Action Taken

1. Involve in Students Fight Being called to Guidance Office for
Disciplinary Action
2. Usually misbehaving in class
3. Violated School Rules (Bringing and using Confiscated by the Adviser
Cellphone during Class hours)
4. Disrespectful to Classmates
5. Disrespectful to Teacher/s
6. Involve in Being called to the Guidance Office for
Disciplinary Action.
Will not be accepted to Sta. Rosa Academy of
San Nicolas, Inc.

I, ANNE BERNADETTE D. VOCAL the adviser of Grade 8- St. Francis Xavier of Sta. Rosa
Academy of San Nicolas Ilocos Norte Inc., School Year 2017-2018 declare that all aforementioned
incident taken by ZYMON MATTHEW BUTAY are correct and true as per teachers’ record.

_____________________________________ _____________________________________
Student Parent

Prepared by: Attested by:

ANNE BERNADETTE D. VOCAL SR. MA. SONIA C. de GUZMAN, MCST

Class Adviser Guidance Counselor/ School Principal

STA. ROSA ACADEMY OF SAN NICOLAS

ILOCOS NORTE INC.
SAN NICOLAS, ILOCOS NORTE

ANECDOTAL RECORD
STUDENT: LUIS ANGELO ULEP
YR. & SECTION: GRADE 8- ST. FRANCIS XAVIER

Incident Action Taken

1. Involve in Students Fight Being called to Guidance Office for
Disciplinary Action
2. Usually misbehaving in class
3. Violated School Rules Confiscated by the Adviser
 (Bringing and using Cellphone during
Class hours)
 Using earrings
4. Disrespectful to Classmates/ Teacher/s
5. Destroyed Kapis Window
6. Punched and Bullied his Classmate (Cedric
Russel Dumlao)
7. Bullied his classmate Louie Guillermo
8. Bullied his Classmate Justine Asuncion
9. Not doing his classroom obligations

I, ANNE BERNADETTE D. VOCAL the adviser of Grade 8- St. Francis Xavier of Sta. Rosa
Academy of San Nicolas Ilocos Norte Inc., School Year 2017-2018 declare that all aforementioned
incident taken by ZYMON MATTHEW BUTAY are correct and true as per teachers’ record.

_______________________________ _____________________________________
Student Parent

Prepared by: Attested by:

ANNE BERNADETTE D. VOCAL SR. MA. SONIA C. de GUZMAN, MCST

Class Adviser Guidance Counselor/ School Principal