Republic of the Philippines

DEPARTMENT OF EDUCATION
Region IV A CALABARZON
Division of General Trias City
SANTIAGO ELEMENTARY SCHOOL

ANECDOTAL RECORD

Name of Student: _______________________________ LRN _______________________ Grade/Section II-TRIAS

Address ____________________________________Birthday________________Gender___________ Age _______

Name of Father________________________________ Contact Number ___________________________________

Name of Mother ______________________________ Contact Number ___________________________________

REASON:

REMARKS/AGREEMENT:

_________________________________ ________________________________
PARENT’S SIGNATURE OVER PRINTED NAME STUDENT’S SIGNATURE OVER PRINTED NAME

Noted by:

_________________________
Guidance Counselor

Prepared by:

_____________________
Adviser

APPROVED:

_______________________
School Principal