DepEd Form 137 REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF EDUCATION
BUREAU OF ELEMENTARY EDUCATION
REGION VII- CENTRAL VISAYAS
SCHOOLS DIVISION OF NEGROS ORIENTAL

ELEMENTARY SCHOOL PERMANENT RECORD

LRN:

I. NAME: DIVISION: SCHOOL:

( Surname) ( Given Name ) (M.I.)

SEX: DATE OF BIRTH: PLACE: DATE OF ENTRANCE:

( Town/ Province/City )

PARENT/GUARDIAN:
(Name) (Address) (Occupation)

II. ELEMENTARY SCHOOL PROGRESS

GRADE LEVEL SCHOOL SCHOOL YEAR TEACHER

KINDERGARTEN
Grade -I School
School: :
________________________________________________ Grade -II School
School: :
________________________________________________
School Year: ___________________________ School Year: ___________________________

Periodic Ratings FINAL Periodic Ratings FINAL

Learning Areas Remarks Learning Areas Remarks
1 2 3 4 GRADE 1 2 3 4 GRADE

MOTHER TONGUE MOTHER TONGUE

FILIPINO FILIPINO
ENGLISH ENGLISH
MATHEMATICS MATHEMATICS
ARALING PANLIPUNAN ARALING PANLIPUNAN
EDUKASYON SA PAGPAPAKATAO EDUKASYON SA PAGPAPAKATAO
MAPEH MAPEH
MUSIC MUSIC
ART ART
PHYSICAL EDUCATION PHYSICAL EDUCATION
HEALTH HEALTH
GENERAL AVERAGE GENERAL AVERAGE
ELIGIBLE FOR ADMISSION TO GRADE _____ Teacher:_____________________ ELIGIBLE FOR ADMISSION TO GRADE _____ Teacher:_____________________

Grade -III School

School: :
________________________________________________ Grade -IV School
School: :
________________________________________________
School Year: ___________________________ School Year: ___________________________

Periodic Ratings FINAL Periodic Ratings FINAL

Learning Areas GRADE
Remarks Learning Areas
GRADE
Remarks
1 2 3 4 1 2 3 4
MOTHER TONGUE MOTHER TONGUE
FILIPINO FILIPINO
ENGLISH ENGLISH
MATHEMATICS MATHEMATICS
SCIENCE SCIENCE
ARALING PANLIPUNAN ARALING PANLIPUNAN
EDUKASYON SA PAGPAPAKATAO EDUKASYON SA PAGPAPAKATAO
MAPEH MAPEH
MUSIC MUSIC
ART ART
PHYSICAL EDUCATION PHYSICAL EDUCATION
HEALTH HEALTH
GENERAL AVERAGE GENERAL AVERAGE
ELIGIBLE FOR ADMISSION TO GRADE _____ Teacher:_____________________ ELIGIBLE FOR ADMISSION TO GRADE _____ Teacher:_____________________

Grade -V School
School: :
________________________________________________ Grade -VI School
School: :
________________________________________________
School Year: ___________________________ School Year: ___________________________

Periodic Ratings FINAL Periodic Ratings FINAL

Learning Areas Remarks Learning Areas Remarks
GRADE GRADE
 FINAL FINAL
Learning Areas Remarks Learning Areas Remarks
1 2 3 4 GRADE 1 2 3 4 GRADE

MOTHER TONGUE MOTHER TONGUE

FILIPINO FILIPINO
ENGLISH ENGLISH
MATHEMATICS MATHEMATICS
SCIENCE SCIENCE
ARALING PANLIPUNAN ARALING PANLIPUNAN
EDUKASYON SA PAGPAPAKATAO EDUKASYON SA PAGPAPAKATAO
MAPEH MAPEH
MUSIC MUSIC
ART ART
PHYSICAL EDUCATION PHYSICAL EDUCATION
HEALTH HEALTH
GENERAL AVERAGE GENERAL AVERAGE
ELIGIBLE FOR ADMISSION TO GRADE _____ Teacher:_____________________ ELIGIBLE FOR ADMISSION TO GRADE _____ Teacher:_____________________
III.LEARNER'S OBSERVED VALUES
GRADE ___ S.Y. ___________ GRADE ___ S.Y. ___________ GRADE ___ S.Y. ___________
CORE VALUES BEHAVIOR STATEMENT
1 2 3 4 1 2 3 4 1 2 3 4
Expresses one's spiritual beliefs while
respecting the spiritual beliefs of others.
1. MAKA-DIYOS
Shows adherence to ethical principles by
upholding the truth in all undertakings.

Is sensitive to individual, social and cultural

differences.
2. MAKATAO
Demonstrates contributions toward solidarity.

Cares for the environment and utilizes

3.MAKA-KALIKASAN resources wisely, 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.

GRADE ___ S.Y. ___________ GRADE ___ S.Y. ___________ GRADE ___ S.Y. ___________
CORE VALUES BEHAVIOR STATEMENT
1 2 3 4 1 2 3 4 1 2 3 4
Expresses one's spiritual beliefs while
respecting the spiritual beliefs of others.
1. MAKA-DIYOS
Shows adherence to ethical principles by
upholding the truth in all undertakings.
Is sensitive to individual, social and cultural
differences.
2. MAKATAO
Demonstrates contributions toward solidarity.

Cares for the environment and utilizes

3.MAKA-KALIKASAN resources wisely, 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.

Marking Non-Numerical Rating

AO – Always Observed
IV. ATTENDANCE RECORD
Grade Level
SO – Sometimes Observed RO – Rarely Observed NO – Not Observed
No. of School Days
No. of School Days Cause No. of School Days Present
Absent

CERTIFICATION OF TRANSFER
TO WHOM IT MAY CONCERN:
This is to certify that this is a true Elementary School Performance Record of
_________________________ . He/ She is eligible for transfer and
admission to Grade/ Year ______________________________________.

Signature

Date Designation