DEPED FORM 137-E Republika ng Pilipinas LRN NO.

________________________
(Republic of the Philippines)
Kagawaran ng Edukasyon
(Department of Education, Culture and Sports)
KAWANIHAN NG EDUKASYONG ELEMENTARYA
(BUREAU OF ELEMENTARY EDUCATION)
REHIYON III-CENTRAL LUZON
(REGION III-CENTRAL LUZON)
SANGAY NG NUEVA ECIJA
(DIVISION OF NUEVA ECIJA)
PALAGIANG TALAAN SA MABABANG PAARALAN
(ELEMENTARY SCHOOL PERMANENT RECORD)
I. Pangalan______________________________________ Sangay_________________ Paaralan_________________________________________
(Name) Apelyido Unang ngalan M.I. (Division) (School)
Kasarian__________ Petsa ng Kapanganakan_____________________ Pook____________________ Petsa ng Pagpasok____________________
(Sex) (Date of Birth) (Place) Bayan/Lalawigan/Lungsod (Date of Entrance)
Magulang/Tagapag-alaga_________________________________________________________________________________________________
Pangalan Tirahan Hanapbuhay
(Name) (Address) (Occupation)
II. Kindergarten – SY ______________________
Final Assessment
Developmental Domain 1st 2nd 3rd 4th Moving up to Grade 1 Remarks
PHYSICAL MOTOR
PERSONAL-SOCIAL DEVELOPMENT
AFFECTIVE DEVELOPMENT
COGNITIVE DEVELOPMENT
NUMERACY
SENSORY-PERCEPTUAL
PAG-UNLAD SA MABABANG PAARALAN
(ELEMENTARY SCHOOL PROGRESS)
III Grade I – School_____________________________ Grade II – School______________________________
School Year_______________ School Year______________

Periodic Rating Gen. Remarks Periodic Rating Gen. Remarks

Learning Areas 1 2 3 4 Ave. Learning Areas Ave.
1 2 3 4

AVERAGE
Adviser’s Signature__________________________ Adviser’s
AVERAGE Signature_____________________________
Eligible for Admission to Grade Two Eligible for Admission to Grade Three
Grade III – School_____________________________ Grade IV – School_______________________________
School Year_______________ School Year______________

Periodic Rating Gen. Remarks Periodic Rating Gen. Remarks

Learning Areas Ave. Learning Areas 1 2 3 4 Ave.
1 2 3 4

AVERAGE

Adviser’s Signature__________________________ Adviser’s Signature_____________________________

Eligible for Admission to Grade Four Eligible for Admission to Grade Five

Grade V – School_____________________________ Grade VI – School_______________________________

Periodic Rating
School Year_______________ Gen. Remarks School Year______________
Learning Areas Ave. Periodic Rating Gen. Remarks
1 2 3 4 Learning Areas 1 2 3 4 Ave.

AVERAGEAdviser’s Signature__________________________ Adviser’s Signature_____________________________

AVERAGE
Eligible for Admission to Grade Six Eligible for Admission to Grade Seven
IV CHARACTER BUILDING
Gr. I
Gr. 2 S.Y. Gr. 3 S.Y.
Sch. Yr. ______ _____________ _____________
1 2 3 4 F.R. Core Quarter Quarter
Behavior Statements
1. Honesty Values 3 4 1 2 3 4 1 2
2.Courtesy Expresses one’s spiritual
3. Helpfulness and beliefs while respecting the
MAKA- spiritual beliefs of others
Cooperation
DIYOS Shows adherence to ethical
4. Resourcefulness and principles by upholding
Creativity truth
5. Consideration for Others Shows adherence to ethical
6. Sportsmanship principles by upholding
7. Obedience truth
MAKATAO
Demonstrates
8. Self-Reliance
contributions toward
9. Industry solidarity
10. Cleanliness and Cares for the environment
Orderliness MAKA and utilizes resources
11. Promptness & Punctuality KALIKASAN wisely, judiciously, and
12. Sense of Responsibility economically
Demonstrates pride in
13. Love of God being a Filipino; exercises
14. Patriotism / Love of God the rights and
Guide for Ratings: A – Outstanding C – Good responsibilities of a
E - Poor MAKABANSA Filipino citizen.
B – Very Good D – Fair Demonstrates appropriate
behavior inGr.
Gr. 1 S.Y. _____________ carrying
2 S.Y.out
_____________ Gr. 3 S.Y. _____________
activities in the school,
Quarter community, and countryQuarter Quarter
Core Values Behavior Statements
1 2 3 4 1 2 3 4 1 2 3 4
Expresses one’s spiritual beliefs while
respecting the spiritual beliefs of
MAKA- others
DIYOS Shows adherence to ethical principles
by upholding truth
Shows adherence to ethical principles
by upholding truth
MAKATAO Demonstrates contributions toward
solidarity
Cares for the environment and utilizes
MAKA
resources wisely, judiciously, and
KALIKASAN economically
Demonstrates pride in being a Filipino;
exercises the rights and
responsibilities of a Filipino citizen.
MAKABANSA
Demonstrates appropriate behavior in
carrying out activities in the school,
community, and country

IV. ATTENDANCE RECORD

Grade No .of School No. of School Cause No. of Times Tardy Cause No. of School
Days Days Absent Days Present
Kinder
I
II
III
IV
V
VI

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 to Grade/
Year_______________________.

_____________________________
Signature
________________________ _____________________________
Date Designation