Department of Education

Region III
Division of Pampanga
SAN PABLO 2ND NATIONAL HIGH SCHOOL
Lubao, Pampanga
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STUDENT INFORMATION AND ANECDOTAL RECORD

I. General Information:
Name: ____________________________________________________________ Gender: _________
Surname Given Name Middle Name
Birthplace: ______________________________________ Birthday: ___________________________
Address: _________________________________________________________________________________
House No. Purok/Sitio Barangay Municipality Province
Contact No.: ________________________________ Email address: ____________________________
Religion: ___________________________________

II. Family Background:

Name Contact No. Occupation
Father
Mother
Guardian
Siblings:

CCT Recipient: ___ Yes ___No Control No.: __________________________________________

III. Health and Medical Record:

IV. Academic Record:

Grad School School Section Adviser
e Year
Interest/Hobbies: ____________________________________________________________________________________________
Subject/Things I am great at: __________________________________________________________________________________
Subject/Things I need extra help: _______________________________________________________________________________
Extra-Curricular Activities: ___________________________________________________________________________________
Mode of transportation when going to school: ____________________________________________________________________
Achievements/ Accomplishments:
Date Accomplishment Date Accomplishment

Additional Educational Supervision/Remediation:

Unsatisfactory Academic
Date Intervention Remarks
Performance

V. Disciplinary Records:
A. Absenteeism and Tardiness:
Date Reason Intervention Remarks

* In case student had no record of being absent, cutting classes or tardy during a particular school year kindly write NO RECORD OF BEING
ABSENT OR TARDY for the S.Y. __ (Grade and Section) and affix your signature on the remarks slot. Write the report on the first available slot.
B. Minor Offense:
Date Incident Intervention Remarks

* In case student had no record of violation during a particular school year kindly write NO VIOLATION COMMITED or write positive observable
behavior of the student then write S.Y. __ (Grade and Section) and affix your signature on the remarks slot. Write the report on the first available
slot.
C. Major Offense:
Date Incident Intervention Remarks

* In case student had no record of violation during a particular school year kindly write NO VIOLATION COMMITED or write positive observable
behavior of the student then write S.Y. __ (Grade and Section) and affix your signature on the remarks slot. Write the report on the first available
slot.
Other Remarks: _____________________________________________________________________________________________
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