Division of City Schools

City of Urdaneta
St. Andrew Montessori and High School Inc.
Nancayasan, Urdaneta City, Pangasinan

Year-End Teachers’ Clearance

School Year 2020-2021
The Principal
Sir/Madam:
This is to inform you that I have satisfactorily settled all the property and financial obligations in the school and
that I have submitted all the required reports as listed below. May I then be granted the Year-End Clearance for School
Year 2020-2021.

1. School Form 1 ________________ 13. Library

a. Borrowed Books ____________________

2. School Form 2 _________________
b. Borrowed Materials ____________________
3. School Form 3 ___________________
14. Classroom inventory and room safety
4. School Form 5 ___________________
a. room keys __________________
5. School Form 8 ___________________
b. books __________________
6. School Form 10 ___________________
c. equipment ___________________
7. DepEd Form 138 ____________________
d. furniture __________________
8. CS Form 48 ____________________
15. Accomplishment Reports (if applicable)
9. Curriculum Map ____________________
_______________
10. Guidance Form ____________________

11. Lesson Plans/DLL ____________________

12. List of Students with

General Average ____________________

In the exigency of service, I am willing to report to work and attend Summer INSET for Teachers.

Present Home Address: Nancamaliran East Int. Urdaneta City, Pangasinan

Telephone/Cell phone Numbers: 09467085158

CARMELA Y. TABANIAG MARISOL B. OLPINDO

School Property Custodian Printed Name and Signature of Teacher

Approved and clearance granted:

JULIETA R. TAN
Principal
 Division of City Schools
City of Urdaneta
St. Andrew Montessori and High School Inc.
Nancayasan, Urdaneta City, Pangasinan

Year-End Teachers’ Clearance

School Year 2020-2021
The Principal
Sir/Madam:
This is to inform you that I have satisfactorily settled all the property and financial obligations in the school and
that I have submitted all the required reports as listed below. May I then be granted the Year-End Clearance for School
Year 2020-2021.

1. School Form 1 ________________ 13. Library

c. Borrowed Books ____________________

2. School Form 2 _________________
d. Borrowed Materials ____________________
3. School Form 3 ___________________
14. Classroom inventory and room safety
4. School Form 5 ___________________
d. room keys __________________
5. School Form 8 ___________________
e. books __________________
6. School Form 10 ___________________
f. equipment ___________________
7. DepEd Form 138 ____________________
d. furniture __________________
8. CS Form 48 ____________________
15. Accomplishment Reports (if applicable)
9. Curriculum Map ____________________
_______________
10. Guidance Form ____________________

11. Lesson Plans/DLL ____________________

12. List of Students with

General Average ____________________

In the exigency of service, I am willing to report to work and attend Summer INSET for Teachers.

Present Home Address: Casampagaan, Laoac, Pangasinan

Telephone/Cell phone Numbers: 09108339375

CARMELA Y. TABANIAG CHELSSIAH N. MANGSAT

School Property Custodian Printed Name and Signature of Teacher

Approved and clearance granted:

JULIETA R. TAN
Principal