Leyte Normal University

College of Education
INTEGRATED LABORATORY SCHOOL
Tacloban City

Record of Co-Curricular Involvement/Participation of Students

S.Y. 2021-2022

For students: Please fill up the needed information for the Name of Activity/Organization, Level
of Participation and Position/Place. Please attach you certificates in Appendix A for reference.
The adviser shall evaluate your submitted certificates.

In recognition of the leadership skills, services and participation of the pupils/students in different
competitions the following points in the area of co-curricular activities performance shall be granted  based on
Enclosure No. 2 DepEd Order No. 92, s. 2009.

Level of
Participation Date of
Name of Position/Place the Event Signature of
(International, Points
Activity/Organizatio National, (Placer/ Coach/Adviser/
(m/d/y) Earned
n regional, Participant) Teacher
Division, District
or School)

Checked by: Verified by:

__________________________________ __________________________________
Adviser’s Signature Over Printed Name Evaluator’s Signature Over Printed Name

APPENDIX A
Certificates