Republic of the Philippines

Department of Education
Caraga Administrative Region
Bislig Ctiy Division
BISLIG I DISTRICT

___________________________________

CERTIFICATION
TO WHOM IT MAY CONCERN:

This is to certify that _________________________ of ___________________________ Grade ______

Adviser has submitted the following records/documents for checking to wit:

1. Form 1 – School Register

2. STS form 2 – Family Background and Profile
3. Form 2 – Teachers monthly Report of Enrolment and Attendance
4. STS Form 4 – Absenteeism and Drop-out Profile (Optional)
5. School Form 5 – Report on Promotion and Level of Proficiency
6. School Form 6 – Summarized Report on Promotion and Level of Proficiency
7. Form 138 – Report Card
8. Form 137 – Permanent Record
9. Grade Sheet
10. Class Record
11. List of Graduates
12. Diploma
13. Ranking of Honor Pupils
14. Resolution
15. Certification for Number of School Days

Issued this ______ day of March 2014 at Poblacion, Bislig City.

DISTRICT CHECKING COMMITTEE

____________________ _______________________ ____________________

Member Member Member

Attested by:
VICTOR A. ODTOHAN
SP-III/District In-Charge

DIVISION REVIEW and APPRAISAL COMMITTEE

Validated by:

ANTONIETTA O. NARRA ARDALITA C. CAOMATE, ED. D.

DEPRS/DRAC DEPS/DRAC