Department of Education

CARAGA Administrative Region

Division of Agusan del Sur
TUMALOG NATIONAL SCIENCE HIGH SCHOOL
Sitio Tumalog, Zillovia, Talacogon, Agusan del Sur
School ID: 317449
September 5, 2022
Date
MINERVA T. ALBIS, PhD.
Schools Division Superintendent
DepEd, Division of Agusan del Sur D
Prosperidad, Agusan del Sur
a
t
Ma'am: e
May I have the honor to inform your good office that I have satisfactorily cleared myself of all property and money accountabilities
and responsibilities in the school. All reports required of me have been submitted on the dates indicated below with the signature
of the designated receiving/collecting officer as my proof.
Reports Date Signature Remittances Signature
1. SF1 1. Boy Scout
2. SF2 2. Girl Scout
3. SF3 3. Red Cross
4. 4. Anti-TB
Form 137-E/A with STS, Health Card/
Birth Certificate/ PFFT
5. Form 138/ A 5. District Teacher's Association
6. SF5 6. TECHNOLYMPICS
7. Form 48 7. School Teacher's Association
8. Lesson Plan
HR-PTA Project Accomp. Report
8.
9. Class Record 9. DASCO
10. 10.
Grading Sheet/ Consolidation Sheets/ Residence Certificate
Ranking
11. Accomplished IPCRF 11. MTAP/ Math
12. 12. Science Club
Inventory (textbooks/ manuals,
furniture, donations)
13. IPPD/ Action Plan 13. PTA
14. Property Custodian 14. School Canteen
15. Form 86 (Annual Health Examination) 15. Others
16. DORP Plan & Accomplished Report
17. Phil-IRI (Filipino/English)
18. SREA (Elem)
Test Questionnaires with TOS, MPS, List
19. of Least Learned Skill
20. SALN
My last day of service in this school is on _________________________________.
Until further notice, my mailing address is Purok 8, Patin-ay, Prosperidad, Agusan del Sur.
Purpose of this clearance: _______________________________________

Attested:
ALEXANDER G. MONDEJAR GERALD P. PIZARRO
School Head Teacher's Signature over Printed Name

1st Endorsement

Respectfully forwarded to the Schools Division Superintendent, Gov. D.O. Plaza, Government Center, Prosperidad,
Agusan del Sur, complete/ conditional clearance of _________________________________.
It is requested that approval be granted. For conditional clearance, the District Supervisor/ In-charge and the School
Head are responsible in making follw-up of deficiencies.

Attested Recommending Aprroval:

ALEX SARZATE RICKY P. OROSCO

PSDI Division EPS

Approved: MINERVA T. ALBIS, PhD.

Schools Division Superintendent
 Department of Education
CARAGA Administrative Region
Division of Agusan del Sur
AGUSAN DEL SUR NATIONAL SCIENCE HIGH SCHOOL
Gov. D.O.Plaza Government Center, Prosperidad, Agusan del Sur
School ID: 304704

Date
MINERVA T. ALBIS, Ph.D.
OIC-Schools Division Superintendent
DepEd, Division of Agusan del Sur
Prosperidad, Agusan del Sur

Madam:
I have the honor to inform your good office that I have satisfactorily cleared myself of all the property and money accountabilities
in the school. All reports required of me have been submitted on the dates indicated with the signature of the designated receiving/
collecting officer as my proof.
Reports Date Signature Remittances Signature
1. SF1 N/A 1. Boy Scout
2. SF2 N/A 2. Girl Scout
3. SF3 N/A 3. Red Cross
4. Form 137-E/A with STS, Health Card/ 4. Anti-TB
Birth Certificate/ PFFT N/A
5. Form 138/ A 5. PRES (Cluster I Athletic
N/A Association)
6. SF5 6. TECHNOLYMPICS
7. Form 48 7. School Teacher's Association
8. Lesson Plan
HR-PTA Project Accomp. Report
N/A 8.
9. Class Record N/A 9. DASCO
10. Grading Sheet/ Consolidation Sheets/ 10.
Residence Certificate
Ranking N/A
11. Accomplished IPCRF N/A 11. MTAP/ Math
12. Inventory (textbooks/ manuals, 12. Science Club
furniture, donations) N/A
13. IPPD/ Action Plan N/A 13. PTA
14. Property Custodian 14. School Canteen
15. Form 86 (Annual Health Examination) 15. Others
16. DORP Plan & Accomplished Report
17. Phil-IRI (Filipino/English) N/A
18. SREA (Elem) N/A
Test Questionnaires with TOS, MPS, List
19. of Least Learned Skill N/A
20. SALN
My last day of service in this school is on _________________________________.
Until further notice, my mailing address is __________________________________________________.
Purpose of this clearance: _______________________________________

GERMAN C. TALAGON
Signature over Printed Name
Attested:
EMERALD A. OTIC MARIA ROTELLA D. NIEPEZ MARIO L. AYUBAN
Faculty President School Librarian-Designate ICT/ LIS In-charge/ Property Custodian-Designate

JESSA KRIS L. GEOLINA ZALDY M. CHUA

AA II/ MOOE Liquidation Incharge GPTA President

1st Endorsement

Respectfully forwarded to the Schools Division Superintendent, Gov. D.O. Plaza, Government Center, Prosperidad,
Agusan del Sur, complete/ conditional clearance of _________________________________.
It is requested that approval be granted. For conditional clearance, the District Supervisor/ In-charge and the School
Head are responsible in making follw-up of deficiencies.

Recommending Approval:
JOCELYN L. MENIL-DINAPO
Prosperidad III District Supervisor

Approved: MINERVA T. ALBIS, Ph.D.

OIC-Schools Division Superintendent