DepEd Form 137-A

Republic of the Philippines

DEPARTMENT OF EDUCATION
Region XII

School

Municipality

SECONDARY STUDENT’S PERMANENT RECORD

NAHINE JERALD Date of Birth: Year 1998 Month APRIL Day 27 Sex MALE
(Surname) (Given Name)
Place of Birth: Province SARANGANI Town _______________________ Barrio
________________________________
Parent of Guardian: JOAN N. DANIAL SAN JUAN, MAASIM, SARANGANI PROVINCE HOUSE
KEEPING
(Name) (Address) (Occupation)
Elementary course completed School: HILLTOP ELEMENTARY SCHOOL Year: 2010 - 2011 Gen. Ave. 87.50
Total number of years in school to complete elementary courses: 6 yrs

School COLON NATIONAL HIGH SCHOOL Year: FIRST Section: BILARDO School Year 20 11 -
20 12
PERIODICAL RATING
SUBJECT Averaging/Cumulative Final Action Taken Units Earned
1 2 3 4 Rating

June July Aug Sept Oct Nov Dec Jan Feb Mar April May TOTAL
Days of School
Days Present
Total number of years in School to date 7 years

School: COLON NATIONAL HIGH SCHOOL Year: SECOND Section: DAVIS School Year 20 12 -
20 13
PERIODICAL RATING
SUBJECT Averaging/Cumulative Final Rating Action Units Earned
1 2 3 4 Taken
 June July Aug Sept Oct Nov Dec Jan Feb Mar April May TOTAL
Days of School
Days Present
Total number of years in School to date 8 years

NAME
________________________________________________________________________________________________________
_______________
(Surname) (First Name)
School COLON NATIONAL HIGH SCHOOL Year: THIRD Section: COULSON School Year 20 13 -
20 14

PERIODICAL RATING Extra-

SUBJECT Averaging/Cumulative Final Action Units curricular
1 2 3 4 Rating Taken Earned Activities

June July Aug Sept Oct Nov Dec Jan Feb Mar April May TOTAL
Days of School
Days Present
Total number of years in School to date 9 years

School: COLON NATIONAL HIGH SCHOOL Year: FOURTH Section: ARCHIMEDES School Year 20 14
- 20 15
PERIODICAL RATING Extra-
SUBJECT Averaging/Cumulative Final Action Units curricul
1 2 3 4 Rating Taken Earned ar
Activitie
s

June July Aug Sept Oct Nov Dec Jan Feb Mar April May TOTAL
Days of School
Days Present
Total number of years in School to date 10 years
 C E R T I F I C A T E O F T R A N S F E R

To Whom It May Concern:

I certify that thus us a true record of ________________________________, this student is eligible, on this
__________ day of ______________________, 20_____, for admission to the _______________ year as a
regular/an Irregular and had no money or property responsibility in this school.

_________________________
(Principal)
Copy of this record sent to principal of _______________________________________________________ school
on ________________________________________, 20____________.

_________________________
(Principal)