BAHAY PAGBASA BILANG:____ Nilalaman(5%): ___

Pangalan::_____________________________________________________ Mekaniks (5%): ___

Baitang:_________________________Petsa:______________
KABUUAN(10%)___
Pamagat ng Kuwento:_______________________________________

May-akda ng Kuwento:_____________________________________

Natutunang Aral sa Kuwento: _______________________________________________

Mga Tauhan sa Binasang Kuwento:____________________________________________

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Ang kuwento ay….

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Natutunan ko sa kuwento na….

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