Student Anecdotal Record

DATE:_____________________________
DESCRIPTION OF THE INCIDENT_____________________________________________________
________________________________________________________________________________
Republic of the Philippines
________________________________________________________________________________ Department of Education
Cordillera Administrative Region
________________________________________________________________________________
________________________________________________________________________________ PINES CITY NATIONAL HIGH SCHOOL

-SENIOR HIGH SCHOOL LUCBAN
DESCRIPTION OF THE LOCATION/SETTING__________________________________________ CAMPUS
SY 2022-2023
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
NOTES/RECOMMENDATION/ACTION TAKEN________________________________________
ANECDOTAL
______________________________________________________________________________
_____________________________________________________________________________
______________________________________________________________________________
RECORD
AGREEMENT:_________________________________________________________________
______________________________________________________________________________
SIGNATURE OF STUDENT OVER PRINTED NAME SIGNATURE OF PARENT OVER PRINTED NAME
SIGNATURE OF ADVISER OVER PRINTED NAME
PROFILE
NAME:______________________________________ NAME OF PARENTS:
LRN:________________________________________ FATHER:_________________________ OCCUPATION:__________________
GRADE AND SECTION:___________________ BUSINESS ADDRESS:_________________________CONTACT #:_____________________
AGE:_______________ MOTHER:_________________________ OCCUPATION:__________________
GENDER:______________ BUSINESS ADDRESS:_________________________CONTACT #:_____________________
BIRTHDATE:__________________________________ GUARDIAN( IF NOT LIVING WITH PARENTS)
BIRTHPLACE:_________________________________ NAME:_____________________________ OCCUPATION:__________________
ETHNICITY:___________________________________ BUSINESS ADDRESS:_________________________CONTACT #:_____________________
ADDRESS (BAGUIO CITY)_________________________________________________ RELATIONSHIP:____________________________________
PERMANENT ADDRESS:__________________________________________________ NO. OF SIBLINGS:_________
SOCIAL MEDIA ACCOUNTS:_______________________________________________ TELL SOMETHING ABOUT YOUSELF:________________________________________
RELIGION:____________________________________ _________________________________________________________________
EDUCATION NICKNAME:___________________________
ELEMENTARY:______________________________________________ FAVORITE QUOTES:_______________________________________________________
SECONDARY(JUNIOR):_______________________________________ ________________________________________________________________________
HOBBY:_________________________________________
GOAL IN LIFE:_____________________________________________________________
_________________________________________________________________________
OTHERS (PLS. SPECIFY):___________________________________________________
________________________________________________________________________
PERSONAL INFORMATION: DATE:_____________________________

DESCRIPTION OF THE INCIDENT_____________________________________________________ DESCRIPTION OF THE INCIDENT_____________________________________________________
________________________________________________________________________________ ________________________________________________________________________________
________________________________________________________________________________ ________________________________________________________________________________
________________________________________________________________________________ ________________________________________________________________________________
________________________________________________________________________________ ________________________________________________________________________________
DESCRIPTION OF THE LOCATION/SETTING____________________________________________ DESCRIPTION OF THE LOCATION/SETTING__________________________________________
_______________________________________________________________________________ _______________________________________________________________________________
_______________________________________________________________________________ _______________________________________________________________________________
_______________________________________________________________________________ _______________________________________________________________________________
NOTES/RECOMMENDATION/ACTION TAKEN________________________________________ NOTES/RECOMMENDATION/ACTION TAKEN________________________________________
______________________________________________________________________________ ______________________________________________________________________________
_____________________________________________________________________________ _____________________________________________________________________________
______________________________________________________________________________ ______________________________________________________________________________
AGREEMENT:_________________________________________________________________ AGREEMENT:_________________________________________________________________
______________________________________________________________________________ ______________________________________________________________________________
SIGNATURE OF STUDENT OVER PRINTED NAME SIGNATURE OF PARENT OVER PRINTED NAME SIGNATURE OF STUDENT OVER PRINTED NAME SIGNATURE OF PARENT OVER PRINTED NAME
SIGNATURE OF ADVISER OVER PRINTED NAME SIGNATURE OF ADVISER OVER PRINTED NAME
DATE:_____________________________ PROFILE
NAME:______________________________________ NAME OF PARENTS:
LRN:________________________________________ FATHER:_________________________ OCCUPATION:__________________
GRADE AND SECTION:___________________ BUSINESS ADDRESS:_________________________CONTACT #:_____________________
AGE:_______________ MOTHER:_________________________ OCCUPATION:__________________
GENDER:______________ BUSINESS ADDRESS:_________________________CONTACT #:_____________________
BIRTHDATE:__________________________________ GUARDIAN( IF NOT LIVING WITH PARENTS)
BIRTHPLACE:_________________________________ NAME:_____________________________ OCCUPATION:__________________
ETHNICITY:___________________________________ BUSINESS ADDRESS:_________________________CONTACT #:_____________________
ADDRESS (BAGUIO CITY)_________________________________________________ RELATIONSHIP:____________________________________
PERMANENT ADDRESS:__________________________________________________ NO. OF SIBLINGS:_________
SOCIAL MEDIA ACCOUNTS:_______________________________________________ TELL SOMETHING ABOUT YOUSELF:________________________________________
RELIGION:____________________________________ _________________________________________________________________
EDUCATION NICKNAME:___________________________
ELEMENTARY:______________________________________________ FAVORITE QUOTES:_______________________________________________________
SECONDARY(JUNIOR):_______________________________________ ________________________________________________________________________
HOBBY:_________________________________________
GOAL IN LIFE:_____________________________________________________________
_________________________________________________________________________
OTHERS (PLS. SPECIFY):___________________________________________________
________________________________________________________________________
DATE:_____________________________
PERSONAL INFORMATION:
DESCRIPTION OF THE INCIDENT_____________________________________________________ DESCRIPTION OF THE INCIDENT_____________________________________________________
________________________________________________________________________________ ________________________________________________________________________________
________________________________________________________________________________ ________________________________________________________________________________
________________________________________________________________________________ ________________________________________________________________________________
________________________________________________________________________________ ________________________________________________________________________________
DESCRIPTION OF THE LOCATION/SETTING__________________________________________ DESCRIPTION OF THE LOCATION/SETTING__________________________________________
_______________________________________________________________________________ _______________________________________________________________________________
_______________________________________________________________________________ _______________________________________________________________________________
_______________________________________________________________________________ _______________________________________________________________________________
NOTES/RECOMMENDATION/ACTION TAKEN________________________________________ NOTES/RECOMMENDATION/ACTION TAKEN________________________________________
______________________________________________________________________________ ______________________________________________________________________________
_____________________________________________________________________________ _____________________________________________________________________________
______________________________________________________________________________ ______________________________________________________________________________
AGREEMENT:_________________________________________________________________ AGREEMENT:_________________________________________________________________
______________________________________________________________________________ ______________________________________________________________________________
SIGNATURE OF STUDENT OVER PRINTED NAME SIGNATURE OF PARENT OVER PRINTED NAME SIGNATURE OF STUDENT OVER PRINTED NAME SIGNATURE OF PARENT OVER PRINTED NAME
SIGNATURE OF SUBJECT TEACHER OVER PRINTED NAME SIGNATURE OF SUBJECT TEACHER OVER PRINTED NAME
DATE:_____________________________
ANECDOTAL ANECDOTAL
RECORD RECORD
________________________________________________________________________________________________ ________________________________________________________________________________________________
ANECDOTAL ANECDOTAL
RECORD RECORD
________________________________________________________________________________________________ ________________________________________________________________________________________________

Student Anecdotal Record

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Student Anecdotal Record

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DATE:_____________________________

DESCRIPTION OF THE INCIDENT_____________________________________________________

________________________________________________________________________________ PINES CITY NATIONAL HIGH SCHOOL

SIGNATURE OF ADVISER OVER PRINTED NAME

LRN:________________________________________ FATHER:_________________________ OCCUPATION:__________________

GRADE AND SECTION:___________________ BUSINESS ADDRESS:_________________________CONTACT #:_____________________

AGE:_______________ MOTHER:_________________________ OCCUPATION:__________________

GENDER:______________ BUSINESS ADDRESS:_________________________CONTACT #:_____________________

BIRTHDATE:__________________________________ GUARDIAN( IF NOT LIVING WITH PARENTS)

BIRTHPLACE:_________________________________ NAME:_____________________________ OCCUPATION:__________________

ETHNICITY:___________________________________ BUSINESS ADDRESS:_________________________CONTACT #:_____________________

ADDRESS (BAGUIO CITY)_________________________________________________ RELATIONSHIP:____________________________________

PERMANENT ADDRESS:__________________________________________________ NO. OF SIBLINGS:_________

SOCIAL MEDIA ACCOUNTS:_______________________________________________ TELL SOMETHING ABOUT YOUSELF:________________________________________

ELEMENTARY:______________________________________________ FAVORITE QUOTES:_______________________________________________________

OTHERS (PLS. SPECIFY):___________________________________________________

PERSONAL INFORMATION: DATE:_____________________________

DESCRIPTION OF THE LOCATION/SETTING____________________________________________ DESCRIPTION OF THE LOCATION/SETTING__________________________________________

NOTES/RECOMMENDATION/ACTION TAKEN________________________________________ NOTES/RECOMMENDATION/ACTION TAKEN________________________________________

LRN:________________________________________ FATHER:_________________________ OCCUPATION:__________________

GRADE AND SECTION:___________________ BUSINESS ADDRESS:_________________________CONTACT #:_____________________

AGE:_______________ MOTHER:_________________________ OCCUPATION:__________________

GENDER:______________ BUSINESS ADDRESS:_________________________CONTACT #:_____________________

BIRTHDATE:__________________________________ GUARDIAN( IF NOT LIVING WITH PARENTS)

BIRTHPLACE:_________________________________ NAME:_____________________________ OCCUPATION:__________________

ETHNICITY:___________________________________ BUSINESS ADDRESS:_________________________CONTACT #:_____________________

ADDRESS (BAGUIO CITY)_________________________________________________ RELATIONSHIP:____________________________________

PERMANENT ADDRESS:__________________________________________________ NO. OF SIBLINGS:_________

SOCIAL MEDIA ACCOUNTS:_______________________________________________ TELL SOMETHING ABOUT YOUSELF:________________________________________

ELEMENTARY:______________________________________________ FAVORITE QUOTES:_______________________________________________________

OTHERS (PLS. SPECIFY):___________________________________________________

DESCRIPTION OF THE LOCATION/SETTING__________________________________________ DESCRIPTION OF THE LOCATION/SETTING__________________________________________

NOTES/RECOMMENDATION/ACTION TAKEN________________________________________ NOTES/RECOMMENDATION/ACTION TAKEN________________________________________

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LRN:____________________________ FATHER:_ OCCUPATION:______

GRADE AND SECTION:_______ BUSINESS ADDRESS:_CONTACT #:_________

AGE:___ MOTHER:_ OCCUPATION:______

GENDER:__ BUSINESS ADDRESS:_CONTACT #:_________

BIRTHPLACE:___________________ NAME:_ OCCUPATION:____

ETHNICITY:_______________________ BUSINESS ADDRESS:_CONTACT #:_________

ADDRESS (BAGUIO CITY)_____________ RELATIONSHIP:

PERMANENT ADDRESS:__________________________________________ NO. OF SIBLINGS:_

SOCIAL MEDIA ACCOUNTS:_______ TELL SOMETHING ABOUT YOUSELF:

ELEMENTARY: FAVORITE QUOTES:_________

DESCRIPTION OF THE LOCATION/SETTING__ DESCRIPTION OF THE LOCATION/SETTING

NOTES/RECOMMENDATION/ACTION TAKEN NOTES/RECOMMENDATION/ACTION TAKEN

LRN:____________________________ FATHER:_ OCCUPATION:______

GRADE AND SECTION:_______ BUSINESS ADDRESS:_CONTACT #:_________

AGE:___ MOTHER:_ OCCUPATION:______

GENDER:__ BUSINESS ADDRESS:_CONTACT #:_________

BIRTHPLACE:___________________ NAME:_ OCCUPATION:____

ETHNICITY:_______________________ BUSINESS ADDRESS:_CONTACT #:_________

ADDRESS (BAGUIO CITY)_____________ RELATIONSHIP:

PERMANENT ADDRESS:__________________________________________ NO. OF SIBLINGS:_

SOCIAL MEDIA ACCOUNTS:_______ TELL SOMETHING ABOUT YOUSELF:

ELEMENTARY: FAVORITE QUOTES:_________

DESCRIPTION OF THE LOCATION/SETTING DESCRIPTION OF THE LOCATION/SETTING

NOTES/RECOMMENDATION/ACTION TAKEN NOTES/RECOMMENDATION/ACTION TAKEN