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Department of Education

School
Logo
Region III-Central Luzon
here Schools Division of Pampanga
TARIK SULIMAN HIGH SCHOOL
Sagrada Familia, Masantol, Pampanga
Guidance and Counseling Office
Form No. ___ dropped out form

Date: _____________________

Name: _________________________________Grade and Section: __________________________


Address: ___________________________________________________________________________
Name of Parent/Guardian: ____________________________________________________________
Reason /s for Dropped Out:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
__________________________________________________________________________________

Duration of Visitation(s)/Interview(s): _____________________________

Agreement/Terms and Conditions:


______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

OTHERS:
_____________________________________________________________________________________

____________________________ __________________________
Parent(s)/Guardian(s) Signature Student ‘s Signature

___________________________ __________________________
Class Adviser Signature Name & Signature of Guidance Counselor

Noted:

Dominic S. Sunga
Principal

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