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ANECDOTAL RECORD

OBSERVER:____________________________________ OBSERVATION DATE:_________________


STUDENT’S NAME:______________________________ OBSERVATION TIME:_________________
YEAR & GRADE:_______________

DESCRIPTION OF THE INCIDENT:


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DESCRIPTION OF LOCATION:
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NOTES/ SUGGESTIONS/ACTIONS:
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SIGNATURE OF STUDENT: ____________________________________

ADVISER:

JOEWELLYN V. LIM
T-II

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