Republic of the Philippines

Department of Education
Region IV-A
SCHOOLS DIVISION OF QUEZON PROVINCE
DOÑA SALUD NATIONAL HIGH SCHOOL
SAN NARCISO, QUEZON

INDIVIDUAL STUDENT TREE PLANTING AND GREENING RECORD

(The revitalized Tree Planting and Greening as per DECS NO. 57, s. 1996)

Name of Student: ____________________________________________________________________

Number of Trees
Date Place Certified by:
Year Specie
Planted Survived Planted Planted Name & Signature

This is to certify that __________________________________________________, having

complied with DepEd tree planting requirement is eligible for graduation.

MELVIN S. PAPA
School RTGP Coordinator

APPROVED:

VERGEL E. VICTOR
Head Teacher I

Note: This form should be attached to Form 137 – A Pupil/Student Permanent Record. Pupil
in the primary grade may just be required to take care of the young trees and do other
greening projects.

“Sa Doña Salud,

Mga Bata ay Very GOOD!”
Address: Brgy. Guinhalinan,
San Narciso, Quezon
Contact Number: 0935-211-4300
Email Address: 301281@deped.gov.ph
 Republic of the Philippines
Department of Education
Region IV-A
SCHOOLS DIVISION OF QUEZON PROVINCE
DOÑA SALUD NATIONAL HIGH SCHOOL
SAN NARCISO, QUEZON

____________________________
Division RTGP Coordinator

“Sa Doña Salud,

Mga Bata ay Very GOOD!”
Address: Brgy. Guinhalinan,
San Narciso, Quezon
Contact Number: 0935-211-4300
Email Address: 301281@deped.gov.ph