Form 137-A

Republic of the Philippines

DEPARTMENT OF EDUCATION
NEGROS ISLAND REGION

____________________________________
School
____________________________________
Municipality

SECONDARY STUDENT'S PERMANENT RECORD

Date of Birth: Year______Month_____Day______Sex____

(Surname) (Given Name)
Place of Birth:
Province Town Barrio
Parent Guardian:
(Name) (Address) (Occupation)
Elementary course completed School Level Gen. Ave
RECORD OF STANDARD INTELLIGENCE AND ACHIEVEMENT TEST

Year ______Section ______ School Yr __________ Year _______

School _________________________________

PERIODICAL
SUBJECT RATING Final Rating Action Taken
1 2 3 4
Filipino
English
Mathematics
Science
Araling Panlipunan
EsP
EPP/TLE
MAPEH
Music
Arts
PE
Health
Days
of Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Total
Schoo
l
Days
Prese
nt
 REPORT ON LEARNER'S OBSERVED VALUES
Quarter
Core Values Behavior Statements
1 2 3 4
Expresses one's spiritual beliefs while
1. MAKA-DIYOS respecting the spiritual beliefs of others
Shows adherence to ethical principles by upholding truth
Is sensitive to individual, social, and cultural differences
2. MAKATAO
Demonstrates contributions towards solidarity
Cares for the environment and utilizes resources
3. MAKAKALIKA
judiciously, and economically
Demonstrates pride in being a Filipino; exercises
the rights and responsibilities of a Filipino citizen
4. MAKABANSA
Demonstrates appropriate behavior in carrying out
activities in the school, community, and country

CERTIFICATE OF TRANSFER
To Whom It May Concern:
I certify that this is a true record of , the student is eligible, on this day of
, 20_ for admission to the year as a regular/an irregular and had no
money or property responsibility in this school.
Remarks

(Principal)

Copy of this record sent to principal of School

on , 20 .

(Principal)
Form 137-A
Republic of the Philippines
DEPARTMENT OF EDUCATION
NEGROS ISLAND REGION
____________________________________
School
____________________________________
Municipality

SECONDARY STUDENT'S PERMANENT RECO

(Surname) (Given Name)

Place of Birth: Province
Parent Guardian:
(Name)
Elementary course completed School

RECORD OF STANDARD INTELLIGENCE AND ACHIEVE

Year _______ Section ______ School Yr __________
School _________________________________

PERIODICAL RATING
SUBJECT Final Rating
1 2 3 4
Filipino
English
Mathematics
Science
Araling Panlipunan
EsP
EPP/TLE
MAPEH
Music
Arts
PE
Health

Jun Jul Aug Sept Oct Nov Dec

Days of School
Days Present
blic of the Philippines
ENT OF EDUCATION
OS ISLAND REGION
_______________________
School
_______________________
Municipality

DENT'S PERMANENT RECORD

Date of Birth: Year______Month_____Day______Sex____

Town Barrio

(Address) (Occupation)
Level Gen. Ave

TELLIGENCE AND ACHIEVEMENT TEST

Year _______

Action Taken

Jan Feb Mar Apr May Total