Republika ng Pilipinas

(Republic of the Philippines)

Kagawaran ng Edukasyon
(Department of Education)
KAWANIHAN NG EDUKASYON ELEMENTARYA
(BUREAU OF ELEMENTARY EDUCATION)
Rehiyon XI
(Region XI)
DIVISION OF ISLAND GARDEN CITY OF SAMAL
(Sangay ng Island Garden City of Samal)

DepEd Form 137-E

LRN: ________________

PALAGIANG TALAAN SA MABABANG PAARALAN

(ELEMENTARY SCHOOL PERMANENT RECORD)

Pangalan
(Name)

Kasarian _____

___ Sangay ____

__________________________
Apelyido

Unang Pangalan

MI

_______ Paaralan _____________________

(Division)

(School)

_____ Petsa ng Kapanganakan ____________ Pook _______________________ Petsa ng Pagpasok ______________

(Sex)

(Date of Birth)

Magulang/Tagapag-alaga

(Place)

____________ ____

(Parent/Guardian)

Bayan/Lalawigan/Lungsod
(Town/Province/City)

________________

_______

Pangalan
(Name)

(Date of Entrance)

___

___

_________

Tirahan
(Address)

____

Hanapbuhay
(Occupation)

PAG-UNLAD SA MABABANG PAARALAN

(ELEMENTARY SCHOOL PROGRESS)

Grade I

School: ______________________________
School Year: __________________________
Teacher: ______________________________

Total No. of Years in School to Date: ______

Grade III

____

Eligible for Admission to Grade

Grade II

Total No. of Years in School to Date: ______

School: ______________________________
School Year: __________________________
Teacher: ______________________________

Learning Areas
Mother Tongue
Filipino
English
Mathematics
Science
Araling Panlipunan
Edukasyon sa Pagpapakatao
MAPEH
Music
Arts
Physical Education
Learning Areas
Health

Final
Grade

Remarks

School: _____________________________
School Year: _________________________
Teacher_________________________________

Grade IV

Eligible for Admission to Grade

____

School: _____________________________
School Year: _________________________
Teacher_________________________________

Total No. of Years in School to Date: ______

Total No. of Years in School to Date: ______

Eligible for Admission to Grade

Eligible for Admission to Grade

____
____

Grade V School: ______________________________

Grade VI
School: _____________________________
School Year: __________________________
School Year:

_________________________
Teacher: ______________________________
Teacher_________________________________
1

Final
Grade

Filipino
EnglishGeneral Average
Mathematics
Science
Araling Panlipunan
Core Values
Behavior Statements
Edukasyon sa Pagpapakatao
Edukasyong Pantahanan at
Pangkabuhayan
MAPEH
1. Maka-Diyos
Expresses ones spiritual beliefs while
Music
respecting the spiritual beliefs of others
Arts
Shows adherence to ethical principles by
Physical Education
upholding truth
Health

Remarks
Total No. of Years in School to Date: ______
Total No. of Years in School to Date: ______

Eligible for Admission to Grade

Eligible for Admission to Grade

____
____

III. REPORT ON LEARNERS OBSERVED VALUES

Grade & Sec.: ______ ______
School Year: _____________

Grade & Sec.: ______ ______

School Year: _____________

Grade & Sec.: ______ ______

School Year: _____________

2. Makatao

Is sensitive to individual, social, and

cultural differences
General Average
Demonstrates contributions toward
solidarity
Cares for the environment and utilizes
3. Makakalikasan resources wisely, 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
Guide for Rating:

Core Values

AO Always Observed

Behavior Statements

SO Sometimes Observed
Grade & Sec.: ______ ______
School Year: _____________

1
1. Maka-Diyos

2. Makatao

Expresses ones spiritual beliefs while

respecting the spiritual beliefs of others
Shows adherence to ethical principles by
upholding truth
Is sensitive to individual, social, and
cultural differences
Demonstrates contributions toward
solidarity

RO Rarely Observed
Grade & Sec.: ______ ______
School Year: _____________

NO Not Observed

Grade & Sec.: ______ ______

School Year: _____________

3. Makakalikasan

4. Makabansa

Cares for the environment and utilizes

resources wisely, judiciously, and
economically.
Demonstrates pride in being a Filipino;
exercises the rights and responsibilities of
a Filipino citizen
Demonstrates appropriate behavior in
carrying out activities in the school,
community, and country

Guide for Rating:

AO Always Observed

SO Sometimes Observed

RO Rarely Observed

NO Not Observed

IV. ATTENDANCE RECORD

Grade &
Section

No. of School
Days

No. of School
Days Absent

Cause

No. of Times
Tardy

Cause

No. of School
Days Present

CERTIFICATE OF TRANSFER
To Whom It May Concern:
This is to certify that this is a true record of the Elementary School Permanent Record of _____________________________.
He/She is eligible for transfer and admission to ___________________.
________________________________
(Signature Over Printed Name)

_____________________
Date

MARIO D. FLORES
________________________________
(Designation)