Republic of the Philippines

Department of Education
Region III – Central Luzon
SCHOOLS DIVISION OF PAMPANGA
High School Blvd. Brgy. Lourdes, City of San Fernando

Sta. Ana District

STA. LUCIA ELEMENTARY SCHOOL

SOCIO/ ACADEMIC/ ANECDOTAL RECORD

Sta. Lucia Elementary School
S.Y. 2018-2019

Name: ________________________________ Residence_________________________________ Birthdate_____________

Father: ______________________________ Mother: ______________________________
No. of Children in the Boy: __ Girl: ____ Living with Parents: Yes: ___No: ____
Family:________
State if both parents are Yes: ____ No: ____ If no, pls. specify:
living:_______ _______________
Parents Monthly Income: Php______________ Economic Status: Very Poor ____ Poor ___ Average ____ High
____

I. Pre-Elementary Education
Entrance Age: Nursery: ____ Kinder: _____

II. Elementary Education

Graduate with Honors? Yes ____ No ____(Please check) If yes, specify
_____________________
(to be filled after
graduation)
A. Academic Profile
1. Reading

GRADE III
1 2 3 4
Non-Reader
Frustration
Instructional
Independent
Legend: 1-Non Reader 2-Frustration 3-Instructional 4-Independent
(Please check appropriate box in each grade applicable opposite Nos. 1, 2, 3, or 4 and case may be.)

2. Mathematics

GRADE III
1 2 3 4
Addition
Subtraction
Multiplication
Division
Problem Solving
Legend: W- level of mastery is very poor X- some degree of mastery but needs more practice
Y- just enough mastery Z- manifest excellence
(Above code shall be entered for each of the curriculum year)
 Republic of the Philippines
Department of Education
Region III – Central Luzon
SCHOOLS DIVISION OF PAMPANGA
High School Blvd. Brgy. Lourdes, City of San Fernando

Sta. Ana District

STA. LUCIA ELEMENTARY SCHOOL

B. Oral Participation/Recitation

GRADE III
1 2 3 4
Passive
Poor
Active

C. Any Academic honor obtained in: D. Special Talents/Skills/Winnings

Grade I _________________ I II III IV V VI

_
Grade II _________________ 1. Singing
_
Grade III _________________ 2. Dancing
_
Grade IV _________________ 3. Music Reading
_
Grade V _________________ 4. Drawing/Painting
_
Grade VI _________________ 5. Dramatics
_
6. Speaking
(Please Specify) a. Declamation
b. Oratorical
7. Athletics
8. Leadership
9. Others (Pls. Specify)

E. Cases of Significant Misdemeanor/s

FIRST QUARTER SECOND QUARTER THIRD QUARTER FOURTH QUARTER

DATE Cases of DATE Cases of DATE Cases of DATE Cases of
Significant Significant Significant Significant
Misdemeanor/s Misdemeanor/s Misdemeanor/s Misdemeanor/s

Prepared by: Noted:

CHERRIE MAE G. LAZATIN RONNIE D. VILLEZA

 Republic of the Philippines
Department of Education
Region III – Central Luzon
SCHOOLS DIVISION OF PAMPANGA
High School Blvd. Brgy. Lourdes, City of San Fernando

Sta. Ana District

STA. LUCIA ELEMENTARY SCHOOL

Teacher 1 Principal II