S

(Thi

School ID 127933 RegionX Division

School Name Maputi Elementary School

AGE as of
1st Friday
of June
BIRTH BIRTH IP
NAME Sex MOTHER
LRN DATE PLACE (Specify
(Last Name, First Name, Middle Name) (M/F) (nos. of TONGUE
(mm/ dd/yy) ( Province) Ethnic Group)
years as
per last
birthday)
 AGE as of
1st Friday
of June
BIRTH BIRTH IP
NAME Sex MOTHER
LRN DATE PLACE (Specify
(Last Name, First Name, Middle Name) (M/F) (nos. of TONGUE
(mm/ dd/yy) ( Province) Ethnic Group)
years as
per last
birthday)
 AGE as of
1st Friday
of June
BIRTH BIRTH IP
NAME Sex MOTHER
LRN DATE PLACE (Specify
(Last Name, First Name, Middle Name) (M/F) (nos. of TONGUE
(mm/ dd/yy) ( Province) Ethnic Group)
years as
per last
birthday)
 AGE as of
1st Friday
of June
BIRTH BIRTH IP
NAME Sex MOTHER
LRN DATE PLACE (Specify
(Last Name, First Name, Middle Name) (M/F) (nos. of TONGUE
(mm/ dd/yy) ( Province) Ethnic Group)
years as
per last
birthday)
 AGE as of
1st Friday
of June
BIRTH BIRTH IP
NAME Sex MOTHER
LRN DATE PLACE (Specify
(Last Name, First Name, Middle Name) (M/F) (nos. of TONGUE
(mm/ dd/yy) ( Province) Ethnic Group)
years as
per last
birthday)
 AGE as of
1st Friday
of June
BIRTH BIRTH IP
NAME Sex MOTHER
LRN DATE PLACE (Specify
(Last Name, First Name, Middle Name) (M/F) (nos. of TONGUE
(mm/ dd/yy) ( Province) Ethnic Group)
years as
per last
birthday)
 AGE as of
1st Friday
of June
BIRTH BIRTH IP
NAME Sex MOTHER
LRN DATE PLACE (Specify
(Last Name, First Name, Middle Name) (M/F) (nos. of TONGUE
(mm/ dd/yy) ( Province) Ethnic Group)
years as
per last
birthday)

List and code of Indicators under REMARK column

Indicator Code Required Information Indicator Code
Transferred Ou T/O Name of Public (P) Private (PR) School & EffectivCCT Recipient CCT

Transferred IN T/I Name of Public (P) Private (PR) School & EffectivBalik-Aral B/A
Dropped DRP Reason and Effectivity Date Learner With Dissabilit LWD
Late Enrollment LE Reason (Enrollment beyond 1st Friday of June) Accelarated ACL
 School Form 1 (SF 1) School Register
(This replaced Form 1, Master List & STS Form 2-Family Background and Profile)

Misamis Oriental District Naawan

School Year 2014 - 2015 Grade Level II Section

ADDRESS NAME OF PARENTS

RELIGION
House # / Father (1st name only if
Mother (Maiden: 1st Name,
Street/Sitio/ Barangay Municipality/ City Province family name identical to
Middle & Last Name)
Purok learner)
 ADDRESS NAME OF PARENTS

RELIGION
House # / Father (1st name only if
Mother (Maiden: 1st Name,
Street/Sitio/ Barangay Municipality/ City Province family name identical to
Middle & Last Name)
Purok learner)
 ADDRESS NAME OF PARENTS

RELIGION
House # / Father (1st name only if
Mother (Maiden: 1st Name,
Street/Sitio/ Barangay Municipality/ City Province family name identical to
Middle & Last Name)
Purok learner)
 ADDRESS NAME OF PARENTS

RELIGION
House # / Father (1st name only if
Mother (Maiden: 1st Name,
Street/Sitio/ Barangay Municipality/ City Province family name identical to
Middle & Last Name)
Purok learner)
 ADDRESS NAME OF PARENTS

RELIGION
House # / Father (1st name only if
Mother (Maiden: 1st Name,
Street/Sitio/ Barangay Municipality/ City Province family name identical to
Middle & Last Name)
Purok learner)
 ADDRESS NAME OF PARENTS

RELIGION
House # / Father (1st name only if
Mother (Maiden: 1st Name,
Street/Sitio/ Barangay Municipality/ City Province family name identical to
Middle & Last Name)
Purok learner)
 ADDRESS NAME OF PARENTS

RELIGION
House # / Father (1st name only if
Mother (Maiden: 1st Name,
Street/Sitio/ Barangay Municipality/ City Province family name identical to
Middle & Last Name)
Purok learner)

olumn
Prepared by:
Required Information BoSY EoSY

CCT Control/reference number & Effectivity Date MALE

(Signature of Adviser over Prin

Name of school last attended & Year FEMALE

Specify
TOTAL
Specify Level & Effectivity Data BoSY Date: EoSYD
n

Sunflower

GUARDIAN (If not Parent) REMARK/S

Contact Number
(Parent
/Guardian)
(Please refer to the
Name Relationship
legend on last page)
GUARDIAN (If not Parent) REMARK/S
Contact Number
(Parent
/Guardian)
(Please refer to the
Name Relationship
legend on last page)
GUARDIAN (If not Parent) REMARK/S
Contact Number
(Parent
/Guardian)
(Please refer to the
Name Relationship
legend on last page)
GUARDIAN (If not Parent) REMARK/S
Contact Number
(Parent
/Guardian)
(Please refer to the
Name Relationship
legend on last page)
GUARDIAN (If not Parent) REMARK/S
Contact Number
(Parent
/Guardian)
(Please refer to the
Name Relationship
legend on last page)
GUARDIAN (If not Parent) REMARK/S
Contact Number
(Parent
/Guardian)
(Please refer to the
Name Relationship
legend on last page)
 GUARDIAN (If not Parent) REMARK/S
Contact Number
(Parent
/Guardian)
(Please refer to the
Name Relationship
legend on last page)

Certified Correct:

dviser over Printed Name) (Signature of School Head over Printed Name)

EoSYDate: BoSY Date: EoSYDate:

 School Form 3 (SF3
(This replaced

School ID 127933

School Name Maputi Elementary School

Subject Area & Title Subject Area & Title Subject Area & Title
MTB English Math
LEARNER'S NAME MTB 2 English 2 Math 2
NO. (Last Name, First
Name, Middle Name) Date Date Date
Issued Returned Issued Returned Issued

1 Amarga, Fox Chiecel M. 6/5/2017 6/5/2017 6/5/2017

2 Asis, Andrie Jan G. 6/5/2017 6/5/2017 6/5/2017

3 Cerna, Arrxian Joy A. 6/5/2017 6/5/2017 6/5/2017

4 Espra, John Felmhor N. 6/5/2017 6/5/2017 6/5/2017

5 Gaid, Julius C. 6/5/2017 6/5/2017 6/5/2017

6 Gape, Rien Mark D. 6/5/2017 6/5/2017 6/5/2017

7 Giga, Jobert 6/5/2017 6/5/2017 6/5/2017

8 Jabonero, Adrian Carl R. 6/5/2017 6/5/2017 6/5/2017

9 Laugo, Elfrid B. 6/5/2017 6/5/2017 6/5/2017

10 Limin, Cyril Jake 6/5/2017 6/5/2017 6/5/2017

11 Mapa, Christian L. 6/5/2017 6/5/2017 6/5/2017

12 Mejia, Kish Oliven D. 6/5/2017 6/5/2017 6/5/2017

13 Nale, Jhon Ivan 6/5/2017 6/5/2017 6/5/2017

14 Obial, Justine Vallar 6/5/2017 6/5/2017 6/5/2017

15 Pastor, Jericho G. 6/5/2017 6/5/2017 6/5/2017

16 Pombo, Tom Patrick 6/5/2017 6/5/2017 6/5/2017

17 Puga, Art Jan L. 6/5/2017 6/5/2017 6/5/2017

18 Sorin, Zedrick C. 6/5/2017 6/5/2017 6/5/2017

19 Tac-an, Mattneo A. 6/5/2017 6/5/2017 6/5/2017

20 Ubanan, Christian Louis T. 6/5/2017 6/5/2017 6/5/2017

 Subject Area & Title Subject Area & Title Subject Area & Title
MTB English Math
LEARNER'S NAME MTB 2 English 2 Math 2
NO. (Last Name, First
Name, Middle Name) Date Date Date
Issued Returned Issued Returned Issued

MALE | TOTAL = 20

1 Castro, Jellian Cel 6/5/2017 6/5/2017 6/5/2017

2 Daang, Nidhi A. 6/5/2017 6/5/2017 6/5/2017

3 Gonzales, Ashley Jian 6/5/2017 6/5/2017 6/5/2017

4 Juarez, Juven Lou T. 6/5/2017 6/5/2017 6/5/2017

5 Mapa, Crisell L. 6/5/2017 6/5/2017 6/5/2017

6 Priela, Ashley Joyce J. 6/5/2017 6/5/2017 6/5/2017

7 Ronquillo, Khyshiel B. 6/5/2017 6/5/2017 6/5/2017

8 Roxas, Kassandra Mae C. 6/5/2017 6/5/2017 6/5/2017

9 Velez, Mary Emmanuelle D. 6/5/2017 6/5/2017 6/5/2017

10 Ybaez, Anthonnia Divine A. 6/5/2017 6/5/2017 6/5/2017

 Subject Area & Title Subject Area & Title Subject Area & Title
MTB English Math
LEARNER'S NAME MTB 2 English 2 Math 2
NO. (Last Name, First
Name, Middle Name) Date Date Date
Issued Returned Issued Returned Issued

FEMALE | TOTAL = 10

Combined TOTAL = 30
GUIDELINES: In case of losses/un
1. Title of Books Issued to each learner must be recorded by the class adviser.
2. The Date of Issuance and the Date of Return shall be reflected in the form. A. In Column Date Re
3. The Total Number of Copies issued at BoSY shall be reflected in the form. B. In Column Remark/
(for code FM), TLTR=
4. The Total Number of Copies of Books Returned at the EoSYshall be reflected in the form. Custodian (for code TD
DO#14, 2.2012.
5. All textbooks being used must be included. Additional copy/ies of this form may use if needed.
Form 3 (SF3) Books Issued and Returned
(This replaced Form 1 & Inventory of Text Book)

School Year 2017 - 2018

Grade Level 2 Section Sunflower

Subject Area & Title Subject Area & Title Subject Area & Title Subject Area & Title Subject Area & Title Subject Area & Title
Math ESP Filipino Ara Pan MAPEH
Math 2 ESP 2 Filipino 2 Ara Pan 2 MAPEH 2

Date Date Date Date Date Date

Returned Issued Returned Issued Returned Issued Returned Issued Returned Issued Returned

6/5/2017 6/5/2017 6/5/2017 6/5/2017

6/5/2017 6/5/2017 6/5/2017 6/5/2017

6/5/2017 6/5/2017 6/5/2017 6/5/2017

6/5/2017 6/5/2017 6/5/2017 6/5/2017

6/5/2017 6/5/2017 6/5/2017 6/5/2017

6/5/2017 6/5/2017 6/5/2017 6/5/2017

6/5/2017 6/5/2017 6/5/2017 6/5/2017

6/5/2017 6/5/2017 6/5/2017 6/5/2017

6/5/2017 6/5/2017 6/5/2017 6/5/2017

6/5/2017 6/5/2017 6/5/2017 6/5/2017

6/5/2017 6/5/2017 6/5/2017 6/5/2017

6/5/2017 6/5/2017 6/5/2017 6/5/2017

6/5/2017 6/5/2017 6/5/2017 6/5/2017

6/5/2017 6/5/2017 6/5/2017 6/5/2017

6/5/2017 6/5/2017 6/5/2017 6/5/2017

6/5/2017 6/5/2017 6/5/2017 6/5/2017

6/5/2017 6/5/2017 6/5/2017 6/5/2017

6/5/2017 6/5/2017 6/5/2017 6/5/2017

6/5/2017 6/5/2017 6/5/2017 6/5/2017

6/5/2017 6/5/2017 6/5/2017 6/5/2017

Subject Area & Title Subject Area & Title Subject Area & Title Subject Area & Title Subject Area & Title Subject Area & Title
Math ESP Filipino Ara Pan MAPEH
Math 2 ESP 2 Filipino 2 Ara Pan 2 MAPEH 2

Date Date Date Date Date Date

Returned Issued Returned Issued Returned Issued Returned Issued Returned Issued Returned

6/5/2017 6/5/2017 6/5/2017 6/5/2017

6/5/2017 6/5/2017 6/5/2017 6/5/2017

6/5/2017 6/5/2017 6/5/2017 6/5/2017

6/5/2017 6/5/2017 6/5/2017 6/5/2017

6/5/2017 6/5/2017 6/5/2017 6/5/2017

6/5/2017 6/5/2017 6/5/2017 6/5/2017

6/5/2017 6/5/2017 6/5/2017 6/5/2017

6/5/2017 6/5/2017 6/5/2017 6/5/2017

6/5/2017 6/5/2017 6/5/2017 6/5/2017

6/5/2017 6/5/2017 6/5/2017 6/5/2017

 Subject Area & Title Subject Area & Title Subject Area & Title Subject Area & Title Subject Area & Title Subject Area & Title
Math ESP Filipino Ara Pan MAPEH
Math 2 ESP 2 Filipino 2 Ara Pan 2 MAPEH 2

Date Date Date Date Date Date

Returned Issued Returned Issued Returned Issued Returned Issued Returned Issued Returned

In case of losses/unreturned, please provide information with the following code: Prepared By:

A. In Column Date Returned, codes are: FM=Force Majeure, TDO: Transferred/Dropout, NEG=Negligence AID
B. In Column Remark/Action Taken, codes are: LLTR=Secured Letter from Learner duly signed by parent/guardian (Signature
(for code FM), TLTR=Teacher prepared letter/report duly noted by School Head for submission to School Property
Custodian (for code TDO), PTL=Paid by the Learner (for code NEG). References: DO#23, s.2001, DO#25, s.2003, Date BoSY:___________
DO#14, 2.2012.
REMARK/ACTION TAKEN
(Please refer to the
legend on last page)
REMARK/ACTION TAKEN
(Please refer to the
legend on last page)
 REMARK/ACTION TAKEN
(Please refer to the
legend on last page)

AIDA B. BUCTOLAN
(Signature over printed name)

ate BoSY:____________ Date EoSY: ___________

School Form 3: Page 2 of ________