Form 137A Copy of this record sent to the principal/registrar of

School:
Date:
Republic of the Philippines
DEPARTMENT OF EDUCATION
Region VI- Western Visayas
Division of Capiz
DUMALAG CENTRAL NATIONAL HIGH SCHOOL
Poblacion, Dumalag, Capiz
LRN:
ID no:
Name: Date of Birth:
Family Name First Name M.I. Year Month Day
Place of Birth:
Street/Brgy. Town/City Province
Parent/Guardian: Address:
Elementary Grades Completed(School): School Year: Gen. Ave.
Total Number of Years to Complete Elementary Course: Sex:
School: School Year:
Year & Section: Adviser:
Periodical Ratings
Subject Final Rating Action Taken
1 2 3 4
English ( ) Has Advanced Units in:
Mathematics ( )
Filipino ( )
Science ( ) Lacks Units in:
Araling Panlipunan ( )
ICT ( )
MAPEH ( ) To be classified as:
Music ( )
Arts ( ) Total number in School
Physical Education ( ) to date _____________________________
Health ( )
Eduk. sa Pagpapakatao ( ) General Average:
Enviro/ Astronomy ( ) Rank:

Months: June July Aug Sept. Oct. Nov. Dec. Jan. Feb. March April Total Extra Cur. Activities
Days of School:
Days Present

School: School Year:

Year & Section: Adviser:
Periodical Ratings
Subject Final Rating Action Taken
1 2 3 4
English ( ) Has Advanced Units in:
Mathematics ( )
Filipino ( )
Science ( ) Lacks Units in:
Araling Panlipunan ( )
ICT ( )
MAPEH ( ) To be classified as:
Music ( )
Arts ( ) Total number in School
Physical Education ( ) to date _____________________________
Health ( )
Eduk. sa Pagpapakatao ( ) General Average:
Trade Drawing ( )
Research ( ) Rank:
Months: June July Aug Sept. Oct. Nov. Dec. Jan. Feb. March April Total Extra Cur. Activities
Days of School:
Days Present

School: School Year:

Year & Section: Adviser:
Periodical Ratings
Subject Final Rating Action Taken
1 2 3 4
English ( ) Has Advanced Units in:
 Has Advanced Units in:
Mathematics ( )
Filipino ( )
Science ( ) Lacks Units in:
Araling Panlipunan ( )
ICT ( )
MAPEH ( ) To be classified as:
Music ( )
Arts ( ) Total number in School
Physical Education ( ) to date _____________________________
Health ( )
Eduk. sa Pagpapakatao ( ) General Average:
Applied Chemistry ( )
Research ( ) Rank:
Months: June July Aug Sept. Oct. Nov. Dec. Jan. Feb. March April Total Extra Cur. Activities
Days of School:
Days Present

Name:

School: School Year:

Year & Section: Adviser:
Periodical Ratings
Subject Final Rating Action Taken
1 2 3 4
English ( ) Has Advanced Units in:
Mathematics ( )
Filipino ( )
Science ( ) Lacks Units in:
Araling Panlipunan ( )
ICT ( )
MAPEH ( ) To be classified as:
Music ( )
Arts ( ) Total number in School
Physical Education ( ) to date _____________________________
Health ( )
Eduk. sa Pagpapakatao ( ) General Average:
Electronics ( )
Research ( ) Rank:
Months: June July Aug Sept. Oct. Nov. Dec. Jan. Feb. March April Total Extra Cur. Activities
Days of School:
Days Present

School: School Year:

Year & Section: Adviser:
Periodical Ratings
Subject Final Rating Action Taken
1 2 3 4
English ( ) Has Advanced Units in:
Mathematics ( )
Filipino ( )
Science ( ) Lacks Units in:
Araling Panlipunan ( )
ICT ( )
MAPEH ( ) To be classified as:
Music ( )
Arts ( ) Total number in School
Physical Education ( ) to date _____________________________
Health ( )
Eduk. sa Pagpapakatao ( ) General Average:
( )
( ) Rank:
Months: June July Aug Sept. Oct. Nov. Dec. Jan. Feb. March April Total Extra Cur. Activities
Days of School:
Days Present

School: School Year:

Year & Section: Adviser:
 Periodical Ratings
Subject Final Rating Action Taken
1 2 3 4
English ( ) Has Advanced Units in:
Mathematics ( )
Filipino ( )
Science ( ) Lacks Units in:
Araling Panlipunan ( )
ICT ( )
MAPEH ( ) To be classified as:
Music ( )
Arts ( ) Total number in School
Physical Education ( ) to date _____________________________
Health ( )
Eduk. sa Pagpapakatao ( ) General Average:
( )
( ) Rank:
Months: June July Aug Sept. Oct. Nov. Dec. Jan. Feb. March April Total Extra Cur. Activities
Days of School:
Days Present

I certify that this is a true record of who is eligible for

admission to .She / He has advanced units in
lacks units in and has no money/property responsibility in this school.

GELYN B. FACTO
Principal I

(NOT VALID WITHOUT SCHOOL SEAL)

Form 137A Copy of this record sent to the principal/registrar of
School:
Date:
Republic of the Philippines
DEPARTMENT OF EDUCATION
Region VI- Western Visayas
Division of Capiz
DUMALAG CENTRAL NATIONAL HIGH SCHOOL
Poblacion, Dumalag, Capiz
LRN:
ID no:
Name: Date of Birth:
Family Name First Name M.I. Year Month Day
Place of Birth:
Street/Brgy. Town/City Province
Parent/Guardian: Address:
Elementary Grades Completed(School): School Year: Gen. Ave.
Total Number of Years to Complete Elementary Course: Sex:
School: School Year:
Year & Section: Adviser:
Periodical Ratings
Subject Final Rating Action Taken
1 2 3 4
English ( ) Has Advanced Units in:
Mathematics ( )
Filipino ( )
Science ( ) Lacks Units in:
Araling Panlipunan ( )
TVE ( )
MAPEH ( ) To be classified as:
Music ( )
Arts ( ) Total number in School
Physical Education ( ) to date _____________________________
Health ( )
Eduk. sa Pagpapakatao ( ) General Average:
ICF ( )
Trade Drawing ( ) Rank:

Months: June July Aug Sept. Oct. Nov. Dec. Jan. Feb. March April Total Extra Cur. Activities
Days of School:
Days Present

School: School Year:

Year & Section: Adviser:
Periodical Ratings
Subject Final Rating Action Taken
1 2 3 4
English ( ) Has Advanced Units in:
Mathematics ( )
Filipino ( )
Science ( ) Lacks Units in:
Araling Panlipunan ( )
TVE ( )
MAPEH ( ) To be classified as:
Music ( )
Arts ( ) Total number in School
Physical Education ( ) to date _____________________________
Health ( )
Eduk. sa Pagpapakatao ( ) General Average:
ICF ( )
Trade Drawing ( ) Rank:
Months: June July Aug Sept. Oct. Nov. Dec. Jan. Feb. March April Total Extra Cur. Activities
Days of School:
Days Present

School: School Year:

Year & Section: Adviser:
Periodical Ratings
Subject Final Rating Action Taken
1 2 3 4
English ( ) Has Advanced Units in:
Mathematics ( )
Filipino ( )
Science ( ) Lacks Units in:
Araling Panlipunan ( )
TVE ( )
MAPEH ( ) To be classified as:
Music ( )
Arts ( ) Total number in School
Physical Education ( ) to date _____________________________
Health ( )
Eduk. sa Pagpapakatao ( ) General Average:
ICF ( )
Entrpeneurship ( ) Rank:
Months: June July Aug Sept. Oct. Nov. Dec. Jan. Feb. March April Total Extra Cur. Activities
Days of School:
Days Present

Name:

School: School Year:

Year & Section: Adviser:
Periodical Ratings
Subject Final Rating Action Taken
1 2 3 4
English ( ) Has Advanced Units in:
Mathematics ( )
Filipino ( )
Science ( ) Lacks Units in:
Araling Panlipunan ( )
TVE ( )
MAPEH ( ) To be classified as:
Music ( )
Arts ( ) Total number in School
Physical Education ( ) to date _____________________________
Health ( )
Eduk. sa Pagpapakatao ( ) General Average:
( )
( ) Rank:
Months: June July Aug Sept. Oct. Nov. Dec. Jan. Feb. March April Total Extra Cur. Activities
Days of School:
Days Present

School: School Year:

Year & Section: Adviser:
Periodical Ratings
Subject Final Rating Action Taken
1 2 3 4
English ( ) Has Advanced Units in:
Mathematics ( )
Filipino ( )
Science ( ) Lacks Units in:
Araling Panlipunan ( )
TVE ( )
MAPEH ( ) To be classified as:
Music ( )
Arts ( ) Total number in School
Physical Education ( ) to date _____________________________
Health ( )
Eduk. sa Pagpapakatao ( ) General Average:
( )
( ) Rank:
Months: June July Aug Sept. Oct. Nov. Dec. Jan. Feb. March April Total Extra Cur. Activities
Days of School:
Days Present

School: School Year:

Year & Section: Adviser:
 Periodical Ratings
Subject Final Rating Action Taken
1 2 3 4
English ( ) Has Advanced Units in:
Mathematics ( )
Filipino ( )
Science ( ) Lacks Units in:
Araling Panlipunan ( )
TVE ( )
MAPEH ( ) To be classified as:
Music ( )
Arts ( ) Total number in School
Physical Education ( ) to date _____________________________
Health ( )
Eduk. sa Pagpapakatao ( ) General Average:
( )
( ) Rank:
Months: June July Aug Sept. Oct. Nov. Dec. Jan. Feb. March April Total Extra Cur. Activities
Days of School:
Days Present

I certify that this is a true record of who is eligible for

admission to .She / He has advanced units in
lacks units in and has no money/property responsibility in this school.

GELYN B. FACTO
Principal I

(NOT VALID WITHOUT SCHOOL SEAL)