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Republic of the Philippines

Department of Education
Region VII, Central Visayas
DIVISION OF LAPU-LAPU CITY
PAJO NIGHT HIGH SCHOOL
Sangi Rd. Lapu-Lapu City
Anecdotal Record

Name:_____________________________________Sex:_______ Age:_____ LRN:___________________


Grade Level/Year:_____________________ Section:__________________
Birthdate:_________________
Parent/Guardian:________________________________
Address:_______________________________________
Phone/Mobile number:___________________________
Elementary: Year Graduated:_____________________________
High School/Last School attended:_________________________

I.Forms Submitted: Date Submitted


 Form 138 ( Report Card ) _____ _____________
 Birth Certificate _____ _____________
 Form 137 _____ _____________

II.Incidents/Offences
Date Incidents/Offences Action Taken & Signature

III. Parents Follow Up in School


Date Purpose/Comments Signature

IV. Home Visitation


Date Purpose/Comments Signature

Marlyn O. Pasuquin
Guidance Coordinator

Checked and Verified by:

MARISSA D. PATALINGHUG
HTIII-Officer In-Charge

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