REPUBLIKA NG PILIPINAS

(Republic of the Philippines) SAMPLE FOR ELEMENTARY

KAGAWARAN NG EDUKASYON
(Department of Education)
Rehiyon III
Region III
TANGGAPAN NG SANGAY NG MGA PAARALAN SA LUNGSOD NG MALOLOS
Schools Division Office of City of Malolos
Lungsod ng Malolos
City of Malolos

DepEd FORM137-E
LRN: ____________________

PALAGIANG TALAAN SA PAARALANG ELEMENTARYA

(ELEMENTARY SCHOOL PERMANENT RECORD)

I. Pangalan Purok Paaralan

(Name) (Apelyido) (Unang Ngalan) (Gitnang Ngalan) (District) (School)
(Surname) (First Name) (Middle Name)

Kasarian Petsa ng Kapanganakan Pook Petsa ng Pagpasok

(Sex) (Date of Birth) (Place) (Town/Province/City) (Date of Entrance)
Bayan / Lalawigan / Lungsod
Magulang/Tagapag-alaga
Pangalan Tirahan Hanapbuhay
(Name) (Address) (Occupation)

II. PAG-UNLAD SA PAARALANG ELEMENTARYA

(ELEMENTARY SCHOOL PROGRESS)

Grade ____ School Grade ___ School

School Year Adviser School Year Adviser
Quarter Final Quarter Final
Learning Areas Grade Remarks Learning Areas Grade
1 2 3 4 1 2 3 4
Filipino Filipino
English English
Mathematics Mathematics
Science Science
Araling Panlipunan (AP) Araling Panlipunan (AP)
Edukasyon sa Pagpapakatao (EsP) Edukasyon sa Pagpapakatao (EsP)
Edukasyong Pantahanan at Edukasyong Pantahanan at
Pangkabuhayan (EPP) Pangkabuhayan (EPP)
MAPEH MAPEH
Music Music
Arts Arts
P.E. P.E.
Health Health
Mother Tongue Mother Tongue
General Average General Average

Eligible for Admission to Grade Eligible for Admission to Grade

Grade ____ School Grade ___ School

School Year Adviser School Year Adviser

Learning Areas Quarter Final

Remarks Learning Areas Quarter Final
1 2 3 4 Grade 1 2 3 4 Grade
Filipino Filipino
English English
Mathematics Mathematics
Science Science
Araling Panlipunan (AP) Araling Panlipunan (AP)
Edukasyon sa Pagpapakatao (EsP) Edukasyon sa Pagpapakatao (EsP)
Edukasyong Pantahanan at Edukasyong Pantahanan at
Pangkabuhayan (EPP) Pangkabuhayan (EPP)
MAPEH MAPEH
Music Music
Arts Arts
P.E. P.E.
Health Health
Mother Tongue
General Average General Average

Eligible for Admission to Grade Eligible for Admission to Grade

Grade ____ School Grade ___ School

School Year Adviser School Year Adviser
 Quarter Final Quarter Final
Learning Areas Grade Remarks Learning Areas Grade
1 2 3 4 1 2 3 4
Filipino Filipino
English English
Mathematics Mathematics
Science Science
Araling Panlipunan (AP) Araling Panlipunan (AP)
Edukasyon sa Pagpapakatao (EsP) Edukasyon sa Pagpapakatao (EsP)
Edukasyong Pantahanan at Edukasyong Pantahanan at
Pangkabuhayan (EPP) Pangkabuhayan (EPP)
MAPEH MAPEH
Music Music
Arts Arts
P.E. P.E.
Health Health

General Average General Average

Eligible for Admission to Grade Eligible for Admission to Grade

LEMENTARY

Hanapbuhay
(Occupation)

Remarks

Remarks
Remarks
Grade ______ School Grade ___ School
School Year Adviser School Year: Adviser
Quarter Final Quarter Final
Learning Areas Remarks Learning Areas Remarks
1 2 3 4 Grade 1 2 3 4 Grade
Filipino Filipino
English English
Mathematics Mathematics
Science Science
Araling Panlipunan (AP) Araling Panlipunan (AP)
Edukasyon sa Pagpapakatao (EsP) Edukasyon sa Pagpapakatao (EsP)
Edukasyong Pantahanan at Edukasyon Pantahanan at
Pangkabuhayan (EPP) Pangkabuhayan (EPP)
MAPEH MAPEH
Music Music
Arts Arts
P.E. P.E.
Health Health

General Average General Average

Eligible for Admission to Grade ___________ Eligible for Admission to Grade ____________

III. LEARNER'S OBSERVED VALUES

Gr.___ Schl. Yr._______ Gr.___ Schl. Yr._______ Gr.___ Schl. Yr._______ Gr.___ Schl. Yr._______
Core Values Behavior Statements
1 2 3 4 1 2 3 4 1 2 3 4 1 2 3
Express one's spiritual beliefs while respecting
the spiritual beliefs of others
1. Maka-Diyos
Shows adherence to ethical principles by
upholding the truth in all undertakings
Is sensitive to individual, social, and cultural
2. Makatao differences; resists stereotyping people
Demonstrates contributions toward solidarity

Cares for the environment and utilizes

3. Makakalikasan resources wisely, judiciously and economically

Demonstrated appropriate behavior in carrying

4. Makabansa out activities in the school, community and
country.

Gr.___ Schl. Yr._______ Gr.___ Schl. Yr._______ Gr.___ Schl. Yr._______ Gr.___ Schl. Yr._______
Core Values Behavior Statements
1 2 3 4 1 2 3 4 1 2 3 4 1 2 3
Express one's spiritual beliefs while respecting
the spiritual beliefs of others
1. Maka-Diyos
Shows adherence to ethical principles by
upholding the truth in all undertakings
Is sensitive to individual, social, and cultural
2. Makatao differences; resists stereotyping people
Demonstrates contributions toward solidarity

Cares for the environment and utilizes

3. Makakalikasan resources wisely, judiciously and economically

Demonstrated appropriate behavior in carrying

4. Makabansa out activities in the school, community and
country.

AO - Always Observed SO - Sometimes Observed RO - Rarely Observed NO - Not Observed

IV. ATTENDANCE RECORD

No. of School No. of School No. of Times No. of School Days
Grade Cause Cause
Days Days Absent Tardy 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 Grade _________________________.

Signature

Date
 Remarks

Gr.___ Schl. Yr._______

4

Gr.___ Schl. Yr._______

4

No. of School Days

Present
CATE OF TRANSFER