DepEd Form IX

SCHOOL
School Address
email/telephone number
STUDENT'S GRADUATION FORM

LRN ____________ Track/Strand: _____________________________________________

Name: Surname, Given Name Middle Name Date of Birth: Year: _____
Place of Birth: Province: Bulacan Town: _________
Parent/Guardian: Occupation:
Address of Parent/Guardian:
Junior High School Completer from: _______________________________________

Gen. Ave:
SCHOOL: ' SCHOOL:
Classified as: Grade 11 Semester: 1st School Year: 2017-2018 Classified as: Grade 12

SUBJECTS Final Grade Action Taken SUBJECTS

Average: 0 Average:
Days of School ________________ Days Present____________ Days of School ________________
SCHOOL_____________________________________Summer_________________ SCHOOL________________________________________
SUBJECT/S Final Grade Action Taken SUBJECT/S

Days of School ________________ Days Present Days of School ________________

SCHOOL: SCHOOL: '

Classified as: Grade 11 Semester: 2nd School Year: 207-2018 Classified as: Grade 12

SUBJECTS Final Grade Action Taken SUBJECTS

DepEd Form IX

Average: 0 Average:
Days of School ________________ Days Present____________ Days of School ________________
SCHOOL_____________________________________Summer_________________ SCHOOL________________________________________
SUBJECT/S Final Grade Action Taken SUBJECT/S

Days of School ________________ Days Present Days of School ________________

 DepEd Form IX

RM

_____________________________________
Month:_________ Day: ___
Barangay: _____________

School Year:

Semester: 1st School Year: 2018-2019

UBJECTS Final Grade Action Taken

Average: 0
__________ Days Present____________
_____________________________Summer________________
SUBJECT/S Final Grade Action Taken

__________ Days Present______

Semester: 2nd School Year: 2018-2019

UBJECTS 3rd Quarter Action Taken

 DepEd Form IX

Average:
__________ Days Present____________
_____________________________Summer________________
SUBJECT/S Final Grade Action Taken

__________ Days Present___________

 SUMMARY OF SUBJECTS
Grade 11 Grade 12
Subjects Semester School Year Subjects Semester School Year

CERTIFICATION Checked against original copy:

I certify that this is a true rec _____________________ DR. CECILIA S. CUSTODIO

as per requirement of the Department of Education. He/She is elig EPS- In charge of Private Schools

for graduation in the School Year/S 2018-2019

The above-mentioned name met the required no. of 80 hrs during his/her
Work Immersion at PARTNER INDUSTRY, ADDRESS AND DATE. EPS- Quality Assurance Division, RO3

____________________________________________
School Principal/School Head