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Republic of the Philippines

Region VIII
Ormoc City Division
DOLORES NATIONAL HUGH SCHOOL
Brgy. Dolores, Ormoc City, Leyte

ANECDOTAL RECORD FORM

Name:________________________________________________Age:___________Sex:_______
Year & Section: _________________________________________
Teacher:______________________________________________

Date and Place Observed Incident Comments

Prepared by: Approved by:

________________________ ________________________
Signature Over Printed Name Guidance Counselor

Noted:

_________________________
School Principal

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