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Saint Mary’s College

Basic Education Department


City of Catbalogan

PAASCU Accredited
Elementary and Junior High School Department

Name: ________________________

Grade &Sec: ____________________


Extra and Co-Curricular Activities
TOTAL: _______________
S.Y. _______________

Homeroom Officer: Points Teacher’s Signature


President
V-President ___________________
Secretary/ Treasurer & Beadle Adviser
Other Officer
Member
Club Organization
Club: _____________________ Points Teacher’s Signature
President
V-President
______________
Secretary/ Treasurer & Beadle
Club Moderator
Other Officer
Member
Club: _____________________ Points Teacher’s Signature
President
V-President
______________
Secretary/ Treasurer & Beadle
Club Moderator
Other Officer
Member
Club: _____________________ Points Teacher’s Signature
President
V-President
______________
Secretary/ Treasurer & Beadle
Club Moderator
Other Officer
Member
Club: _____________________ Points Teacher’s Signature
President
V-President
______________
Secretary/ Treasurer & Beadle
Club Moderator
Other Officer
Member
Club: _____________________ Points Teacher’s Signature
President
V-President
______________
Secretary/ Treasurer & Beadle
Club Moderator
Other Officer
Member
Club: _____________________ Points Teacher’s Signature
President
V-President
______________
Secretary/ Treasurer & Beadle
Club Moderator
Other Officer
Member
Club: _____________________ Points Teacher’s Signature
President ______________
V-President Club Moderator
Secretary/ Treasurer & Beadle
Other Officer

In-campus Activities

ACTIVITY DATE RANK/PLACE/Designation POINTS MODERATOR


(Champion, Runners Up, SIGNATURE
Participant or
Organizer/Facilitator, etc.)

TOTAL SCORE

OFF-Campus Activities and Events


Events/Activities Date Rank/Place or Points Moderators/Coach/Teachers
Signature
Designation

TOTAL SCORE

Noted by:

HARLY QUENE TINA A. MENGOTE


Class Adviser

Recommending Approval:

JASON P. TY
BED Activity Coordinator

Approved by:

MRS. VILMA T. CABUENAS


BED Academic Coordinator

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