DIVINE SAVIOUR MONTESSORI SCHOOL, INC.

PHASE 1 BLK 1 LOT 6 EASTCOM CENTRAL SAN ISIDRO, RODRIGUEZ, RIZAL

TEACHER’S NAME: _____________________________________________________________

COMPLETE ADDRESS: ______________________________________________________________
______________________________________________________________

ADVISORY CLASS: _____________________________________________________________

CONTACT NUMBER: ______________________________________________________________

TEACHER’S CLEARNCE
S. Y. 2019-2020

This is to certify that I have satisfactorily settled all the property and financial obligations
in the school and that I have submitted all the required reports as listed below. May I then be
granted the Year-End Clearance for S.Y. 2019-2020.

SUBMITTED REQUIREMENTS DATE RECEIVED BY SIGNATURE

SUBMITTED REPRESENTATIVE
1. FORM 138
2. FORM 137
3. FORM 1
PRINTED COPIES OF THE
FOLLOWING:
4. SF5 ( FOR K1 TO HS)
5. SF5a, SF5b, SF6 (FOR SHS)
6. GRADING SHEETS AND
SUMMARY SHEETS PER
QUARTER
7. CLASS RECORD
8. LIST OF HONOR STUDENTS/
RANKING
EMAILED SOFTCOPY OF THE FF:
1. SF5 (FOR K1 TO HS)
2. SF5a, SF5b, SF6 ( FOR SHS)
3. CLASS RECORD (EXCEL)
4. GRADING SHEETS/SUMMARY
SHEETS PER QUARTER
5. LIST OF HONOR STUDENTS/
RANKING
6. LIST OF STUDENTS WITH
THEIR GENERAL AVERAGE
( WITH 3 DECIMAL PLACES)
SCHOOL PROPERTIES:
1. KEYS
2. ISSUED/BORROWED BOOKS

______________________________________
TEACHER’S SIGNATURE OVER PRINTED NAME
NOTED BY: APPROVED BY:

MRS. REVERIE C. IGNACIO / MS. JUDITH L. LOTO MS. DIONISIA ROSARIO J. CABRILLAS
ASSISTANT PRINCIPAL / ACADEMIC CHAIRMAN SCHOOL PRINCIPAL