DNCR-F-ORD-033/RO/01112019

ANNEX B

PARENTAL CONSENT FORM FOR TEST TAKERS

To Whom it may concern,

This is to give consent to my child Jennifer S. Fabia enrolled in San Juan City

Academic High School, Division of San Juan for School year 2020-2021, to

take the Pilot Test for the Year-End Assessment.

Please put a check on the box that corresponds to your answer.

Grade level:

Grade 1 Grade 3 Grade 6

Grade 7 Grade 11 Grade 12

Access to Assessment:
Online

_________________________________
Signature Over Printed Name

Date: 2/25/2022