School Form 1 School Register for Senior High School (SF1-SHS)

School Name School ID District Division

Semester School Year Grade Level Track and Strand
Section Course (For TVL Only)

COMPLETE ADDRESS PARENTS GUARDIAN

(if learner is not Living with Parent)

Sex (M/F)
NAME BIRTHDATE AGE Religious
LRN (Last Name, First Name, Name Mother's Maiden Name Name
Extension, Middle Name)
(mm/dd/yyyy) Affiliation House No./ Street/ Municipality/ Father's Name (Last Name, First Name, (Last Name, First Name,
Sitio/ Purok Barangay Province (Last Name, First Name, Name Relationship
City Extension, Middle Name) Name Extension, Middle Name Extension, Middle
Name) Name)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40

<=== TOTAL MALE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33

SFRT 2017
 Region

Contact Number REMARKS

of Parent/ (Please refer to the legend)
Guardian

SFRT 2017
 COMPLETE ADDRESS PARENTS GUARDIAN
(if learner is not Living with Parent)

Sex (M/F)
NAME BIRTHDATE AGE Religious
LRN (Last Name, First Name, Name Mother's Maiden Name Name
Extension, Middle Name)
(mm/dd/yyyy) Affiliation House No./ Street/ Municipality/ Father's Name (Last Name, First Name, (Last Name, First Name,
Sitio/ Purok Barangay Province (Last Name, First Name, Name Relationship
City Extension, Middle Name) Name Extension, Middle Name Extension, Middle
Name) Name)
34
35
36
37
38
39
40

<=== TOTAL FEMALE

<=== COMBINED
Legend: List and Code of Indicators under REMARKS column
Beginning of the Prepared By:
Indicator Code Required Information Indicator Code Required Information REGISTERED End of the Semester
Semester
Transferred T/O CCT Recipient CCT CCT Control/reference
Out number & Effectivity Date MALE
Balik Aral B/A Name of school last attended
Transferred In & Year
T/I
Name of School, Date of 1st Learner With LWE
Specify Exceptionality of the Signature of Adviser over Printed Name
Attendance and Date of Last Exceptionality Learner FEMALE
Specify Level & Effectivity
Attendance if Transferred Out Accelerated ACL Date
Beginning of the Semester Date:
TOTAL

SFRT 2017
 Contact Number REMARKS
of Parent/ (Please refer to the legend)
Guardian

of Adviser over Printed Name

End of the Semester Date:

SFRT 2017
 School Form 2 Daily Attendance Report of Learners for Senior High School (SF2-SHS)
School Name School ID District Division

Semester School Year Grade Level Track and Strand

Section Course/s (only for TVL) Month of

DATE
NAME Total for the Month
No. (Last Name, First Name, Name Extension, Middle
Name) M T W TH F S M T W TH F S M T W TH F S M T W TH F S M T W TH F S ABSENT TARDY

10

11

12

13

14

15

16

17

<=== MALE | TOTAL Per Day ===>

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25
HS)
Region

REMARKS
1. If No Longer in School (NLS), state reason, please refer to legend number. 2. If TRANSFERRED
IN/OUT, write the name of School. 3. If SHIFTING IN/OUT, write the name of
Track/Strand/Program).
 DATE
NAME Total for the Month
No. (Last Name, First Name, Name Extension, Middle
Name) M T W TH F S M T W TH F S M T W TH F S M T W TH F S M T W TH F S ABSENT TARDY

26

27

<=== FEMALE | TOTAL Per Day ===>

Combined TOTAL Per Day

No. of Days of Classes:

GUIDELINES: 1. CODES FOR CHECKING ATTENDANCE Month:
1. The attendance shall be accomplished daily. Refer to the codes for checking learners' attendance (blank) - Present; (x) - Absent; Tardy (half shaded = Upper for
2. To compute the following: Late Comer, Lower for Cutting Classes)
* Enrolment (as of 1st Friday of the semester)

2. REASONS/CAUSES FOR NO LONGER IN SCHOOL Late Enrolment during the month (beyond cut-off)

a. Percentage of Enrolment = x 100 (NLS)

Registered Learners as of end of the month Registered Learners as of end of the month

Enrolment as of 1st Friday of the school year

a. Domestic-Related Factors Percentage of Enrolment as of end of the month
a.1. Had to take care of siblings Average Daily Attendance
Total Daily Attendance a.2. Early marriage/pregnancy
b. Average Daily Attendance =
Number of School Days in reporting month a.3. Parents' attitude toward schooling Percentage of Attendance for the month
a.4. Family problems
Number of students absent for 5 consecutive days
Average daily attendance
c. Percentage of Attendance for the month = x 100
Registered Learners as of end of the month
b. Individual-Related Factors
3. Every end of the month, the Class Adviser will submit this form to the Office of the Principal for recording of summary table into School Form 4. Once b.1. Illness
No Longer in School (NLS)
signed by the School Head, this form should be returned to the Class Adviser. b.2. Overage
4. The Class Adviser will provide neccessary interventions including but not limited to home visitation to learner/s who were absent for 5 consecutive days b.4. Drug Abuse
b.5. Poor Academic Performance
Transferred Out
and/or those at risk of dropping out. b.6. Lack of Interest/Distractions
5. Attendance performance of learners will be reflected in the SF9-SHS of every grading period. b.7. Hunger/Malnutrition Transferred In

Shifting Out

c. School-Related Factors Shifting In

c.1. Teacher Factor
c.2. Physical Condition of Classroom
c.3. Peer Influence
I certify that this report is true and correct:
d. Geographic/Environmental
d.1. Distance between home and school
d.2. Armed conflict (incl. tribal wars & clan feuds)
d.3. Calamities/Disasters Signature of Class Ad

e. Financial-Related
e.1. Child labor, work Attested By:

f. Others (Specify) Signature of School H

a. Death
b. Transferred to School Abroad
c. Transferred to International School
d. Transferred to ALS
 REMARKS
1. If No Longer in School (NLS), state reason, please refer to legend number. 2. If TRANSFERRED
IN/OUT, write the name of School. 3. If SHIFTING IN/OUT, write the name of
Track/Strand/Program).

No. of Days of Classes:

Summary

M F TOTAL
the semester)

h (beyond cut-off)

of the month

end of the month

e month

consecutive days

ol (NLS)

port is true and correct:

Signature of Class Adviser over Printed Name

Signature of School Head over Printed Name

 School Form 3 Books Issued and Returned for Senior High School (SF3-SHS)
School Name School ID District Division

Semester School Year Grade Level Track and Strand

Section Course/s (only for TVL)

Book / ModuleTitle Book / ModuleTitle Book / ModuleTitle Book / ModuleTitle Book / ModuleTitle Book / ModuleTitle Book / ModuleTitle Book / ModuleTitle Book / ModuleTitle

NAME
No. (Last Name, First Name, Name Extension,
Middle Name) Date (mm/dd/yy) Date (mm/dd/yy) Date (mm/dd/yy) Date (mm/dd/yy) Date (mm/dd/yy) Date (mm/dd/yy) Date (mm/dd/yy) Date (mm/dd/yy) Date (mm/dd/yy)
Issued Returned Issued Returned Issued Returned Issued Returned Issued Returned Issued Returned Issued Returned Issued Returned Issued Returned

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
TOTAL MALE ===>
1
2
3
4
5
6
7
8
9
10
11
12
13
SHS)
Region

/ ModuleTitle Book / ModuleTitle

REMARKS/ACTION TAKEN
(Please refer to the codes below)
(mm/dd/yy) Date (mm/dd/yy)
Returned Issued Returned
 Book / ModuleTitle Book / ModuleTitle Book / ModuleTitle Book / ModuleTitle Book / ModuleTitle Book / ModuleTitle Book / ModuleTitle Book / ModuleTitle Book / ModuleTitle

NAME
No. (Last Name, First Name, Name Extension,
Middle Name) Date (mm/dd/yy) Date (mm/dd/yy) Date (mm/dd/yy) Date (mm/dd/yy) Date (mm/dd/yy) Date (mm/dd/yy) Date (mm/dd/yy) Date (mm/dd/yy) Date (mm/dd/yy)
Issued Returned Issued Returned Issued Returned Issued Returned Issued Returned Issued Returned Issued Returned Issued Returned Issued Returned

14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
TOTAL FEMALE ===>
COMBINED ===>

GUIDELINES:
1. Title of Books Issued to each learner must be recorded by the Class Adviser.
2. The Date of Issuance and the Date of Return shall be reflected in the form.
3. The Total Number of Copies issued shall be reflected in the form.
4. The Total Number of Copies of Books Returned shall be reflected in the form.
5. All textbooks being used must be included. Additional copies of this form may be used if needed.
In case of lost/unreturned books, please provide information with the following code:
Prepared By:
A. In Column Date Returned, codes are: FM=Force Majeure, TDO: Transferred/Dropout, NEG=Negligence
B. In Column Remark/Action Taken, codes are: LLTR=Secured Letter from Learner duly signed by parent/guardian (for code
FM), TLTR=Teacher prepared letter/report duly noted by School Head for submission to School Property Custodian (for code
TDO), PTL=Paid by the Learner (for code NEG). References: DO No.23, s.2001, DO No.25, s.2003, DO No.14, s.2012.
Signature of Class A
/ ModuleTitle Book / ModuleTitle

REMARKS/ACTION TAKEN
(Please refer to the codes below)
(mm/dd/yy) Date (mm/dd/yy)
Returned Issued Returned

ature of Class Adviser over Printed Name

 School Form 4 Monthly Learners' Movement and Attendance for Senior High School (SF4-SH

School Name District Division Region

School ID Semester School Year

ATTENDANCE DROPPED OUT TRANSFERRED OUT TRANSFERRED IN SHIFTED O

REGISTERED
LEARNERS (A) (A+B) (A) (A+B) (A) (A+B) (A)
(As of End Cumulative Cumulative Cumulative Cumulative Cumulative Cumulative Cumulative
TRACK STRAND Daily % for the
Number as
(B) Total for
Number as of Number as
(B) Total for
Number as Number as
(B) Total for
Number as of Number as
(B) Total fo
of the Month) Average Month the Month the Month the Month the Month
of Previous End of the of Previous of End of the of Previous End of the of Previous
Month Month Month Month Month Month Month

M F T M F T M F T M F T M F T M F T M F T M F T M F T M F T M F T M F T M F T M

TOTAL FOR GRADE 11

TOTAL FOR GRADE 12

GRAND TOTAL

Prepared and Submitted By:

Signature of School Head over Printed Name

SF4-SHS)

Region

For the Month of

SHIFTED OUT SHIFTED IN

(A+B) (A) (A+B)

Cumulative Cumulative Cumulative
(B) Total for (B) Total for
Number as of Number as Number as of
the Month the Month
End of the of Previous End of the
Month Month Month

F T M F T M F T M F T M F T
 School Form 5A End of Semester and School Year Status of Learners for Senior High School (SF5A-SHS)

School Name School ID District Division

Semester School Year Grade Level Section

Track and Strand Course/s (only for TVL)

BACK SUBJECT/S END OF

LEARNER'S NAME END OF SCHOOL
No. LRN List down subjects where learner obtained a rating SEMESTER
(Last Name, First Name, Name Extension, Middle Name) YEAR STATUS
below 75%) STATUS (Regular/ Irregular)
(Complete/ Incomplete)

MALE
1 105228090002 1111111 COMPLETE REGULAR SUMMARY TABL
2 105896090008 BORJA, JOHN CARLO TABLADA COMPLETE REGULAR STATUS
3 105882090025 BUAN, CHRIS ANTONIO COMPLETE REGULAR COMPLETE
4 105887090020 CESAR, ROVI B. COMPLETE REGULAR INCOMPLETE
5 105881090012 DELA CRUZ, MARKLLY VELASQUEZ COMPLETE REGULAR TOTAL
6 105886090027 ESPINO, ROSVE COMPLETE REGULAR
7 105891090106 GAMBOA, RODEL CASINAO COMPLETE REGULAR SUMMARY TABLE
8 105895070012 GOMEZ, CHARLES DOMASIAN COMPLETE REGULAR STATUS
9 105891090119 GONZALES, MARC JUDE BANGUIS COMPLETE REGULAR COMPLETE
10 105882080058 GUTRIERREZ, EM - JAY CORTEZ COMPLETE REGULAR INCOMPLETE
11 105891090136 LICU, RAYMOND G. COMPLETE REGULAR TOTAL
12 106421070064 MACALINO, AXLE ROSE C. COMPLETE REGULAR
13 105882090078 MAGAT, RAVEN MILLAGARCIA COMPLETE REGULAR SUMMARY TABLE (End of t
14 105882090088 MENESES, LUISITO F. COMPLETE REGULAR STATUS
15 105882090093 MIRANDA, RAVIN TRILLANES COMPLETE REGULAR REGULAR
16 105882090100 PABALAN, JOHN KARLO CAINDOY COMPLETE REGULAR IRREGULAR
17 105892090116 PANGILINAN, PAUL CLINT DIAZ COMPLETE REGULAR TOTAL
18 105886120012 PUNSALAN, JOHN CORDERO COMPLETE REGULAR
19 105892090130 PUNZALAN, MARRON LULU COMPLETE REGULAR
20 105892090131 PUYAT, OREN CHRISTIAN ROVER COMPLETE REGULAR
21 105892090140 REYES, LORENZO FLORES COMPLETE REGULAR
22 105892090141 REYES, MARK AIN TIONGSON COMPLETE REGULAR
23 105882080108 ROLDAN, EARL GALANG COMPLETE REGULAR
24 105887070054 ROQUE, JULUIS ACE COMPLETE REGULAR
25 105898090214 SARMIENTO, JUSTINE LAPUZ COMPLETE REGULAR
26 105887090075 SUMANG, KYLE S. COMPLETE REGULAR
27 136620090225 TUAZON, JOHN KEMNETH CUNANAN COMPLETE REGULAR

FEMALE

Prepared By:

ISRAEL T. L
Signature of Class Adviser

Certified Correct By:

CATALINA G. YALUN
Signature of School Head

Reviewed By:

Signature of Division Represen

GUIDELINES:
This form shall be accomplished after each semester in a school year, leaving the End of School Year Status Column and Summary Table for End of School Year Status blank/unfilled at the end of the 1st
Semester. These data elements shall be filled up only after the 2nd semester or at the end of the School Year.
 BACK SUBJECT/S END OF
LEARNER'S NAME END OF SCHOOL
No. LRN List down subjects where learner obtained a rating SEMESTER
(Last Name, First Name, Name Extension, Middle Name) YEAR STATUS
below 75%) STATUS (Regular/ Irregular)
(Complete/ Incomplete)

This form shall be accomplished after each semester in a school year, leaving the End of School Year Status Column and Summary Table for End of School Year Status blank/unfilled at the end of the 1st
Semester. These data elements shall be filled up only after the 2nd semester or at the end of the School Year.

INDICATORS:
End of Semester Status
Complete - number of learners who completed/satisfied the requirements in all subject areas (with grade of at least 75%)
Incomplete - number of learners who did not meet expectations in one or more subject areas, regardless of number of subjects failed (with grade less than 75%)
Note: Do not include learners who are No Longer in School (NLS)

End of School Year Status

Regular - number of learners who completed/satisfied requirements in all subject areas both in the 1st and 2nd semester
Irregular - number of learners who were not able to satisfy/complete requirements in one or both semesters
A-SHS)

Region

SUMMARY TABLE 1ST SEM

MALE FEMALE TOTAL

27 27
0 0 0
27 27

SUMMARY TABLE 2ND SEM

MALE FEMALE TOTAL

27 27

MARY TABLE (End of the School Year Only)

MALE FEMALE TOTAL
27 27

ISRAEL T. LUGTU
gnature of Class Adviser over Printed Name

ALINA G. YALUNG / PRICIPAL IV

gnature of School Head over Printed Name

re of Division Representative over Printed Name

f the 1st
 School Form 5B List of Learners with Complete SHS Requirements (SF5B-SHS)
School
School Name District Division Region
ID
School
Semester Section
Year
Track and Strand Course/s (only for TVL)

Completed SHS in
2 SYs? (Y/N)
LEARNER'S FULL NAME National Certification
No. LRN Level Attained
(Last Name, First Name, Name Extension, Middle Name) (only if applicable)

MALE

1 105228090002 ABNES, TITO SAYCO Y SUMMARY TABLE A

2 105896090008 BORJA, JOHN CARLO TABLADA Y STATUS MALE FEMALE TOTAL
3 105882090025 BUAN, CHRIS ANTONIO Y CARPENTRY NCII Learners who
4 105887090020 CESAR, ROVI B. Y completed SHS
Program within 2 27 27
5 105881090012 DELA CRUZ, MARKLLY VELASQUEZ Y SYs or 4
6 105886090027 ESPINO, ROSVE MONTALES Y semesters

7 105891090106 GAMBOA, RODEL CASINAO Y Learners who

8 105895070012 GOMEZ, CHARLES DOMASIAN Y CARPENTRY NCII completed SHS
Program in more
9 105891090119 GONZALES, MARC JUDE BANGUIS Y than 2 SYs or 4
10 105882080058 GUTRIERREZ, EM - JAY CORTEZ Y semesters
11 105891090136 LICU, RAYMOND G. Y TOTAL
12 106421070064 MACALINO, AXLE ROSE C. Y
13 105882090078 MAGAT, RAVEN MILLAGARCIA Y
14 105882090088 MENESES, LUISITO F. Y
15 105882090093 MIRANDA, RAVIN TRILLANES Y CARPENTRY NCII SUMMARY TABLE B
16 105882090100 PABALAN, JOHN KARLO CAINDOY Y CARPENTRY NCII STATUS MALE FEMALE TOTAL
17 105892090116 PANGILINAN, PAUL CLINT DIAZ Y CARPENTRY NCII NC III
18 105886120012 PUNSALAN, JOHN CORDERO Y NC II 8 8
19 105892090130 PUNZALAN, MARRON LULU Y NC I
20 105892090131 PUYAT, OREN CHRISTIAN ROVER Y TOTAL
21 105892090140 REYES, LORENZO FLORES Y
Note: NCs are recorded here for documentation but is not a requirement for
graduation.
 Completed SHS in
2 SYs? (Y/N)
LEARNER'S FULL NAME National Certification
No. LRN Level Attained
(Last Name, First Name, Name Extension, Middle Name)
(only if applicable)

Note: NCs are recorded here for documentation but is not a requirement for
105892090141 REYES, MARK AIN TIONGSON Y CARPENTRY NCII graduation.
22
23 105882080108 ROLDAN, EARL GALANG Y CARPENTRY NCII
24 105887070054 ROQUE, JULUIS ACE Y
25 105898090214 SARMIENTO, JUSTINE LAPUZ Y
26 105887090075 SUMANG, KYLE S. Y GUIDELINES:
27 136620090225 TUAZON, JOHN KEMNETH CUNANAN Y CARPENTRY NCII
1. This form should be accomplished by the Class Adviser at End of School
Year.
2. It should be compiled and checked by the School Head and
passed to the Division Office before graduation.

FEMALE
Reviewed By:

ISRAEL T. LUGTU
Signature of Class Adviser over Printed Name

Certified Correct & Submitted By:

CATALINA G. YALUNG / PRINCIPAL IV

Signature of School Head over Printed Name

Reviewed By:

Signature of Division Representative over Printed Name

 Completed SHS in
2 SYs? (Y/N)
LEARNER'S FULL NAME National Certification
No. LRN Level Attained
(Last Name, First Name, Name Extension, Middle Name)
(only if applicable)
 School Form 6 Summarized Report of Learner Status as of End of Semester and School Year for Senior High School (SF6-SHS)

School Name School ID District Division

Semester School Year

END OF SCHOOL YEAR

END OF SEMESTER STATUS
(Fill up only at the end of the second se

GRADE LEVEL
COMPLETE INCOMPLETE TOTAL REGULAR IRREGULAR

MALE FEMALE TOTAL MALE FEMALE TOTAL MALE FEMALE TOTAL MALE FEMALE TOTAL MALE FEMALE

GRADE 11
TRACK/STRAND/COURSE

SUB TOTAL
GRADE 12
TRACK/STRAND/COURSE

SUB TOTAL
TOTAL

Prepared and Submitted By: Reviewed & Validated By: Noted By:
Signature of School Head over Printed Name Signature of Division Representative over Printed Name Signature of Divisio
GUIDELINES:
1. After receiving and validating the report on Status of Learners submitted by the Class Adviser, the School Head shall compute the grade level total per track/strand/course and school t
2. This report shall be forwarded to the Division Office by the end of the semester.
3. Column for End of School Year shall be accomplished at the end of SY or every after the 2nd semester
4. Protocols of validation & submission are under the discretion of the Schools Division Superintendent.
6-SHS)

Region

OOL YEAR
the second semester.)

ULAR TOTAL

TOTAL MALE FEMALE TOTAL

ature of Division Superintendent over Printed Name

e and school total.

 School Form 7 School Personnel Basic Profile and Assignment for Senior High School (SF7-SHS)
School Name School ID District Division
Semester School Year
(A) Nationally-Funded Teaching & Teaching Related Items (B) Nationally-Funded Non-Teaching Items (C ) Other Appointments and Funding S

Appointment:
Title of Designation
Title of Plantilla Position Title of Plantilla Position (Contractual,
Number of Number of (as it appears in the contract/document:
(as it appears in the appointment (as it appears in the appointment Substitute,
Incumbent Incumbent Teacher, Clerk, Security Guard, Driver etc.)
document/PSIPOP) document/PSIPOP) Volunteer, Others
specify)

EDUCATIONAL QUALIFICATION Daily Program (time

Nature of
Employee Appointment/ Grade and
No. (or Tax Name of School Personnel Fund Position/
Employment
Major/
Subjects Taught, Advisory Sections
Identification (Arrange by Sex Status Class & Other Ancillary (Enumerate DAY
Source Designation Degree/ Specialization/ From
Number - Position, Descending) (Regular/ Minor Assignments sections (M/T/W/T
T.I.N.) Probationary/ Postgraduate Specialized taught) (00:00)
H/F)
Part Time) Training Attended

First Semester:

Second Semester:

Advisory:
Ancillary Assignment/s:
Ave. Minutes per D
First Semester:

Second Semester:

Advisory:
Ancillary Assignment/s:
Ave. Minutes per D
First Semester:

Second Semester:

Advisory:
Ancillary Assignment/s:
Ave. Minutes per D
First Semester:

Second Semester:

Advisory:
Ancillary Assignment/s:
Ave. Minutes per D
First Semester:
 EDUCATIONAL QUALIFICATION Daily Program (time
Nature of
Employee Appointment/ Grade and
No. (or Tax Name of School Personnel Fund Position/
Employment
Major/
Subjects Taught, Advisory Sections
Identification (Arrange by Sex Status Class & Other Ancillary (Enumerate DAY
Source Designation Degree/ Specialization/ From
Number - Position, Descending) (Regular/ Minor Assignments sections (M/T/W/T
T.I.N.) Probationary/ Postgraduate Specialized taught) (00:00)
H/F)
Part Time) Training Attended

Second Semester:

Advisory:
Ancillary Assignment/s:
Ave. Minutes per D
First Semester:

Second Semester:

Advisory:
Ancillary Assignment/s:
Ave. Minutes per D

GUIDELINES:
1. This form shall be accomplished at the beginning of each semester by the School Head and is submitted to the Division Office. In case of movement of teachers and other
personnel during the semester, an updated SHSF-7 must be submitted to the Division Office at the end of the semester.
2. All school personnel, regardless of position/nature of appointment should be included in this form and should be listed from the highest rank to the lowest. Si
3. Please reflect subjects being taught including advisory class or ancillary assignment (if any). Other administrative duties must also be reported.
4. Daily Program Column is for teaching personnel only. Updated as of:
SHS)
Region

nd Funding Sources

Number of Incumbent
Fund Source
(SEF, PTA,
NGO's etc.) Teaching Non-Teaching

Remarks:
ogram (time duration)
*For Detailed Items, Indicate
name of school/office,
*For IP - Ethnicity)
Total Actual *For additional loads from
To Teaching JHS- please indicate the number
(00:00) Minutes per of teaching minutes per week)
Week

e. Minutes per Day

e. Minutes per Day

e. Minutes per Day

e. Minutes per Day

 Remarks:
ogram (time duration)
*For Detailed Items, Indicate
name of school/office,
*For IP - Ethnicity)
Total Actual *For additional loads from
To Teaching JHS- please indicate the number
(00:00) Minutes per of teaching minutes per week)
Week

e. Minutes per Day

e. Minutes per Day

Signature of School Head over Printed Name

ated as of:

School Form 7, Page ___ of ________

SF 8

Department of Education
School Form 8 Learner's Basic Health and Nutrition Report for Senior High School (SF8-SHS)
(For All Grade Levels)

School Name District Division Region

School ID Grade Section Track/Strand (SHS) School Year

Learner's Name Nutritional Status

Birthdate Weight Height Height² Height for
No. LRN (Last Name, First Name, Name Age BMI Remarks
(MM/DD/YYYY) (kg) (m) (m²) BMI Category Age (HFA)
Extension, Middle Name) (kg/m²)
MALE

FEMALE

SFRT 2017
 Learner's Name Nutritional Status
Birthdate Weight Height Height² Height for
No. LRN (Last Name, First Name, Name Age BMI Remarks
(MM/DD/YYYY) (kg) (m) (m²) BMI Category Age (HFA)
Extension, Middle Name) (kg/m²)

SUMMARY TABLE
Nutritional Status Height for Age (HFA)
Summary Table Summary Table
SEX Severely
Severely Wasted Wasted Normal Overweight Obese TOTAL Stunted Normal Tall Total
Stunted
MALE
FEMALE
TOTAL

Date of Assessment: Conducted/Assessed By: Certified Correct By: Reviewed By:

SFRT 2017

SFRT 2017