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Republic of the Philippines


Department of Education
MIMAROPA REGION
SCHOOLS DIVISION OF ORIENTAL MINDORO
ANECDOTAL RECORDS OF STUDENT
S.Y. 2022-2023
LRN No.: ________________________

A. Personal Data

1. Name: ________________________________________________________Age:___ ____Sex: ________________


2. Date of Birth:___ ______________________________ ________________________________________________
3. Address: ___________________________________________________________________________
4. Contact Number:_ ____________________________ Email Address: __________________________
5. Languages/ Dialects Spoken at Home:_____TAGALOG__ 6. Religion: _______________________

B. Family and Cultural Background


1. Parents Father (mark with + if deceased) Mother
Name:_ ______________________________________ _______________________,____________
Date of Birth:________________________ _________ ____________________________________
Permanent Address:____________________________
____________________________________________________
Contact Number:______________________________ ______________________________________
Highest Educational Attainment:______________________
______________________________________
Occupation:__________________________________ _____________________________________
Religion:_________________________ ____________
______________________________________
Physical Disabilities:____________________________
_____________________________________
Monthly Income:_______________________________
_____________________________________
2. No. of Brothers:_________ No. of Sisters:___________ Ordinal Position in the Family:____________
3. Parental Status of Parents: _____________________________________________________________
4. If not Living w/ Parents:
Name of Guardian: ___________________________________ ___________________________________
Relationship: _______________________________________________________________________
Contact number of Guardian:_______________________________________________ ___________________

Date and Time Behavior and Misconduct Remarks Signature of Parents


Prepared by:

GRACE M. CLAVERIA
Class Adviser

Checked by: Noted by:

RODERICK F. FONTE ALEX M. MAGBANUA, EdD.


Head Teacher III Principal II

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