DECS FORM 137-E
Republika ng Pilipinas
(Republic of the Philippines)
Kagawaran ng Edukasyon, Kultura at Isports
(Department of Education, Kultura at Isports)
KAWANIHAN NG EDUKASYONG ELEMENTARYA
(BUREAU OF ELEMENTARY EDUCATION)
Rehiyon____
(REGION)
PALAGIANG TALAAN SA MABABANG PAARALAN
(ELEMENTARY SCHOOL PERMANENT RECORD)
I. Pangalan_________________________________________Sangay_______________Paaralan _____________________________
(Name) Apelyido Unang Ngalan M.I (Division) (School)
(Surname) (Given)
Kasarian ________ Petsa ng Kapanganakan _____________ (Pook) ______________________ Petsa ng Pagpasok ______________
(Sex) (Date of Birth) (Place) Bayan/Lalawigan/Lungsod (Date of Entrance)
(Town/Province/City)
Magulang/Tagapag-alaga ______________________________________________________________________________________
Pangalan Tirahan Hanapbuhay
(Name) (Address) (Occupation)
PAG-UNLAD SA MABABANG PAARALAN (ELEMENTARY SCHOOL PROGRESS)
Grade I - School _____________________________ Grade II - School ______________________________
School Year _________________________ School Year _________________________
Learning Periodic Rating Remarks Learning Periodic Rating Remarks
Areas 1 2 3 4 Areas 1 2 3 4
General Average____________________ General Average____________________
Eligible for Admission to Grade _______________ Eligible for Admission to Grade _____________
Grade III - School ______________________________ Grade IV - School _______________________________
School Year __________________________ School Year ___________________________
Learning Periodic Rating Remarks Learning Periodic Rating Remarks
Areas 1 2 3 4 Areas 1 2 3 4
General Average____________________ General Average______________________
Eligible for Admission to Grade _______________ Eligible for Admission to Grade _____________
Grade V - School ________________________________ Grade VI - School ___________________________
School Year _____________________________ School Year _______________________
Learning Periodic Rating Remarks Learning Periodic Rating Remarks
Areas 1 2 3 4 Areas 1 2 3 4
General Average____________________ General Average____________________
Eligible for Admission to Grade ____________ Eligible for Admission to Grade _______________
II. II. CHARACTER BUILDING
Gr, Sch, Yr Gr, Sch, Yr Gr, Sch, Yr
1 2 3 4 F.R 1 2 3 4 F.R 1 2 3 4 FR
1. Honesty
2. Courtesy
3. Helpfulness & Cooperation
4. Obedience
5. Consideration for others
6. Sportmanship
7. Love of Country
8. Self-Reliance
9. Industry
10. Cleanliness & Orderliness
Gr, Sch, Yr Gr, Sch, Yr Gr, Sch, Yr
1 2 3 4 F.R 1 2 3 4 F.R 1 2 3 4 FR
11. Honesty
12.
13. Courtesy
14. Helpfulness & Cooperation
15. Obedience
16. Consideration for others
17. Sportmanship
18. Love of Country
19. Self-Reliance
20. Industry
21. Cleanliness & Orderliness
(No, of (No, of School No. of Times (No, of School
(Grade) School Days) Days Absent) Cause Tardy) Cause Days Present)
(CERTIFICATE OF TRANSFER)
TO WHOM IT MAY CONCERN:
This is to certify that this is a true record of the Elementary Schools Permanent Record of ___________________________
________________. He/She is eligible for transfer and admission to Grade/Year ________________________________________.
________________________________________
Signature
______________________________________ _______________________________________
Date Designation
