Division Memorandum
To:
From:
010, Assistants Schools Division Superintendent Chiefs CID, SGOD Education Program Supervisors Public Schools District Supervisors Public tary Scho I Heads All Othcerned
O'IY SEHOOLS DIVIItN Of
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MANUTOLENTINO, 2 AS. Ed/ Officer-In-Charge Office of the Schools Division Superintendent
Subject: Official Format of FORM 137 (Elementary School Permanent Record) Date: June 23,2016
Attached herewith is the official format of the Form 137 (ELEMENTARY SCHOOL PERMANENT RECORD). In this regard, all Public Elementary School Heads are advised to begin implementing the use of said Forrr 137 starting School Year 2016-2017. For your information and compliance.
CSDO Building, Dasmariñas Community Affair Compound, Brgy. Burol II, City of Dasmariñas 41 15 Email: dasmarinas.citydeped.gov.ph I Website: www.depeddasma.edu.ph Phone: 046-432-9355, 046-432-9384 1 Tele-Fax: 046-432-3629
DepEd Form 137-E
LRN Republic of the Philippines
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Department of Education
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BUREAU OF ELEMENTARY EDUCATION Re96 40 0rilV - A (CALABARZON)
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CITY SCHOOLS DIVISION OF DASMARISTAS
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Via Verde, San Agustin II, citytqf Dasmarifias, Cavite
ELEMENTARY SCHOOL PERMANENT RECORD Name:
School (Surname)
(Given)
(Ml)
Birthday:
Birthplace:
Date of Entrance:
Parent/Guardian:
Address:
ELEMENTARY SCHOOL PROGRESS Early Childhood Care and Development DOMAIN
- Quarter
2 nd
Quarter
SS
RS
SS
RS
School Readiness Year End Assessment 3rd Quarter RS
SCORE
DOMAIN
SS
Language Development
Gross Motor Fine Motor
Cognitive/Intellectual Development - Numeracy
Self-Help
Cognitive/Intellectual Development - Sensory Perception
_
Receptive Language
_
Cognitive/Intellectual Development - Social Environment
,
Expressive Language
Cognitive/Intellectual Development - Physical Environment
,
Cognitive
Fine Motor/Gross Motor
Social-Emotional Social - Emotional Development
Sum of Scaled Score
,
Character and Values Development
Standard Score Interpretation
TOTAL
_
ELIGIBLE FOR ADMISSION TO GRADE: GRADE I - SCHOOL: SCHOOL YEAR:
GRADE II SCHOOL: SCHOOL YEAR: _ QUARTERS
LEARNING AREAS
2
I
QUARTERS
FINAL
3
GRADE
4
LEARNING AREAS
Remarks
English
English
Mathematics
Mathematics
Filipino
Filipino
Araling Panlipunan (Ar.) Edukasyon sa Pagpapakatao (Esp)
Araling Panlipunan op) Edukasyon sa Pagpapakatao (ExP)
Mother Tongue
Mother Tongue
MAPEH
MAPEH
Music
Atirsie
Arts
Arts
PE Health
2
3
4
Remarks
,
,
PE
,
1
FINikL GRADE
.,-,_
, .....
. _
,
,
Health . . •
AVERAGE Teacher
.
AVERAGE
,
LS'ignature
Teacher' Signature
I
ELIGIBLE FOR ADMISSION TO GRADE:
ELIGIBLE FOR ADMISSION TO GRADE:
GRADE III - SCHOOL: SCHOOL YEAR:
GRADE IV - SCHOOL: SCHOOL YEAR: QUARTERS
LEARNING AREAS I
2
3
FINAL GRADE
-4
LEARNING AREAS
Remarks
English
English
MathWilaties
Mathematics
Seienee
Filipino
Science
_
Filipino
Araling Panlipunan (AP)
Araling Panlipunan (AP)
Edukasyon sa Pagpapakatao (EsP)
Edukasyon sa Pagpapakatao , (EcP) Etiukasvong Pantahanan at Pangkatihayan (EPP)
MAPEll
1
2
3
FINAL GRADE
4
,
,
MAPEH
Music
Music
Arts
A its
,
PE
1
PE
Heailh
Health
i
-
p.
AVERAGE
AVERAGE
Teacher :c Signature
1 .
Teacher :v Signature
ELIGIBLE FOR ADMISSION TO GRADE:
ELIGIBLE FOR ADMISSION TO GRADE:
.
.
Remarks
.
_
Mother Tongue
QUARTERS
..........-..
,
GRADE V - SCHOOL: SCHOOL YEAR:
GRADE VI - SCHOOL: SCHOOL YEAR: QUARTERS
LEARNING AREAS .
1
FINAL GRADE
_
23
4
LEARNING AREAS
Remarks
c '
English
QUARTERS
3
1
4
FINAL 1 GRADE
Remarks
English arl
, Mathematics Science Filipino
Mathematics Science
i _
fr
\
,
FSpino
.
Araling Panlipunan (AP.) Edukasyon sa Pagpapakatao (EsP) Edukasyong Pantahanan at Pangkabuhayan (EP?) , MAPEH
,
I
,
Araling Panlipunan (AP) Edukasyon sa Pagpapakatao (EsP) Technology and Livelihood Education (TL E) MAPEH
S.
. .
a
■
Music
Music
.
Arts
.
Arts
PE
5
PE
-.
Health
Health .
,
.,
.
AVERAGE
AVERAGE
I Teacher :c Signature
Teacher Signature
ELIGIBLE FOR ADMISSION TO GRADE:
ELIGIBLE FOR ADMISSION TO GRADE:
CHARACTER BUILDING -
Core Values
, Gr.
Behavior Statements
Sch. Yr. . 3
.
Expresses one's spiritual beliefs while respecting the spiritual beliefs of others Maka-Diyos Shows adherence to ethical principles by upholding truth Is sensitive to individual, social, and I cultural differences Makatao Demonstrates contributions toward solidarity Cares for the environment and utilizes Makaresources wisely, judiciously, and kalikasan economically Demonstrate pride in being a Filipino; exercises the rights and responsibilities , of a Filipino citizen Maka bansa Demonstrates appropriate behavior in carrying out activities in the school, community, and country ,
Core Values
_
..
-
•
2
3
4
4
,
,
_ I
,
,
,
,
Sch. Yr. 2
,
,
fr
3
Sch. Yr.
Gr.
4
2
1
3
.
4
,
Marking AO SO
23
1
.
1
Expresses one's spiritual beliefs while respecting the spiritual beliefs of others Maka-Diyos , Shows adherence to ethical principles by upholding truth Is sensitive to individual, social, and cultural differences Makatao Demonstrates contributions toward solidarity for or th e environment i danutilize uzess Makaresources wisely, judiciously, and kalikasan economically Demonstrate pride in being a Filipino; exercises the rights and responsibilities . of a Filipino citizen Maka bansa Demonstrates appropriatetehavior in , carrying out activities in the school, community, and country
Sch. Yr.
Cr.
.
4
.
Sch.. Yr.
1
.
Gr.
Behavior Statements
Gr.
Sch. Yr.
Gr. 1
234 ,
, : , I
_
.
..
.
i
: ,...„.
. ._
.
4 ,.
_
Non-numerical Rating
Marking RO NO
Always Observed Sometimes Observed
Non-numerical Rating
Rarely Observed Not Observed
ATTENDANCE RECORD Grade
No. of School Days
No. of School Days Absent
No. of Times Tardy
Cause
No. of School Days Present
Cause
I
_
I ,
CERTIFICATE OF TRANSFER
TO WHOM IT MAY CONCERN: This is to certify that this is a true record of the Elementary School Permanent Record of He / She is eligible for transfer and admission to Grade
•
(Signature) Date
(Designation) 'fol'IS••""" - w ••-•
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