Republic of the Philippines

Department of Education
BUREAU OF ELEMENTARY EDUCATION
Region III – Division of Bulacan
A-Z Country
Immaculate Day School
Conception School of Baliuag
FORM 137-E DepEd Government Recognition No.E-086 s. 2001
LRN: 400653150027 #9002 Villa Juliana Subd. Borol 2nd, Balagtas, Bulacan

ELEMENTARY PUPIL’S PERMANENT RECORD

Name: De Jusus Hiroki Zaicee Calambro Date of Birth: Year 2009
Month August Day 24
(Surname) (First Name) (Middle Name)
Sex: Female Place of Birth: Zamora Medical Clinic Pob.I. City of San Jose Del Monte Bulacan Date of
Entrance: June 13, 2016 (Town/Province/City)
Parent's Name/Guardian: Lailane De Jusus Occupation: Call Center Agent
Address of Parents/Guardian: 342 House 4 Borol 2nd, Balagtas, Bulacan

PRE-ELEMENTARY
SCHOOL DATE DATE SCHOOL ATTENDED LEVEL DAYS FINAL PROMOTED
YEAR ENTERED LEFT PRESENT RATING or RETAINED
2014-2015 - - A-Z Country Day School Nursery 198 91.063 Promoted
2015-2016 - - A-Z Country Day School Preparatory 199 93 Promoted

Grade 1: Grade 2
School: A-Z Country Day School Eligible for Admission to Grade 4
School Year 2016-2017 Grade 5
School:_ :
Grading Period Final
Learning Areas Rating School Year: _____________________
1 2 3 4 Eligible for Admission for Grade 7
Mother Tongue 89 School:
Filipino 91
School Year
English 89 Eligible for Admission to Grade 3
Mathematics 91 Grade 4
Araling Panlipunan School:
92
(AP) School Year
Edukasyon sa Eligible for Admission to Grade 5
91
Pagpapakatao ( EsP)
Grade 6
MAPEH 91
School:_________________________________________________________
 Music 89 _____
 Art 91 School Year: _____________________
 Physical Grading
93
Education Final
Learning Areas Period
 Health 92 Rating
Science/Compute
1 2 3 4
87/93 Filipino
r
General Average 91 English
Eligible for Admission to Grade 2 Mathematics
Grade 3 Science
School: Araling Panlipunan (AP)
School Year Edukasyong
Pangkabuhayan at
Grading Period Final
Learning Areas Rating
Paggawa (EPP)
1 2 3 4 MAPEH
Mother Tongue  Music
Filipino  Art
English  Physical Education
Mathematics  Health
Araling Panlipunan (AP) Edukasyon sa
Edukasyon sa Pagpapapakatao (EsP)
Pagpapapakatao Computer
(EsP) General Average
MAPEH Eligible for Admission for Grade 7

 Music
 Art
 Physical
Education
 Health
Science
Computer

General Average

Grading
Final
Learning Areas Period
Rating
1 2 3 4
Filipino
English
Mathematics
Science
Araling Panlipunan (AP)
Edukasyong
Pangkabuhayan at
Paggawa (EPP)
MAPEH
 Music
 Art
 Physical Education
 Health
Edukasyon sa
Pagpapakatao (EsP)
Computer
General Average

Grading Period Final

Learning Areas Rating
1 2 3 4 Grading Period Final
Filipino Learning Areas Rating
1 2 3 4
English Mother Tongue
Mathematics Filipino
Science English
Araling Panlipunan(AP) Mathematics
Edukasyong Araling Panlipunan
Pangkabuhayan at (AP)
Paggawa (EPP) Edukasyon sa
MAPEH Pagpapapakatao
(EsP)
 Music
MAPEH
 Art  Music
 Physical Education  Art
 Health  Physical
Edukasyon sa Education
Pagpapapakatao (EsP)
 Health
Computer Science/Computer
General Average General Average
 REPORT ON LEARNING OBSERVED VALUES
Grade: 1 Grade:_____________ Grade:_____________
School_A-Z Country ______ _____
CORE VALUES BEHAVIOR STATEMENT Day School School:____________ School:
S.Y:2016-2017 ______ _________________
_____________________ S.Y:__________
_____
S.Y:________________
_____

1 2 3 4 1 2 3 4 1 2 3 4
Expresses one’s spiritual beliefs while
respecting the spirituals beliefs of others. SO SO SO AO
1. Maka-Diyos Shows adherence to ethical principles by
upholding truth SO SO AO AO
Is sensitive to individual social, and
cultural differences SO SO SO AO
2.Makatao Demonstrates contributions toward
SO AO AO AO
solidarity
3.Makakalikas Cares for the environment and utilizes
resources wisely, judiciously, and SO AO AO AO
an economically
Demonstrates pride in being a Filipino;
exercise the rights and responsibilities of SO AO AO AO
a Filipino citizen
4.Makabansa Demonstrates appropriate behavior in
carrying out activities in the school, SO SO AO AO
community, and country

Grade:_____________ Grade:_____________ Grade:_____________

____ ______ ______
CORE VALUES BEHAVIOR STATEMENT School:____________ School:____________ School:_____________
______ ______ _____
_____________________ _____________________ _____________________
_____ _____ _____
S.Y:__________ S.Y:________________ S.Y:_________________
_____ ____

1 2 3 4 1 2 3 4 1 2 3 4
Expresses one’s spiritual beliefs while
respecting the spirituals beliefs of others.
1. Maka-Diyos Shows adherence to ethical principles by
upholding truth
Is sensitive to individual social, and
cultural differences
2.Makatao Demonstrates contributions toward
solidarity
3.Makakalikas Cares for the environment and utilizes
resources wisely, judiciously, and
an economically
Demonstrates pride in being a Filipino;
exercise the rights and responsibilities of
a Filipino citizen
4.Makabansa Demonstrates appropriate behavior in
carrying out activities in the school,
community, and country

Marking Non-numerical Rating

AO Always Observed
SO Sometimes Observed
RO Rarely Observed
NO Not Observed

No. of
Grade
School days
1 202
- -
- -
- -
- -
- -
- -
TO WHOM IT MAY CONCERN:
RECORD OF ATTENDANCE
No. of
No. of Days No. of
Cause Cause School Days
Absent Times Tardy
Present
15 - - - 187
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
CERTIFICATE OF TRANSFER

This is to certify that this is a true copy of the Elementary Schools Permanent Record of Hiroki Zaicee. De Jusus
He/She is eligible for transfer and admission to ______2______.
( Grade )
Copy of the record sent to Mary Mount Academy on February 5, 2018.
 Mrs. Ailyn C. Roque
OIC/Principal

NOT VALID WITHOUT SCHOOL DRY SEAL