Republika ng Pilipinas

FORM 137-E (Republic of the Philippines)

Kagawaran ng Edukasyon
Department of Education
KAWANIHAN NG EDUKASYONG ELEMENTARYA
(BUREAU OF ELEMENTARY EDUCATION)
Region X – Northern Mindanao

PALAGIANG TALAAN SA MABABANG PAARALAN

(Elementary School Permanent Record)

I. Pangalan ______________________________________Distrito___________________Paaralan: Cabili Village Elementary School

(Name Surname First Name Middle Name (District)Contact No:.________________ (Sch.)Contact No.: ___________________
Kasarian _______Petsa ng Kapanganakan__________________Pook _________________________Petsa ng Pagpasok___________
(Sex) (Date of Birth) (Place) Bayan/Lungsod/Lalawigan (Date of Entrance)
FATHER / GUARDIAN : ___________________________Place :_______________________Occupation :_________________
MOTHER:__________________________________Occupation:____________________ Parent’s / Guardian’s Contact No. _____________
Learner’s Reference Number ( LRN ): _______________________
II. LEARNING PROGRESS AND ACHIEVEMENT
Grade I – School: _________________________________________ Grade II – School: _________________________________________
School Address: __________________________________________ School Address: ___________________________________________
DE: _________School Year: _____________________D L: _______ DE: ___________School Year: __________________D L: _________
Periodic Rating Final Periodic Rating Final
Learning Areas Rating Remarks Learning Areas Rating Remarks
1 2 3 4 1 2 3 4
Mother Tongue Mother Tongue
Filipino Filipino
English English
Mathematics Mathematics
Araling Panlipunan Araling Panlipunan
MAPEH
MAPEH
Music Music
Arts
Arts
Physical Education
Physical Education
Health
Health
Edukasyon sa Pagpapakatao
Edukasyon sa Pagpapakatao
GENERAL AVERAGE
GENERAL AVERAGE
Eligible for Admission to Grade_________ Teacher Adviser: Eligible for Admission to Grade___________ Teacher Adviser:
Grade III – School: _______________________________________________ Grade IV – School: ________________________________________________
School Address:_________________________________________________ School Address: ___________________________________________________
DE: _________School Year: _________________ DL: __________ DE: ___________School Year: _________________ DL: __________
Periodic Rating Final Periodic Rating Final
Learning Areas Rating Remarks Learning Areas Rating Remarks
1 2 3 4 1 2 3 4
Mother Tongue Filipino
Filipino English
English Mathematics
Mathematics Science
Science Araling Panlipunan
Araling Panlipunan Edukasyong Pantahananan at
Pangkabuhayan
MAPEH
MAPEH
Music
Music
Arts
Arts
Physical Education
Physical Education
Health
Health
Edukasyon sa Pagpapakatao
Edukasyon sa Pagpapakatao
GENERAL AVERAGE
GENERAL AVERAGE
Eligible for Admission to Grade __________ Teacher Adviser:
Eligible for Admission to Grade__________ Teacher Adviser:
Grade V – School: _______________________________________________ Grade VI – School: ______________________________________________
School Address: _______________________________________________ School Address: _________________________________________________
DE: ________School Year: ____________________ DL: _________ DE: _________School Year: ____________________ DL: ________
Periodic Rating Final Periodic Rating Final
Learning Areas Rating Remarks Learning Areas Rating Remarks
1 2 3 4 1 2 3 4
Filipino Filipino
English English
Mathematics Mathematics
Science Science
Araling Panlipunan Araling Panlipunan
Edukasyong Pantahananan at Edukasyong Pantahananan at
Pangkabuhayan Pangkabuhayan
MAPEH MAPEH
Music Music
Arts Arts
Physical Education Physical Education
Health Health
Edukasyon sa Pagpapakatao Edukasyon sa Pagpapakatao
GENERAL AVERAGE GENERAL AVERAGE
Eligible for Admission to Grade__________ Teacher Adviser: Eligible for Admission to Grade_________ Teacher Adviser:

Page ____ of ____

III. CHARACTER BUILDING/LEARNER’S OBSERVED VALUES
Core Values Behavior Statements Gr. Sch. Yr Gr. Sch. Yr Gr. Sch. Yr
1 2 3 4 FR 1 2 3 4 FR 1 2 3 4 FR
1. Maka-Diyos Expresses one’s spiritual belief while
respecting the spiritual beliefs of
others
Shows adherence to ethical principles
by upholding the truth
2. Maka tao Is sensitive to individual, social, and
cultural differences
Demonstrates contributions toward
solidarity
3. Maka Cares for the environment and
kalikasan utilizes resources wisely, judiciously,
and economically
4. Maka bansa Demonstrates pride in being a
Filipino; exercises the rights and
responsibilities of a Filipino Citizen
Demonstrates appropriate behavior in
carrying out activities in the school,
community, and country
Legend: AO – Always Observed SO – Sometimes Observed RO – Rarely Observed NO – Not Observed

Core Values Behavior Statements Gr. Sch. Yr Gr. Sch. Yr Gr. Sch. Yr
1 2 3 4 FR 1 2 3 4 FR 1 2 3 4 FR
1. Maka-Diyos Expresses one’s spiritual belief while
respecting the spiritual beliefs of
others
Shows adherence to ethical principles
by upholding the truth
2. Maka tao Is sensitive to individual, social, and
cultural differences
Demonstrates contributions toward
solidarity
3. Maka Cares for the environment and
kalikasan utilizes resources wisely, judiciously,
and economically
4. Maka bansa Demonstrates pride in being a
Filipino; exercises the rights and
responsibilities of a Filipino Citizen
Demonstrates appropriate behavior in
carrying out activities in the school,
community, and country

Legend: AO – Always Observed SO – Sometimes Observed RO – Rarely Observed NO – Not Observed

IV. ATTENDANCE RECORD

No. of No. of No. of No. of
Grade School School Cause Times Cause School
Days Days Tardy Days
Absent Present

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________________.

______________________________
Name and Signature
_____________________________
Date ______________________________
Designation

REMARKS: Copy of this form is forwarded to

Name of Sch: _______________________________________________________________Sch.ID:____________________________________

Add. of Sch: ________________________________________________________Sch. Contact No. ___________________________________

District: ____________________________________________ Division:______________________________ Region: _______________