FORM 137-E
RepublikangPilipinas
(Republic of the Philippines)
KagawaranngEdukasyon
(Department of Education)
KAWANIHAN NG EDUKASYON ELEMENTARYA
(BUREAU OF ELEMENTARY EDUCATION)
Rehiyon: ________
(Region)
PALAGIANG TALAAN SA MABABANG PAARALAN
(Elementary School Permanent Record) LRN:_______________________
Pangalan ___________________________________________________________________ Sangay__________________Paaralan______________________________
(Name) ApelyidoUnangPangalan M.I. (Division) (School)
Kasarian__________Petsang Kapanganakan__________________Pook___________________________________Petsa ngPagpasok__________________
(Sex) (Date of Birth) (Place) Bayan/lalawigan/Lunsod (Date of Entrance)
(Town/Province/City)
Magulang/Tagapag-alaga____________________________________________________________________________________________________________________
(Parent/Guardian) PangalanTirahanHanapbuhay
(Name) (Address) (Occupation)
PAG-UNLAD SA MABABANG PAARALAN
(Elementary School Progress)
Eligible for Admission to Grade______________________________________________
Grade I-School_________________________________________________________________ Grade II-School________________________________________________________________
School Year__________________________________________________________________ School Year__________________________________________________________________
Periodic Rating Periodic Rating
LEARNING AREAS Remarks LEARNING AREAS Remarks
1 2 3 4 1 2 3 4
Mother Tongue Mother Tongue
Filipino Filipino
English English
Mathematics Mathematics
AralingPanlipunan AralingPanlipunan
MAPEH MAPEH
Music Music
Art Art
Physical Education Physical Education
Health Health
EdukasyonsaPagpapakatao (EsP) EdukasyonsaPagpapakatao (EsP)
General Average General Average
Eligible for Admission to Grade______________________________________________ Eligible for Admission to Grade______________________________________________
Grade III-School______________________________________________________________ Grade IV-School_______________________________________________________________
School Year__________________________________________________________________ School Year__________________________________________________________________
Periodic Rating Periodic Rating
LEARNING AREAS Remarks LEARNING AREAS Remarks
1 2 3 4 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__________________________________________________________________
Periodic Rating Periodic Rating
LEARNING AREAS Remarks LEARNING AREAS Remarks
1 2 3 4 1 2 3 4
General Average General Average
Eligible for admission to Grade _________________________________ Eligible for admission to Grade _________________________________
III. REPORT ON LEARNER’S OBSERVED VALUES
Gr. 1 S.Y. ________________ Gr. 2 S.Y. ________________ Gr. 3 S.Y. ________________
Core Values Quarter Quarter Quarter
Behavior Statements
1 2 3 4 1 2 3 4 1 2 3 4
Expresses one’s spiritual
1. Maka- beliefs while respecting the
Diyos spiritual beliefs of others
Shows adherence to ethical
2. Makatao principles by upholding
truth
Cares for the environment
3. Maka- and utilizes resources
kalikasan wisely, judiciously, and
economically
Demonstrates pride in
being a Filipino; exercises
the rights and responsibi-
4.Makabansa lities of a Filipino citizen.
Demonstrates appropriate
behavior in carrying out
activities in the school,
community, and country
Gr. 4 S.Y. _______________ Gr. 5 S.Y. ________________ Gr. 6 S.Y. ________________
Core Values Quarter Quarter Quarter
Behavior Statements
1 2 3 4 1 2 3 4 1 2 3 4
Expresses one’s spiritual
1. Maka- beliefs while respecting the
Diyos spiritual beliefs of others
Shows adherence to ethical
2. Makatao principles by upholding
truth
Cares for the environment
3. Maka- and utilizes resources
kalikasan wisely, judiciously, and
economically
Demonstrates pride in
being a Filipino; exercises
the rights and responsibi-
4.Makabansa lities of a Filipino citizen.
Demonstrates appropriate
behavior in carrying out
activities in the school,
community, and country
AO – Always Observed SO – Sometimes Observed RO – Rarely Observed NO – Not Observed
IV. ATTENDANCE RECORD
Grade No. of No. of Cause No. of Cause No. of
School School Days Times School Days
Days Absent Tardy 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 of Grade/Year_____________________.
_____________________________________________
Signature
___________________________________________ ____________________________________________
Date Designation
