Republic of the Philippines

Department of Education
REGION VIII
SCHOOLS DIVISION OF ORMOC CITY
District IV
Salvacion National High School
Salvacion, Ormoc City

ANECDOTAL RECORD
Name: ____________________________________________________
Birthdate: __________ Birthplace: __________________ Age: _______
Father: ___________________________ Occupation: _______________
Mother: __________________________ Occupation: _______________
Number of Siblings: _____________ Position in the family: ________
Religion: _________________________ Height: ___________________
Language: ________________________ Weight: ___________________
Hobby: ____________________________________________________
Special Talents: ______________________________________________
Subject/s found easy:_____________ Subject/s found hard: _____________

Do you plan to graduate…

Junior High School? ______ Senior High School? _____ Strand: ___________
College? _____________ What course? ____________________________

What is your motto in life?

___________________________________________________________________________
_______________________________________

What do you want to become in the future and why?

___________________________________________________________________________
_______________________________________

What are the things that may hindrance you from finishing school?
___________________________________________________________________________
___________________________________________________________________________
_____________________

Do you have any concerns with regards to your stay in school?

___________________________________________________________________________
___________________________________________________________________________
_____________________
Date: _______________ Time: ___________ Subject: ___________________
Observations: (Behavior – positive behavior, academic standing, offenses, things need to
improve)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

_________________________________ _________________________________
Signature over Printed Name of Student Signature over Printed Name of Teacher

Date: _______________ Time: ___________ Subject: ___________________

Observations: (Behavior – positive behavior, academic standing, offenses, things need to
improve)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

_________________________________ _________________________________
Signature over Printed Name of Student Signature over Printed Name of Teacher

Date: _______________ Time: ___________ Subject: ___________________

Observations: (Behavior – positive behavior, academic standing, offenses, things need to
improve)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
 _________________________________ _________________________________
Signature over Printed Name of Student Signature over Printed Name of Teacher

Date: _______________ Time: ___________ Subject: ___________________

Observations: (Behavior – positive behavior, academic standing, offenses, things need to
improve)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

_________________________________ _________________________________
Signature over Printed Name of Student Signature over Printed Name of Teacher
Date: _______________ Time: ___________ Subject: _____________________
Observations: (Behavior – positive behavior, academic standing, offenses, things need to improve)
__________________________________
___________________________________________________________________________________
Signature over Printed Name of Parent
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

_________________________________ _________________________________
Signature over Printed Name of Student Signature over Printed Name of Teacher

_________________________________
Signature over Printed Name of Parent

Date: _______________ Time: ___________ Subject: _____________________

Observations: (Behavior – positive behavior, academic standing, offenses, things need to improve)
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

_________________________________ _________________________________
Signature over Printed Name of Student Signature over Printed Name of Teacher

_________________________________
Signature over Printed Name of Parent

Date: _______________ Time: ___________ Subject: _____________________

Date: _______________ Time: ___________ Subject: _____________________
Observations: (Behavior – positive behavior, academic standing, offenses, things need to improve)
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

_________________________________ _________________________________
Signature over Printed Name of Student Signature over Printed Name of Teacher

Date: _______________ Time: ___________ Subject: _____________________

Observations: (Behavior – positive behavior, academic standing, offenses, things need to improve)
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

_________________________________ _________________________________
Signature over Printed Name of Student Signature over Printed Name of Teacher

_________________________________
Signature over Printed Name of Parent