Republic of the Philippines
Department of Education
Region I
Schools Division Office I Pangasinan
Lingayen
SOCIO/ ACADEMIC/ ANECDOTAL RECORD
Basing Elementary School
Name: ______________________________ Residence: _____________________________ Birthdate: _____________
Father: ___________________________________________ Mother: _________________________________________
No. of Children in the Family: _______ Boy: ____ Girl: ____ Living with Parents: Yes: ______ No: ______
State if both parents are living: ______ Yes: _____ No: ____ If no, pls. specify: ______________________
Parents Monthly Income: Php ____________ Economic Status: Very Poor ____ Poor ____ Average ____ High _____
I. Pre-Elementary Education
Entrance age: Nursery: _____ Kinder _____
II. Elementary Education
Graduate with Honors? Yes _____ No _____ (Please check) If yes, specify ____________
(to be filled after graduation)
A. Academic Profile
1. Reading
GRADE I GRADE II GRADE III GRADE IV GRADE V GRADE VI
1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4
Non-Reader
Frustration
Instructional
Independent
Legend: 1-Non Reader 2-Frustration 3-Instructional 4-Independent
(Please check appropriate box in each grade applicable opposite Nos. 1, 2, 3, or 4 and case may be.)
2. Mathematics
GRADE I GRADE II GRADE III GRADE IV GRADE V GRADE VI
1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4
Addition
Subtraction
Multiplicatio
n
Division
Problem Solving
Legend: W - level of mastery is very poor X - some degree of mastery but needs more practice
Y - just enough mastery Z - manifest excellence
(Above code shall be entered for each of the curriculum year)
B. Oral Participation/Recitation
GRADE I GRADE II GRADE III GRADE IV GRADE V GRADE VI
1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4
Passive
Poor
Active
C. Any Academic honor obtained in: D. Special Talents/Skills/Winnings
Grade I _____________ I II III IV V VI
Grade II _____________ 1. Singing
Grade III _____________ 2. Dancing
Grade IV _____________ 3. Music Reading
Grade V _____________ 4. Drawing/Painting
Grade VI _____________
5. Dramatics
6. Speaking
(Please Specify) a. Declaration
b. Oratorical
7. Athletics
8. Leadership
9. Others (Pls. specify)
E. Cases of Significant Misdemeanor/s
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CERTIFICATION is hereby made on the veracity of the above-mentioned entries per item.
GRADE I GRADE II GRADE III GRADE IV GRADE V GRADE VI
Adviser __________ __________ __________ __________ __________ __________
Principal __________ __________ __________ __________ __________ __________
