Republic of the Philippines
Department of Education
National Capital Region
Schools Division Office of Quezon City
E. Rodriguez Jr. High School
___________________________
___________________________
Subject Teacher
___________________________
Dear Mr/Mrs/Ms. ___________________:
Good day!
I am writing to humbly request __________________________________ of
____________________ to be allowed to take up ___________________________________
this _____ Semester of the Academic Year 2025-2026.
The student failed the subject in Grade 11; hence, he/she is instructed to attend
your class. However, if there is a conflict with the schedule provided, his/her
requested class can be held on any day of your convenience.
Failure to meet all the subject requirements would result in delinquency of the
above-mentioned subject.
Thank you for your assistance and cooperation.
Respectfully,
____________________________
Adviser
Noted by:
DAISY GALGANA
SHS Focal Person
Approved by:
Address:Mayon Avenue,Brgy. N.S. Amoranto, Quezon City
Email:
[email protected] __________________________
Subject Teacher
Republic of the Philippines
Department of Education
National Capital Region
Schools Division Office of Quezon City
E. Rodriguez Jr. High School
Attachment A
REMEDIATION FORM
Date: _____________
NAME OF STUDENT:
GRADE AND SECTION:
CLASS ADVISER:
SEMESTER & SCHOOL YEAR:
Subject/s to be taken Teacher and Grade and Modality Teacher’s
Schedule Section to sit-in (F2F, Initials
Blended)
_______________________________ ________________________________
Student’s Signature over Printed Name Adviser’s Signature over Printed Name
Address:Mayon Avenue,Brgy. N.S. Amoranto, Quezon City
Email:
[email protected] Republic of the Philippines
Department of Education
National Capital Region
Schools Division Office of Quezon City
E. Rodriguez Jr. High School
Attachment B
KASUNDUAN SA PAGITAN NG MAGULANG AT GURO TAGAPAYO
(Para sa Guro-Tagapayo)
Ako si ___________________________, Guro Tagapayo ni
___________________________
ng (Baitang at Pangkat) _____________________ ay ipinababatid sa inyo na siya
ay binibigyang pagkakataon na sumailalim sa isang REMEDIATION PROGRAM
upang mabuo ang mga kinakailangang bilang ng asignatura sa Senior High School
upang makapagtapos sa takdang panahon.
Nais ko po ipabatid sa inyo na ang kasunduang ito ay magsisilbing patunay na kayo
ay sumasang-ayon at kusang-loob na makikibahagi sa layunin ng programa para sa
mag-aaral na mayroong status na IRREGULAR STUDENT.
Ang kasunduan din po na ito ay magbibigay patunay sa magiging desisyon ng guro
sa asignatura kung ang inyong anak/alaga ay sumusunod sa mga alituntuning
inilatag ng guro sa pagsisimula ng klase.
(Para sa Magulang)
Ako si _________________________, Magulang/Tagapag-alaga ni
______________________
Ay kusang-loob ng pumapayag na makibahagi sa programa kung saan ang aking
anak/alaga ay sasailalim sa REMEDIATION PROGRAM upang mabuo ang bilang ng
asignatura sa SHS.
Batid ko at lubusang nauunawaan ang layunin ng programa kaya’t bilang pagsang-
ayon aking lalagdaan ang kasunduan ito ngayong ika_____ ng ________________
taong _____________.
___________________________ ________________________________
Pangalan ng Magulang at Lagda Pangalan ng Guro-Tagapayo at Lagda
Naitala ni:
__________________________
Address:Mayon Avenue,Brgy. N.S. Amoranto, Quezon City
Email:
[email protected] Grade Level Coordinator
Address:Mayon Avenue,Brgy. N.S. Amoranto, Quezon City
Email:
[email protected]
