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ACADEMIC PSYCHO-SOCIAL ASSISTANCE PROGRAM

Name of Student:

 ______________________________________________________ 

Previous Year and section:

 ______________________________________________________ 

Date of Enrollment:

______________________________________________________

A Commitment to Improve

Academic Performance, Behavior and Attendance

(For School Year_______________)

Student

I promise to: Attend classes regularly and punctually. Consult withteachers. Attend group sessions called by the guidance counselor. Attend

special classes organized by the school. Limit my involvement in extra-

curricular activities. Develop desirable habits and attitudes. Study in the

library as often as possible.

 __________________________________ Name and Signature of 

Student

Parent

I promise to: Closely monitor my child’s academic performance,attendance and behavior in school. Consult with teachers, homeroom adviser

and guidance counselor at least once every quarter. Provide a home

atmosphere conducive to study and personal formation. Attend card giving

and parenting seminars. Recognize/reinforce improved performance and

behavior of my child.

 __________________________________ Name and Signature of 

Parent

Homeroom Adviser

I promise to: Be available for consultation. Assist the student develop

desirable work habits and attitudes. Regularly monitor student’s

performance and behavior and inform parents about it.

 _________________________________ Name and Signature of HR

Adviser

Subject Teacher

I promise to: Be available for consultation. Assist the student developdesirable work habits and attitudes. Regularly monitor student’s

performance and behavior and inform parents about it.

 __________________________________ Name and Signature of 

Subject Teacher

Guidance Counselor

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I promise to: Assist the student to develop desirable work habits and

attitudes. Assist teachers and parents establish reinforcing measures for

desirable student performance. Conduct conferences/seminars for the

participants. Provide counseling to students.

 __________________________________ Name and Signature

of Guidance Counselor

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Name___________________________________________ Previous Year

Section______________________________________Status___________________________________ 

Causes of my Academic and/or

Behavior Deficiencies

My Targets (Goals) in terms of Grades and/or

Behavior for School Year__________

What I Intend to do to Attain my Goals

 ___________________________________________ 

Name & Signature of Student

 __________________________________________ 

Name & Signature of Parent/Guardian

Date:______________________________________ 

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GUIDANCE CENTERPhilippine Science High School - Ilocos Region Campus

Poblacion East, San Ildefonso Ilocos Sur

RECORD OF TEACHER CONSULTATION OR LIBRARY HOURS

Name:_______________________________________ 

Section:_____________________________ 

Month:_______________________________________ 

Date Time

IN OUT

Signature of 

Teacher /

Librarian

I hereby certify that the abovemenntioned information is true and

correct to

the best of my knowledge.

 ______ ________________________ 

Signature of Student

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GUIDANCE CENTER

Distribution of Homeroom Modules

SECTION ADVISER SIGNATUREI – Ruby Jenahlyn Retreta

I - Diamond Nelson SablayI - Emerald Mary Grace NavarroII - Adelfa Monaliza MandacII - Dahlia Elma RapadaII - Camia Ronnie CalanoIII - Lithium Annellene MadridIII – Cesium Amy PanedaIII – Beryllium Sharon PalomaresIV - Photon Jonellyn AlbanoIV – Graviton Michelle Ducusin