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School Form 1 (SF 1) School Register (This replace Form 1, Master List & STS Form 2-Family Background and Profile) School ID Region Division District School Name School Year Grade Level SECTION LRN AGE as of RELIGION ADDRESS NAME OF PARENTS GUARDIAN (If not Parent) REMARK/S Barangay Province Mother (Maiden) Name Contact Number NAME (Last Name, First Name, Middle Name) Sex (M/F) BIRTH DATE (mm/ dd/yy) BIRTH PLACE (Province) MOTHER TONGUE IP (Specify Ethnic Group) (nos. of years as per last birthday) House # / Street/Sitio/ Purok Municipality/ City Father (1st name only if family name identical to learner) Relationsh ip (Please refer to the legend on last page)

Prototype Forms for Implementation as of June 25

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Page 1: Prototype Forms for Implementation as of June 25

School Form 1 (SF 1) School Register(This replace Form 1, Master List & STS Form 2-Family Background and Profile)

School ID Region Division District

School Name School Year Grade Level SECTION

LRN

AGE as of

RELIGION

ADDRESS NAME OF PARENTS GUARDIAN (If not Parent) REMARK/S

Barangay Municipality/ City Province Mother (Maiden) Name Relationship Contact Number

NAME(Last Name, First Name, Middle Name)

Sex (M/F)

BIRTH DATE (mm/

dd/yy)

BIRTH PLACE

(Province)MOTHER TONGUE

IP (Specify

Ethnic Group)(nos. of years as per last birthday)

House # / Street/Sitio/

PurokFather (1st name only if family name identical to learner)

(Please refer to the legend on last page)

Page 2: Prototype Forms for Implementation as of June 25

LRN

AGE as of

RELIGION

ADDRESS NAME OF PARENTS GUARDIAN (If not Parent) REMARK/S

Barangay Municipality/ City Province Mother (Maiden) Name Relationship Contact Number

NAME(Last Name, First Name, Middle Name)

Sex (M/F)

BIRTH DATE (mm/

dd/yy)

BIRTH PLACE

(Province)MOTHER TONGUE

IP (Specify

Ethnic Group)(nos. of years as per last birthday)

House # / Street/Sitio/

PurokFather (1st name only if family name identical to learner)

(Please refer to the legend on last page)

List and code of Indicators under REMARK columnPrepared by: Certified Correct:

Indicator Code Required Information Indicator Code Required Information BoSY EoSY

Transferred Out T/OName of Public (P) Private (PR) School & Effectivity Date CCT Recipient

CCTCCT Control/reference number & Effectivity Date

MALE 13 14

Transferred IN T/I Name of Public (P) Private (PR) School & Effectivity Date Balik-Aral B/A Name of school last attended & Year FEMALE 14 14(Signature of Adviser over Printed Name) (Signature of School Head over Printed Name)

Dropped DRP Reason and Effectivity Date Learner With Dissability LWDTOTAL 27 28Accelarated ACL Date: Date:

Page 3: Prototype Forms for Implementation as of June 25

School Form 2 (SF2) Daily Attendance Report for learner(This cancel Form 1, Form 2 & STS Form 4 - Absenteeism and Dropout Profile)

School ID School Year Month Reporting

Name of School Grade Level Section

DATE (1st row for date, 2nd row for Day: M,T,W,TH,F)

ABSENT TARDY

MALE | TOTAL Per Day

*LEARNER'S NAME (Last Name, First Name, Middle Name)

Total for the Month REMARK/S (If DROPPED OUT, state reason,

please refer to legend number 2.If TRANSFERRED IN/OUT, write the name of

School.)

Page 4: Prototype Forms for Implementation as of June 25

DATE (1st row for date, 2nd row for Day: M,T,W,TH,F)

ABSENT TARDY

*LEARNER'S NAME (Last Name, First Name, Middle Name)

Total for the Month REMARK/S (If DROPPED OUT, state reason,

please refer to legend number 2.If TRANSFERRED IN/OUT, write the name of

School.)

FEMALE | DAILY TOTAL

Combined TOTAL PER DAY

Page 5: Prototype Forms for Implementation as of June 25

DATE (1st row for date, 2nd row for Day: M,T,W,TH,F)

ABSENT TARDY

*LEARNER'S NAME (Last Name, First Name, Middle Name)

Total for the Month REMARK/S (If DROPPED OUT, state reason,

please refer to legend number 2.If TRANSFERRED IN/OUT, write the name of

School.)

* Automatic Generation thru LIS

GUIDELINES: 1. CODES FOR CHECKING ATTENDANCE Month:

1. The attendance shall be accomplished daily. Refer to the codes for checking learners' attendance. M F TOTAL2. Dates shall be written in the preceding columns beside Learner's Name.

* Enrolment as of 3. To compute the following:

a. Percentage of Enrolment =Registered Learner as of End of the Month

x 1002. REASONS/CAUSES OF DROP-OUTS

Enrolment as of July a. Domestic-Related Factors

b. Average Daily Attendance = Total Daily Attendance a.1. Had to take care of siblings *Percentage of Enrolment as of Number of School Days a.2. Early marriage/pregnancy

c.Percentage of Attendance for the month =Average daily attendance

x 100a.3. Parents' attitude toward schooling

Registered Learner as of End of the month a.4. Family problemsAverage Daily Attendance

b. Individual-Related Factorsb.1. Illness

Percentage of Attendance for the month b.2. Overage

5. Attendance performance of learner is expected to reflect in Form 137 and Form 138 every grading period b.3. Death

* Beginning of School Year cut-off report is every 1st Friday of School Calendar Days b.4. Drug Abuseb.5. Poor academic performance

Drop outb.6. Lack of interest/Distractionsb.7. Hunger/Malnutrition

Transferred outc. School-Related Factorsc.1. Teacher Factor

Transferred inc.2. Physical condition of classroomc.3. Peer influenced. Geographic/Environmental I certify that this is a true and correct report.d.1. Distance between home and school

(Signature of Teacher over Printed Name)d.3. Calamities/Disasterse. Financial-Related Attested by:e.1. Child labor, work

School Form 2: Page 2 of ________ f. Others (Signature of School Head over Printed Name)

No. of Days of Classes:

Summary for the Month

blank- Present; (x)- Absent; Tardy (half shaded= Upper for Late Commer, Lower for Cutting Classes)

Registered Learner as of end of the month

4. Every End of the month, the teacher/adviser submit this form to the office of the principal for recording of summary table into the Form 3. Once signed by the principal, this form should be returned to the adviser.

Number of students with 5 consecutive days of absences:

d.2. Armed conflict (incl. Tribal wars & clan feuds)

Page 6: Prototype Forms for Implementation as of June 25

School Form 3 (SF3) Books Issued and Returned(This replace Form 1 & Inventory of Text Book)

School ID School Year

School Name Grade Level Section

NO.

Subject Area & Title Subject Area & Title Subject Area & Title Subject Area & Title Subject Area & Title Subject Area & Title Subject Area & Title Subject Area & Title Subject Area & Title

Date Date Date Date Date Date Date Date Date

Issued Returned Issued Returned Issued Returned Issued Returned Issued Returned Issued Returned Issued Returned Issued Returned Issued Returned

TOTAL FOR MALE | TOTAL COPIES

*LEARNER'S NAME (Last Name, First Name, Middle Name)

Page 7: Prototype Forms for Implementation as of June 25

NO.

Subject Area & Title Subject Area & Title Subject Area & Title Subject Area & Title Subject Area & Title Subject Area & Title Subject Area & Title Subject Area & Title Subject Area & Title

Date Date Date Date Date Date Date Date Date

Issued Returned Issued Returned Issued Returned Issued Returned Issued Returned Issued Returned Issued Returned Issued Returned Issued Returned

*LEARNER'S NAME (Last Name, First Name, Middle Name)

TOTAL FOR FEMALE | TOTAL COPIES

TOTAL LEARNERS | TOTAL COPIES

* Automatic Generation thru LISGUIDELINES: Prepared By:1. Title of Books Issued to each learner must be recorded by the class adviser.2. The Date of Issuance and the Date of Return shall be reflected in the form.3. The Total Number of Copies issued at BoSY shall be reflected in the form. (Signature over printed name)4. The Total Number of Copies of Books Returned at the EoSYshall be reflected in the form. School Form 3: Page 2 of ________

Page 8: Prototype Forms for Implementation as of June 25

Region: Division: District

School Form 4 (SF4) Monthly Learner's Movement and Attendance(This replace Form 3 & STS Form 4-Absenteeism and Dropout Profile)

Region Division District

School ID

School Name School Year Month Reporting

NAME OF ADVISER SECTION

ATTENDANCE DROPPED OUT TRANSFERRED OUT TRANSFERRED IN

Average Percentage (B) For the Month (B) For the Month (B) For the Month

M F T M F T M F T M F T M F T M F T M F T M F T M F T M F T M F T M F T

1 0 1 1 0 1

ELEMENTARY/SECONDARY:

KINDER

GRADE 1/GRADE 7

GRADE 2/GRADE 8

GRADE 3/GRADE 9

GRADE 4/GRADE 10

GRADE 5/GRADE 11

GRADE 6/GRADE 12

TOTAL FOR NON-GRADED

TOTAL

# Need home visitation as per DECS Service Manual (page, section) Prepared and Submitted by:GUIDELINES:

2. Furnish copy to Division Office: a week after July 31, October 30 & March 31 (Signature of School Head over Printed Name)3. Teachers who are handling advisory class shall be reported.

GRADE/ YEAR LEVEL

REGISTERED LEARNER (As of End of the

Month) (A) Cumulative as of Previous Month

(A+B) Cumulative as of End of the

Month(A) Cumulative as of Previous Month

(A+B) Cumulative as of End of the

Month(A) Cumulative as of Previous Month

(A+B) Cumulative as of

End of the Month

1. This forms shall be accomplished every end of the month using the summary box of Form 1 submitted by the teachers/advisers to update figures for the month. Columns for "Cumulative as of Previous Month" require the figures in "cumulative total reported from previous month".

4. Small school that has one section per grade/year level are not required to fill the columns "Name of Adviser, Grade/Year Level & Section". Instead, they will only accomplish the summary column per grade/year level.

Page 9: Prototype Forms for Implementation as of June 25

School Form 5 (SF 5) Report on Promotion & Level of Proficiency(This replace Forms 18-E1, 18-E2, 18A)

Region Division District

School ID School Year Curriculum

School Name Grade Level Section

LRN

as of End of the current SY

SUMMARY TABLE

MALE FEMALE TOTAL

PROMOTED

RETAINED

LEVEL OF PROFICIENCY

MALE FEMALE TOTAL

LEARNER'S NAME (Last Name, First Name, Middle Name)

GENERAL AVERAGE

(Numerical Value in 3 decimal

places)

ACTION TAKEN: PROMOTED or RETAINED

(RBEC only)

INCOMPLETE SUBJECT/S (This column is for K to 12 Curriculum and

remaining RBEC in High School. Elementary grades level that still implementing RBEC need not to fill up this column)

Completed as of end of current SY

BEGINNNING (B: 74% and

below)

DEVELOPING (D: 75%-79%)

APPROACHING PROFICIENCY

(AP: 80%-84%)

PROFICIENT (P: 85% -89%)

ADVANCED (A: 90% and

above)

Page 10: Prototype Forms for Implementation as of June 25

LRN

as of End of the current SY

LEARNER'S NAME (Last Name, First Name, Middle Name)

GENERAL AVERAGE

(Numerical Value in 3 decimal

places)

ACTION TAKEN: PROMOTED or RETAINED

(RBEC only)

INCOMPLETE SUBJECT/S (This column is for K to 12 Curriculum and

remaining RBEC in High School. Elementary grades level that still implementing RBEC need not to fill up this column)

Completed as of end of current SY

TOTAL MALE

PREPARED BY:

DANALYN V. SERVILLON

Class Adviser

(Name and Signature)

CERTIFIED CORRECT & SUBMITTED:

School Head

(Name and Signature)

GUIDELINES:

1. For All Grades Level

TOTAL FEMALE

COMBINED

* May generate thru Learner's Information System or may lift from Master List of Learners.School Form 5: Page 2 of ________

2. To be prepared by the Adviser. Final rating per subject area should be taken from the record of subject teacher. The class adviser should make the computation of General Average.

2. On the summary table, reflect the total number of learners promoted, retained and the level of proficiency according to the individual general average

3. Must tallied with the total enrollment report as of End of School Year GESP /GSSP (BEIS)

Page 11: Prototype Forms for Implementation as of June 25

School Form 6 (SF6) Summarized Report on Promotionand Level of Proficiency

(This cancel Form 20)

School ID Region Division

School Name District School Year

SUMMARY TABLEGRADE 1 / GRADE 7 GRADE 2 / GRADE 8 GRADE 3 / GRADE 9 GRADE 4 / GRADE 10 GRADE 5 / GRADE 11 GRADE 6 / GRADE 12 TOTAL

MALE FEMALE TOTAL MALE FEMALE TOTAL MALE FEMALE TOTAL MALE FEMALE TOTAL MALE FEMALE TOTAL MALE FEMALE TOTAL MALE FEMALE TOTAL

PROMOTED

RETAINED (RBEC)

LEVEL OF PROFICIENCY MALE FEMALE TOTAL MALE FEMALE TOTAL MALE FEMALE TOTAL MALE FEMALE TOTAL MALE FEMALE TOTAL MALE FEMALE TOTAL MALE FEMALE TOTAL

TOTAL

Prepared and Submitted by: Reviewed & Validated by: Noted by:SCHOOL HEAD DPO/EPS SCHOOLS DIVISION SUPERINTENDENT

GUIDELINES:1. After receiving and validating the Report for Promotion submitted by the class adviser, the School Head shall compute the Total for Grade Level in order to reflect the result in each data field.2. This report together with the copy of Report for Promotion submitted by the class adviser shall be forwarded to the Division Office by the end of the school year.3. The Report on Promotion per Grade Level is reflected in the End of School Year Report of GESP/GSSP

Nos. of BEGINNNING (B: 74% and below)

Nos. of DEVELOPING (D: 75%-79%)

Nos. of APPROACHING PROFICIENCY

(AP: 80%-84%)

Nos. of PROFICIENT (P: 85% -89%)

Nos. of ADVANCED (A: 90% and above)

Page 12: Prototype Forms for Implementation as of June 25

School Form 7 (SF7) School Personnel Assignment List and Basic Profile(This replace Form 12-Monthly Status Report for Teachers, Form 19-Assignment List,

Form 29-Teacher Program and Form 31-Summary Information of Teachers)

School ID Region DivisionSchool Name District School Year

(A) Nationally-Funded Teaching Related Items (B) Nationally-Funded Non Teaching Items (C ) Other Appointments

Fund SourceNumber of Incumbent

Teaching

KINDER 1

No. Sex

EDUCATIONAL QUALIFICATION * Daily Program (time duration)

Minor DAY From To

Title of Plantilla Position (as appeared in the appointment

document)Number of Incumbent

Title of Plantilla Position (as appeared in the appointment

document)Number of Incumbent

Nature of Appointment and Designation (Contractual, Substitute, Volunteer & others) Non-

TeachingLOCALLY FUNDED

Name of School Personnel (Arrange by

Position, Descending) Fund

SourcePosition/

DesignationNature of

Appointment

Subject Taught (include Grade & Section) &

Other Ancillary Assignment (Please

Specify)

Remark/s (For Detailed Items, Indicate name of school/office, For IP's -

Ethnicity)Degree / Post

GraduateMajor/

Specialization

Actual Teaching/ Service

Render

(Mins/Day)

Ave. Minutes per Day

Ave. Minutes per Day

Ave. Minutes per Day

Page 13: Prototype Forms for Implementation as of June 25

No. Sex

EDUCATIONAL QUALIFICATION * Daily Program (time duration)

Minor DAY From To

Name of School Personnel (Arrange by

Position, Descending) Fund

SourcePosition/

DesignationNature of

Appointment

Subject Taught (include Grade & Section) &

Other Ancillary Assignment (Please

Specify)

Remark/s (For Detailed Items, Indicate name of school/office, For IP's -

Ethnicity)Degree / Post

GraduateMajor/

Specialization

Actual Teaching/ Service

Render

(Mins/Day)

GUIDELINES: Submitted by:

(Signature of School Head over Printed Name)

3. * Daily Program Column is for teaching personnel only School Form 7, Page 2 of ________

Ave. Minutes per Day

Ave. Minutes per Day

Ave. Minutes per Day

Ave. Minutes per Day

Ave. Minutes per Day

Ave. Minutes per Day

1. This form shall be accomplished at the beginning of the school year by the school head. In case of movement of teachers and other personnel during SY, updated Form 19 must submit to the Division Office .

2. All school personnel, regardless of position/nature of appointment should be included in this form and should be listed from the highest rank down to the lowest. This form shall also serve as inventory list of school personnel.

Page 14: Prototype Forms for Implementation as of June 25

Republic of the PhilippinesDepartment of Education

Region: _____________________________Division : ____________________________School: _______________________________

LEARNER DATA SHEETPls. Check:( ) Transferee ( ) Balik-Aral( ) Private ( ) PublicName of Previous School: _________________________________________________________Division: ______________________________ Province/Region : ______________________________

Name of Learner: ______________________________________ LRN: __________________Date of Birth : _________________________________ Place of Birth : ____________________

SY House #/Street Barangay Municipality/ProvinceSYSYSYSYSY

Nationality: __________________________ Religion: ______________Name of Father: _______________________________ Occupation : ___________________Highest Educational Attainment of Father: ______________________________Name of Mother: _______________________________ Occupation : ______________________Highest Educational Attainment of Mother: ______________________________Name of Guardian (if Guardian is not the parent): ______________________________________Relationship to Guardian: ________________________________Contact Number of Parents/Guardian: _________________________________Currently living with at least one of the parents : ( ) yes ( ) noDialect use to communicate within the family: ______________________Recipient of 4P's* : Yes/ No SY SY

SY SYSY SY

b.1 Nutritional StatusSY_____ SY_____ SY_____ SY_____ SY_____ SY_____ SY_____

Nutritional Status(e.g.Normal,Below Normal,Above Normal,Severely Wasted)

SY_____ SY_____ SY_____ SY_____ SY_____ SY_____ SY_____( ) Pediculosis( ) Tinea Flava( ) Scabies( ) Eye infection( ) Squinting eyes *Order of ailments (eyes, ears, etc.)( ) Otitis Media( ) Impacted Cerumen( ) Colds/Cough( ) Sinusitis( ) Ringworm( ) Nosebleed( ) Decayed Tooth( ) defective speech( ) Sore Throat( ) Tonsilitis( ) Asthma( ) Allergy( ) Bronchitis( ) Primary Complex( ) Convulsions( ) Frequent headache( ) Heart problem( ) Frequent Stomach Ache

Other illness(specify):

A. PERSONAL DATA (to be accomplished by the parent/pupil during enrolment)

Sex: ___________ Current Address/Residence:

*Programang Pantawid ng Pamilyang Pilipino

B. MEDICAL / HEALTH RECORD (annual updating by the health officer/teacher)

Weight (kg)Height (m)Body Mass Index (BMI)

b.2 Learner's record of ailments: (pls. check) (to be examined by the nurse)

Page 15: Prototype Forms for Implementation as of June 25

b.3 ImmunizationLearner's immunization shots are complete and current: yes /no

SY SYSY_____ SY_____ SY_____ SY_____ SY_____ SY_____ SY_____

b.4.1. Muscular Fitness Partial: Curl Ups Trunk: Lift (cm) 90-Degrees push- ups b.4.2. Flexibility Fitness Sit and Reach Left leg bent (cm) Right leg bent (cm) Shoulder Flexibility *to be commented by PE Teachers Right arm up (cm) Left arm up (cm) b.4.3. Physiological Fitness 1km run - Time: (min/sec)b.5. Sports Talents b.5.1 Anthropometrics Sitting Height (cm) Arm Span (cm) b.5.2. Muscular Power Standing Long Jump (m) Basketball Pass (m) b.5.3 Speed 40-meter sprint (sec.)

C. FAMILY& COMMUNITY PROFILE

Type of community ( ) Residential ( ) Commercial ( )Agricultural ( ) Industrial ( ) Fishing ( ) Mining Disaster Prone/ Armmed Conflict ( ) Yes ( ) NoIdentified as IP Community? If yes, specify: _____________________________________________With electrical services (Home) ( ) Yes ( ) NoWith water services (Home) ( ) Yes ( ) NoDistance of Home from/to school: ___________ (km) Estimated time in going to school : ______ (hour)

D. EDUCATIONAL PROFILE (see attached Form 137)

GUIDELINE:

b.4 Physical Fitness and Sports Talent Test (PFSTT)

Means of going to school: ( ) walking ( ) by boat ( ) vehicles

The Learner Data Sheet shall be accomplish by the parent/pupil during enrolment. While, the medical/health record shall be accomplish by the health officer/clinic teacher at the beginning of every school year. (July?)