Republic of the Philippines

Department of Education
Bureau of Secondary Education
Region 1
DIVISION OF PANGASINAN II
Binalonan
SENIOR HIGH SCHOOL STUDENT PERMANENT RECORD

LEARNER'S INFORMATION
LAST NAME:_____________________________ FIRST NAME:_______________________________________ MIDDLE NAME:________
LRN:_________________________________ DATE OF BIRTH(MM/DD/YYYY)________________ SEX:____________ DATE OF ADMISSIO
ELIGIBILITY FOR SHS ENROLMENT
___ High School Completer* Gen. Ave:________ ____Junior Completer Gen. Ave.________ Date of Graduation/Completion_
Name of School:__________________________________________________ School Address:_________________________________
_____ PEPT Passer** Rating:___________ _____ ALS A&E Passer*** Rating_________ ____Others( Pls. Specify):______
Date of Examination/Assessment(MM/DD/YYYY)_____________________ Name and Adress of Community Learning Center__________
*High School Completers are students who graduated from the secondary school under the old curriculum ***ALS A&E-Alternative Learning System Accreditation and Equivalency tes
**PEPT-Philippine Educational Placement Test for JHS
SCHOLASTIC RECORD
SCHOOL:______________________________________
Indicate if SCHOOL ID:_______________ GRADE LEVEL:___________ S.Y. ___________ S
Subject is
TRACT/STRAND:______________________________________________________________
CORE, SECTION:___________________________
APPLIED,
OR QUARTER
SPECIALIZE
SUBJECTS
D

General Ave. for the Semester

REMARKS:______________________________________________________________________________________________________
Prepared by: Certified True and Correct Date Checked:(MM/DD/YYY
___________________________ _______________________________________ _______________________
Signiture of Adviser over Printed Name Signiture of Authorized Person over Printed Name, Designation
Indicate CLASSES
REMEDIAL if Conducted from( MM/DD/YYYY):__________ to (MM/DD/YYYY):_________ SCHOOL:_______________________________________ SCHOOL
Subject is
CORE,
APPLIED, OR SUBJECTS SEM FINAL
SPECIALIZED GRADE

Name of Teacher/Adviser:________________________________________________________________ Signiture:_________________

SCHOOL:______________________________________ SCHOOL ID:_______________ GRADE LEVEL:___________ S.Y. ___________ S
TRACT/STRAND:______________________________________________________________ SECTION:___________________________
APPLIED,
OR QUARTER
SPECIALIZE SUBJECTS
D

General Ave. for the Semester

REMARKS:______________________________________________________________________________________________________
Prepared by: Certified True and Correct Date Checked:(MM/DD/YYY
___________________________ _______________________________________ _______________________
Signiture of Adviser over Printed Name Signiture of Authorized Person over Printed Name, Designation
REMEDIAL CLASSES Conducted from( MM/DD/YYYY):__________ to (MM/DD/YYYY):_________ SCHOOL:_______________________________________ SCHOOL
Subject is
CORE,
APPLIED, OR SUBJECTS SEM FINAL
SPECIALIZED GRADE

Name of Teacher/Adviser:________________________________________________________________ Signiture:_________________

SCHOOL:______________________________________ SCHOOL ID:_______________ GRADE LEVEL:___________ S.Y. ___________ S
TRACT/STRAND:______________________________________________________________ SECTION:___________________________
APPLIED,
OR QUARTER
SPECIALIZE SUBJECTS
D

General Ave. for the Semester

REMARKS:______________________________________________________________________________________________________
Prepared by: Certified True and Correct Date Checked:(MM/DD/YYY
___________________________ _______________________________________ _______________________
Signiture of Adviser over Printed Name Signiture of Authorized Person over Printed Name, Designation
REMEDIAL CLASSES Conducted from( MM/DD/YYYY):__________ to (MM/DD/YYYY):_________ SCHOOL:_______________________________________ SCHOOL
Subject is
CORE,
APPLIED, OR SUBJECTS SEM FINAL
SPECIALIZED GRADE

Name of Teacher/Adviser:________________________________________________________________ Signiture:_________________

SCHOOL:______________________________________ SCHOOL ID:_______________ GRADE LEVEL:___________ S.Y. ___________ S

TRACT/STRAND:______________________________________________________________ SECTION:___________________________
APPLIED,
OR QUARTER
SPECIALIZE SUBJECTS
D

General Ave. for the Semester

REMARKS:______________________________________________________________________________________________________
Prepared by: Certified True and Correct Date Checked:(MM/DD/YYY
___________________________ _______________________________________ _______________________
Signiture of Adviser over Printed Name Signiture of Authorized Person over Printed Name, Designation
REMEDIAL CLASSES Conducted from( MM/DD/YYYY):__________ to (MM/DD/YYYY):_________ SCHOOL:_______________________________________ SCHOOL
Subject is
CORE,
APPLIED, OR SUBJECTS SEM FINAL
SPECIALIZED GRADE

Name of Teacher/Adviser:________________________________________________________________ Signiture:_________________

Tract/Strand Accomplished:___________________________________________________________________________ SHS General Av

Awards/Honors Received:___________________________________________________________ Date of SHS Graduation ( MM/DD/YY
Certified By: Place School Seal Here:
___________________________________________ _________________
Signiture of School Head over Printed Name Date
Note:
This permanent record or a photocopy of this permanent record that bears the seal of the school and the original
signiture in ink of the School Head shall be considered valid for all legal purposes. Any erasures or alteration
made on this copy should be validated by the School Head. If the student transfers to another school,
the originating school should produce one(1) certified true copy of this permanent record for safe keeping.
The receiving school shall continue filling up the original form. Upon graduation, the school from the student
graduated should keep the original form and produce one (1) certified copy of the Division Office.
REMARKS: (Please indicate the purpose for which this permanent record will be used.)

Date Issued (MM/DD/YYYY)

___________________
ADMISSION:__________

mpletion____________
_______________________
y):_________________
____________________
uivalency test for JHS

______ SEM:________
_________________________
SEM. FINAL ACTION
GRADE TAKEN

___________________
M/DD/YYYY)
__________________

___ SCHOOL ID:__________

SEM. FINAL ACTION
GRADE TAKEN

______________________
______ SEM:________
_________________________
SEM. FINAL ACTION
GRADE TAKEN

___________________
M/DD/YYYY)
__________________

___ SCHOOL ID:__________

SEM. FINAL ACTION
GRADE TAKEN

__________________
 ______ SEM:________
_________________________
SEM. FINAL ACTION
GRADE TAKEN

___________________
M/DD/YYYY)
__________________

___ SCHOOL ID:__________

SEM. FINAL ACTION
GRADE TAKEN

______________________

______ SEM:________
_________________________
SEM. FINAL ACTION
GRADE TAKEN

___________________
M/DD/YYYY)
__________________

___ SCHOOL ID:__________

SEM. FINAL ACTION
GRADE TAKEN

______________________

eneral Average:______
M/DD/YYYY):________