Republika ng Pilipinas Copy of this record sent to

(Republic of the Philippines) Principal of __________________________

Department of Education ______________________________________
Kagarawan ng Edukasyon _______________________________________
KAWANIHAN NG EDUKASYONG ELEMENTARYA Principal
(Bureau of Elementary Education)
Rehiyon I
(Region I)
Division of PANGASINAN II
ROSALES DISTRICT I
(District)
TOMANA ELEMENTARY SCHOOL SPED CENTER
(Paaralan/School)

PALAGIANG TALAAN SA MABABANG PAARALAN

(ELEMENTARY SCHOOL PERMANENT RECORD)
Name: __________________________________________ Gender: ____________ LRN: ____________________
Date of Birth: Year: _________________________ Place of Birth: __________________________________________
Address: ___________________________________________________ Contact No.: ______________________________
Father: __________________________________________ Mother: ___________________________________________
ELEMENTARY SCHOOL PROGRESS
Learners with Special Educational Needs (Self-Contained Class)
Grade/Level __ School ___________________________________________
Grade/Level __ School ___________________________________________
School Year _____________________ School Year _______________________
Periodic Rating FINAL Periodic Rating FINAL
LEARNING DOMAINS REMARKS LEARNING DOMAINS REMARKS
1 2 3 4 RATING 1 2 3 4 RATING
Socio-Emotional Socio-Emotional
Behavioral Behavioral
Language Language
Psychomotor Psychomotor
Daily Living Skills Daily Living Skills
Cognitive Cognitive
Aesthetic & Creative Aesthetic & Creative
Oreintation & Mobility Oreintation & Mobility

Eligible for Admission to Grade/Level __________________ Eligible for Admission to Grade/Level __________________

Grade/Level __ School ___________________________________________

Grade/Level __ School ___________________________________________
School Year ______________________ School Year _______________________
Periodic Rating FINAL Periodic Rating FINAL
LEARNING DOMAINS REMARKS LEARNING DOMAINS REMARKS
1 2 3 4 RATING 1 2 3 4 RATING
Socio-Emotional Socio-Emotional
Behavioral Behavioral
Language Language
Psychomotor Psychomotor
Daily Living Skills Daily Living Skills
Cognitive Cognitive
Aesthetic & Creative Aesthetic & Creative
Oreintation & Mobility Oreintation & Mobility

Eligible for Admission to Grade/Level __________________ Eligible for Admission to Grade/Level __________________

Grade/Level __ School ___________________________________________

Grade/Level __ School ___________________________________________
School Year _______________________ School Year _______________________
Periodic Rating FINAL Periodic Rating FINAL
LEARNING DOMAINS REMARKS LEARNING DOMAINS REMARKS
1 2 3 4 RATING 1 2 3 4 RATING
Socio-Emotional AP AP AP Socio-Emotional
Behavioral P P P Behavioral
Language AP AP AP Language
Psychomotor P P P Psychomotor
Daily Living Skills P P P Daily Living Skills
Cognitive P P P Cognitive
Aesthetic & Creative P P P Aesthetic & Creative
Oreintation & Mobility P P P Oreintation & Mobility

Eligible for Admission to Grade/Level __________________ Eligible for Admission to Grade/Level __________________

Legend:
Beginning (B) 74% and below
Developing (D) 75-79%
Approaching Proficiency (AP) 80-84%
Proficient (P) 85-89%
Advance (A) 90% and above