DepEd Form 137-A
Republic of the Philippines
DEPARTMENT OF EDUCATION
Region II
School
Municipality
SECONDARY STUDENT’S PERMANENT RECORD
Date of Birth: Year Month Day Sex
(Surname) (Given Name)
Place of Birth: Province Town Barrio
Parent of Guardian:
(Name) (Address) (Occupation)
Elementary course completed School Year Gen. Ave.
RECORD OF STANDARD INTELLIGENCE AND ACHIEVEMENT TEST
Name and Form of Test Score Percentile Name & From of Test Score Percentile
Received Rank Received Rank
School Year Section
Total number of years in school to date School Year 20 - 20
PERIODICAL RATING Extra-
Final Action Units
SUBJECT Averaging/Cumulative curricular
1 2 3 4 Rating Taken Earned
Activities
June July Aug Sept Oct Nov Dec Jan Feb Mar April May TOTAL
Days of School
Days Present
Has Advance Units in
Lacks Units in
To be Classified as Total number of years in School to date
(Cur. Year)
School School Year 20 - 20 Section
PERIODICAL RATING Extra-
Final Action Units
SUBJECT Averaging/Cumulative curricular
1 2 3 4 Rating Taken Earned
Activities
June July Aug Sept Oct Nov Dec Jan Feb Mar April May TOTAL
Days of School
Days Present
Has Advance Units in
Lacks Units in
To be Classified as Total number of years in School to date
(Cur. Year)
NAME
(Surname) (First Name)
School School Year 20 - 20 Section
PERIODICAL RATING Extra-
Final Action Units
SUBJECT Averaging/Cumulative curricular
1 2 3 4 Rating Taken Earned
Activities
June July Aug Sept Oct Nov Dec Jan Feb Mar April May TOTAL
Days of School
Days Present
Has Advance Units in
Lacks Units in
To be Classified as Total number of years in School to date
(Cur. Year)
School School Year 20 - 20 Section
PERIODICAL RATING Extra-
Final Action Units
SUBJECT Averaging/Cumulative curricular
1 2 3 4 Rating Taken Earned
Activities
June July Aug Sept Oct Nov Dec Jan Feb Mar April May TOTAL
Days of School
Days Present
Has Advance Units in
Lacks Units in
To be Classified as Total number of years in School to date
(Cur. Year)
C E R T I F I C A T E O F T R A N S F E R
To Whom It May Concern:
I certify that thus us a true record of , this student is eligible, on this
day of , 20 , for admission to the year as a
regular/an Irregular and had no money or property responsibility in this school.
Remarks
(Principal)
Copy of this record sent to principal of school
on , 20 .
(Principal)