Republic of the Philippines

DEPARTMENT OF EDUCATION
National Capital Region
Schools Division Office VALENZUELA
PASOLO ELEMENTARY SCHOOL
Pasolo Road Valenzuela City

REFERRAL SLIP
______________
Date
To the Guidance Counselor,
Please interview ______________________________Grade_____ Section____________.
Chief reason/s for interview___________________________________________________.
Interview requested by:
__________________________

Republic of the Philippines

DEPARTMENT OF EDUCATION
National Capital Region
Schools Division Office VALENZUELA
PASOLO ELEMENTARY SCHOOL
Pasolo Road Valenzuela City

RETURN SLIP
_______________
Date
____________________________,
Interview with _____________________________ will be on ________________________ at
__________________.Please send the above child to the Guidance Center on time.

_______________________
School Guidance Counselor