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School Form 1 School Register for Seni

School Name SJCDC School ID 402358 District Dasmariña


Semester 1st School Year 2019-2020 Grade Level
Section 1 Course (For TVL Only)

COMPLETE ADDRESS

Sex (M/F)
NAME BIRTHDAT Religious
LRN (Last Name, First Name, Name E AGE
Extension, Middle Name) Affiliation House No./ Municipality/
(mm/dd/yyyy) Street/ Sitio/ Barangay Province
Purok City
Cenaon, Clyde Ethelkurt, 40 Lot
Blk 443 Lot
### M 01/14/2003 16 Catholic Salawag Dasmariñas Cavite
Balaoro 23 Ph.6
17& 18
Iglesia Ni Pasong
### Cuasay, Walden, Navarro M 03/14/2002 17 Ph.2 Topaz Imus Cavite
Cristo Buaya 2
Genova, Kurt Christian, St. Felizana
### M 5/7/2002 16 Catholic Blk 27 Lot
Subd. Paliparan II Dasmariñas Cavite
Bernardo
34 Viva
### Gutual, Jerick, Legaspina M 05/31/2002 17 Catholic Salawag Dasmariñas Cavite
Homes
### Paller, Anthony, Cose M Subdivision
Pajaron, John Lee Victor, Iglesia Ni Blk 11 lot
6 M 01/30/2002 17 Blk 4 Lot Golden City Dasmariñas Cavite
Buenafe Cristo 19
32
### Pomida, Prince Romeo, Padullon M 08/15/2002 16 Catholic Molino IV Bacoor Cavite
Summerhill
Blk 10 Lot
### Robles, Russel Neal, Casisid M 07/16/2003 15 Catholic s
3 Ph. 4
P1 Mary Molino IIV Bacoor Cavite
Blk 10 Lot
Homes
### Robles, Restie, Casidsid M 07/13/2002 16 Catholic Blk 4 Lot
3 P1 Mary Molino IV Bacoor Cavite
30 P2
Homes
### Samin, John Allen Keir M 6/3/2002 17 Catholic Garnet St. Molino IV Bacoor Cavite
Maryhomes
10 <===TOTAL MALE Subd.

10818508009 Anonat, Ma. Cristina, Gaviola F


### Artigas, Jhamaila Kim F
Barcenas, Jessa Marie,
### F
Basquinas
### Bartolay, Camelle, Dominguez F
### Bengala, Samantha, Basijan F
### Bibat, Kaizen Nicole, San Jose F
### Bondoc, Reina Flor, Panguelo F
### Clabiron, Kyla F
Delos Santos, Althea Joyce,
### F
Bernabe
Diaz, Princess, Espiritu F
### Elacion, Rei Jenel, Aber F
### Flores, Sheriza Anne, Bentolero F
### Flores, Liezel Ann, Bondoc F
### Foronda, Mariela, Buabe F
### Gamayo, Hanna Mae, Domingo F
10791213011 Go, Jasmine Nicole, Porque F
### Hermanos, Andrea, Yu F
### Herrera, Joana Mae, Ablay F
### Jainga, Aurhea Faye, Quizan F
Lacaba, Joana Berlin, Quizan
### Leona, Andrea, Tumanday F
### Lomeda, Melinda, Tadeo F
### Maristela, Meryll Mae F
### Mateo, Erna, Honrubia F
### Monzon, Eddilyn, Tagat F
### Navales, Edlyn, Bocal F
### Nazareta, Ma. Maica, Gaoat F
### Ocampo, Jan Marie F
Omaging, Aiza, Dataro F
### Ortinez, Joelyn, Miranda F
### Oser, Van Richelle, Bulaquina F

SFRT 2017
for Senior High School (SF1-SHS)
Dasmariñas Division Region IV-A
11 Track and Strand ABM

PARENTS GUARDIAN
(if learner is not Living with Parent) Contact REMARKS
Mother's Maiden Number of
Name (Please refer to the legend)
Father's Name Name (Last Name, First Name, Parent/
(Last Name, First Name, Name (Last Name, First Name, Relationship
Extension, Middle Name) Name Extension, Middle
Name Extension, Middle Guardian
Name)
Cenaon, Ausencio Jr. Name) Del
Palaoro, Nancy
9236080838
Valencia Valle
Cuasay, Walter, Cortez Navarro, Cecil, Aganon 9997474458

Genova, Roberto Jr. 9154704650

Gutual, Rudy Gorgonio 9153248571

Pajaron, Jovencio Adelina, Puno, Buenafe 9952060922


Pomida, Romeo Padullon, Ma. Isabel 9079175176
Robles, Restie Casidsid, Eva 9277477445
Robles, Restie Casidsid, Eva 9277477445
Gales, Johnny. Gaitano 9052640200

SFRT 2017
SFRT 2017
COMPLETE ADDRESS

Sex (M/F)
NAME BIRTHDAT Religious
LRN (Last Name, First Name, Name E AGE
Extension, Middle Name) Affiliation House No./ Municipality/
(mm/dd/yyyy) Street/ Sitio/ Barangay Province
Purok City
### Osumo, Norilene, Celorico F
### Papauran, Marian, Empon F
97912080463 Parona, Jecell F
### Paulmino, Odeyza F
35 <==TOTAL FEMALE

45 <=== COMBINED

Legend: List and Code of Indicators under REMARKS column


Beginning of the
Indicator Code Required Information Indicator Code Required Information REGISTERED
Semester
Transferred T/O CCT Recipient CCT CCT Control/reference
Out number & Effectivity Date MALE 10
Balik Aral B/A Name of school last
Transferred attended & Year
In T/I
Name of School, Date of 1st Learner With LWE
Specify Exceptionality of the
Attendance and Date of Last Exceptionality Learner FEMALE 35
Specify Level & Effectivity
Attendance if Transferred Out Accelerated ACL Date

TOTAL 45

SFRT 2017
PARENTS GUARDIAN
(if learner is not Living with Parent) Contact REMARKS
Mother's Maiden Number of
Name (Please refer to the legend)
Father's Name Name (Last Name, First Name, Parent/
(Last Name, First Name, Name (Last Name, First Name, Relationship
Extension, Middle Name) Name Extension, Middle
Name Extension, Middle Guardian
Name)
Name)

Prepared By:
End of the Semester

MARGIELYN AGUILANDO
Signature of Adviser over Printed Name

Beginning of the Semester Date: End of the Semester Date:

SFRT 2017
SFRT 2017
School Form 2 Daily Attendance Report of Learners for Senio
School Name School ID District

Semester School Year Grade Level

Section Course/s (only for TVL)


DATE
NAME
No. (Last Name, First Name, Name Extension, Middle
Name) M T W TH F S M T W TH F S M T W TH F S M T W TH F S M T
1

10

11

12

13

14

15

16

17

<=== MALE | TOTAL Per Day ===>

10

11

12

13
Senior High School (SF2-SHS)
Division Region

Track and Strand


Month of

Total for the Month REMARKS


1. If No Longer in School (NLS), state reason, please refer to legend number. 2. If
TRANSFERRED IN/OUT, write the name of School. 3. If SHIFTING IN/OUT, write the name of
Track/Strand/Program).
W TH F S ABSENT TARDY
DATE
NAME
No. (Last Name, First Name, Name Extension, Middle
Name) M T W TH F S M T W TH F S M T W TH F S M T W TH F S M T
14

15

16

17

18

19

20

21

22

23

24

25

26

27

<=== FEMALE | TOTAL Per Day ===>

Combined TOTAL Per Day

GUIDELINES: 1. CODES FOR CHECKING ATTENDANCE


1. The attendance shall be accomplished daily. Refer to the codes for checking learners' attendance (blank) - Present; (x) - Absent; Tardy (half shaded = U
2. To compute the following: for Late Comer, Lower for Cutting Classes)

2. REASONS/CAUSES FOR NO LONGER I


a. Percentage of Enrolment = x 100 SCHOOL (NLS)
Registered Learners as of end of the month
Enrolment as of 1st Friday of the school year
a. Domestic-Related Factors
a.1. Had to take care of siblings
Total Daily Attendance a.2. Early marriage/pregnancy
b. Average Daily Attendance =
Number of School Days in reporting month a.3. Parents' attitude toward schooling
a.4. Family problems

Average daily attendance


c. Percentage of Attendance for the month = x 100
Registered Learners as of end of the month
b. Individual-Related Factors
3. Every end of the month, the Class Adviser will submit this form to the Office of the Principal for recording of summary table into School Form 4. Once b.1. Illness
signed by the School Head, this form should be returned to the Class Adviser. b.2. Overage
b.4. Drug Abuse
4. The Class Adviser will provide neccessary interventions including but not limited to home visitation to learner/s who were absent for 5 consecutive
b.5. Poor Academic Performance
days and/or those at risk of dropping out. b.6. Lack of Interest/Distractions
5. Attendance performance of learners will be reflected in the SF9-SHS of every grading period. b.7. Hunger/Malnutrition

c. School-Related Factors
c.1. Teacher Factor
c.2. Physical Condition of Classroom
c.3. Peer Influence

d. Geographic/Environmental
d.1. Distance between home and school
d.2. Armed conflict (incl. tribal wars & clan feuds)
d.3. Calamities/Disasters

e. Financial-Related
e.1. Child labor, work
Total for the Month REMARKS
1. If No Longer in School (NLS), state reason, please refer to legend number. 2. If
TRANSFERRED IN/OUT, write the name of School. 3. If SHIFTING IN/OUT, write the name of
Track/Strand/Program).
W TH F S ABSENT TARDY

No. of Days of Classes:


ENDANCE Month: Summary
f shaded = Upper
M F TOTAL
g Classes)
* Enrolment (as of 1st Friday of the semester)

LONGER IN Late Enrolment during the month (beyond cut-off)

Registered Learners as of end of the month

Percentage of Enrolment as of end of the month

Average Daily Attendance

Percentage of Attendance for the month

Number of students absent for 5 consecutive days

No Longer in School (NLS)

Transferred Out

Transferred In

Shifting Out

Shifting In

I certify that this report is true and correct:

feuds)
Signature of Class Adviser over Printed Name

Attested By:
DATE
NAME
No. (Last Name, First Name, Name Extension, Middle
Name) M T W TH F S M T W TH F S M T W TH F S M T W TH F S M T
f. Others (Specify)
a. Death
b. Transferred to School Abroad
c. Transferred to International School
d. Transferred to ALS
Total for the Month REMARKS
1. If No Longer in School (NLS), state reason, please refer to legend number. 2. If
TRANSFERRED IN/OUT, write the name of School. 3. If SHIFTING IN/OUT, write the name of
Track/Strand/Program).
W TH F S ABSENT TARDY
Signature of School Head over Printed Name
School Form 3 Books Issued and Returned for Senior High School (SF3-S
School Name School ID District Division

Semester School Year Grade Level Track and Strand

Section Course/s (only for TVL)

Book / ModuleTitle Book / ModuleTitle Book / ModuleTitle Book / ModuleTitle Book / ModuleTitle Book / ModuleTitle Book / ModuleTitle Book / ModuleTitle Book / ModuleTitle

NAME
No. (Last Name, First Name, Name Extension,
Middle Name) Date (mm/dd/yy) Date (mm/dd/yy) Date (mm/dd/yy) Date (mm/dd/yy) Date (mm/dd/yy) Date (mm/dd/yy) Date (mm/dd/yy) Date (mm/dd/yy) Date (mm/dd/yy)
Issued Returned Issued Returned Issued Returned Issued Returned Issued Returned Issued Returned Issued Returned Issued Returned Issued

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
TOTAL MALE ===>
1
2
3
4
5
6
7
8
9
10
SF3-SHS)
Division Region

d Strand

Book / ModuleTitle Book / ModuleTitle

REMARKS/ACTION TAKEN
(Please refer to the codes below)
Date (mm/dd/yy) Date (mm/dd/yy)
Returned Issued Returned
Book / ModuleTitle Book / ModuleTitle Book / ModuleTitle Book / ModuleTitle Book / ModuleTitle Book / ModuleTitle Book / ModuleTitle Book / ModuleTitle Book / ModuleTitle

NAME
No. (Last Name, First Name, Name Extension,
Middle Name) Date (mm/dd/yy) Date (mm/dd/yy) Date (mm/dd/yy) Date (mm/dd/yy) Date (mm/dd/yy) Date (mm/dd/yy) Date (mm/dd/yy) Date (mm/dd/yy) Date (mm/dd/yy)
Issued Returned Issued Returned Issued Returned Issued Returned Issued Returned Issued Returned Issued Returned Issued Returned Issued

11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
TOTAL FEMALE ===>
COMBINED ===>

GUIDELINES: In case of lost/unreturned books, please provide information with the following code:
Prepared By:
1. Title of Books Issued to each learner must be recorded by the Class Adviser. A. In Column Date Returned, codes are: FM=Force Majeure, TDO: Transferred/Dropout, NEG=Negligence
2. The Date of Issuance and the Date of Return shall be reflected in the form. B. In Column Remark/Action Taken, codes are: LLTR=Secured Letter from Learner duly signed by parent/guardian (for code
3. The Total Number of Copies issued shall be reflected in the form. FM), TLTR=Teacher prepared letter/report duly noted by School Head for submission to School Property Custodian (for
4. The Total Number of Copies of Books Returned shall be reflected in the form. code TDO), PTL=Paid by the Learner (for code NEG). References: DO No.23, s.2001, DO No.25, s.2003, DO No.14,
5. All textbooks being used must be included. Additional copies of this form may be used if needed.
s.2012.
Signature of C
Book / ModuleTitle Book / ModuleTitle

REMARKS/ACTION TAKEN
(Please refer to the codes below)
Date (mm/dd/yy) Date (mm/dd/yy)
Returned Issued Returned

ignature of Class Adviser over Printed Name


School Form 4 Monthly Learners' Movement and Attendanc

School Name District Division

School ID Semester School Ye

ATTENDANCE DROPPED OUT TRANSFERRED OUT

REGISTERED
LEARNERS (A) (A+B) (A) (A+B)
(As of End Cumulative Cumulative Cumulative Cumulative
TRACK STRAND Daily % for the
Number as
(B) Total for
Number as of Number as
(B) Total for
Number as
of the Month) Average Month the Month the Month
of Previous End of the of Previous of End of
Month Month Month 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

TOTAL FOR GRADE 11

TOTAL FOR GRADE 12


GRAND TOTAL
Prepared and Submitted By:

Signature of Sc
ance for Senior High School (SF4-SHS)

Region

hool Year For the Month of

TRANSFERRED IN SHIFTED OUT SHIFTED IN

(A) (A+B) (A) (A+B) (A) (A+B)


Cumulative Cumulative Cumulative Cumulative Cumulative Cumulative
(B) Total for (B) Total for (B) Total for
Number as Number as of Number as Number as of Number as Number as
the Month the Month the Month
of Previous End of the of Previous End of the of Previous of End of the
Month Month Month Month Month 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
re of School Head over Printed Name
School Form 5A End of Semester and School Year Status of Learn

School Name School ID

Semester School Year

Track and Strand

BACK SUBJECT/S
LEARNER'S NAME
No. LRN List down subjects where learner obtained a rating
(Last Name, First Name, Name Extension, Middle Name)
below 75%)

MALE
BACK SUBJECT/S
LEARNER'S NAME
No. LRN List down subjects where learner obtained a rating
(Last Name, First Name, Name Extension, Middle Name)
below 75%)

FEMALE

GUIDELINES:

This form shall be accomplished after each semester in a school year, leaving the End of School Year Status Column and Summary Table for End of
data elements shall be filled up only after the 2nd semester or at the end of the School Year.

INDICATORS:
End of Semester Status
Complete - number of learners who completed/satisfied the requirements in all subject areas (with grade of at least 75%)
Incomplete - number of learners who did not meet expectations in one or more subject areas, regardless of number of subjects failed (with
Note: Do not include learners who are No Longer in School (NLS)

End of School Year Status


Regular - number of learners who completed/satisfied requirements in all subject areas both in the 1st and 2nd semester
Irregular - number of learners who were not able to satisfy/complete requirements in one or both semesters
earners for Senior High School (SF5A-SHS)

District Division Region

Grade Level Section


Course/s (only for TVL)

END OF
END OF SCHOOL
SEMESTER
YEAR STATUS
STATUS (Regular/ Irregular)
(Complete/ Incomplete)

SUMMARY TABLE 1ST SEM

STATUS MALE FEMALE TOTAL


COMPLETE

INCOMPLETE

TOTAL

SUMMARY TABLE 2ND SEM

STATUS MALE FEMALE TOTAL

COMPLETE

INCOMPLETE

TOTAL

SUMMARY TABLE (End of the School Year Only)

STATUS MALE FEMALE TOTAL

REGULAR

IRREGULAR

TOTAL
END OF
END OF SCHOOL
SEMESTER
YEAR STATUS
STATUS (Regular/ Irregular)
(Complete/ Incomplete)

Prepared By:

Signature of Class Adviser over Printed Name

Certified Correct By:

Signature of School Head over Printed Name

Reviewed By:

Signature of Division Representative over Printed Name

End of School Year Status blank/unfilled at the end of the 1st Semester. These

ed (with grade less than 75%)


School Form 5B List of Learners with Complete SHS Requirements (SF5B-SHS)
School Name School ID District Division Region
Semester School Year Section
Track and Strand Course/s (only for TVL)

Completed SHS
in 2 SYs? (Y/N)
National
LEARNER'S FULL NAME Certification
No. LRN
(Last Name, First Name, Name Extension, Middle Name) Level Attained
(only if applicable)

MALE

SUMMARY TABLE A
STATUS MALE FEMALE TOTAL

Learners who
completed SHS
Program within 2
SYs or 4
semesters

Learners who
completed SHS
Program in more
than 2 SYs or 4
semesters

TOTAL

SUMMARY TABLE B
STATUS MALE FEMALE TOTAL
NC III
NC II
NC I
TOTAL

Note: NCs are recorded here for documentation but is not a requirement for
graduation.
Completed SHS
in 2 SYs? (Y/N)
National
LEARNER'S FULL NAME Certification
No. LRN
(Last Name, First Name, Name Extension, Middle Name) Level Attained
(only if applicable)
Note: NCs are recorded here for documentation but is not a requirement for
graduation.

GUIDELINES:
1. This form should be accomplished by the Class Adviser at End of School
Year.
2. It should be compiled and checked by the School Head and
passed to the Division Office before graduation.

FEMALE
Reviewed By:

Signature of Class Adviser over Printed Name

Certified Correct & Submitted By:

Signature of School Head over Printed Name

Reviewed By:

Signature of Division Representative over Printed Name


Completed SHS
in 2 SYs? (Y/N)
National
LEARNER'S FULL NAME Certification
No. LRN
(Last Name, First Name, Name Extension, Middle Name) Level Attained
(only if applicable)
School Form 6 Summarized Report of Learner Status as of End of Semester and Scho

School Name School ID District

Semester School Year

END OF SEMESTER STATUS

GRADE LEVEL
COMPLETE INCOMPLETE TOTAL

MALE FEMALE TOTAL MALE FEMALE TOTAL MALE FEMALE TOTAL

GRADE 11
TRACK/STRAND/COURSE

SUB TOTAL
GRADE 12
TRACK/STRAND/COURSE

SUB TOTAL
TOTAL

Prepared and Submitted By: Reviewed & Validated By:


Signature of School Head over Printed Name Signature of Division Representative o
GUIDELINES:
1. After receiving and validating the report on Status of Learners submitted by the Class Adviser, the School Head shall comput
2. This report shall be forwarded to the Division Office by the end of the semester.
3. Column for End of School Year shall be accomplished at the end of SY or every after the 2nd semester
4. Protocols of validation & submission are under the discretion of the Schools Division Superintendent.
and School Year for Senior High School (SF6-SHS)

Division Region

END OF SCHOOL YEAR


(Fill up only at the end of the second semester.)

REGULAR IRREGULAR TOTAL

MALE FEMALE TOTAL MALE FEMALE TOTAL MALE FEMALE TOTAL

Noted By:
presentative over Printed Name Signature of Division Superintendent over Printed Name
shall compute the grade level total per track/strand/course and school total.
School Form 7 School Personnel Basic Profile and Assign
School Name School ID District
Semester School Year
(A) Nationally-Funded Teaching & Teaching Related Items (B) Nationally-Funded Non-Teaching Items

Title of Design
Title of Plantilla Position Title of Plantilla Position
Number of Number of (as
(as it appears in the appointment (as it appears in the appointment
Incumbent Incumbent Teacher, Clerk
document/PSIPOP) document/PSIPOP)

EDUCATIONAL QUALIFICATION
Nature of
Employee Appointment/
No. (or Tax Name of School Personnel Fund Position/
Employment
Major/
Identification (Arrange by Sex Status
Source Designation Degree/ Specialization/
Number Position, Descending) (Regular/ Minor
-T.I.N.) Probationary/ Postgraduate Specialized
Part Time) Training Attended
EDUCATIONAL QUALIFICATION
Nature of
Employee Appointment/
No. (or Tax Name of School Personnel Fund Position/
Employment
Major/
Identification (Arrange by Sex Status
Source Designation Degree/ Specialization/
Number Position, Descending) (Regular/ Minor
-T.I.N.) Probationary/ Postgraduate Specialized
Part Time) Training Attended
EDUCATIONAL QUALIFICATION
Nature of
Employee Appointment/
No. (or Tax Name of School Personnel Fund Position/
Employment
Major/
Identification (Arrange by Sex Status
Source Designation Degree/ Specialization/
Number Position, Descending) (Regular/ Minor
-T.I.N.) Probationary/ Postgraduate Specialized
Part Time) Training Attended

GUIDELINES:
1. This form shall be accomplished at the beginning of each semester by the School Head and is submitted to the Division Office. In case of movemen
personnel during the semester, an updated SHSF-7 must be submitted to the Division Office at the end of the semester.
2. All school personnel, regardless of position/nature of appointment should be included in this form and should be listed from the highest rank to the lo
3. Please reflect subjects being taught including advisory class or ancillary assignment (if any). Other administrative duties must also be reported.
4. Daily Program Column is for teaching personnel only.
ssignment for Senior High School (SF7-SHS)
Division Region

(C ) Other Appointments and Funding Sources

Appointment: Number of Incumbent


of Designation
(Contractual, Fund Source
(as it appears in the contract/document:
Substitute, (SEF, PTA,
her, Clerk, Security Guard, Driver etc.)
Volunteer, Others NGO's etc.) Teaching Non-Teaching
specify)

Remarks:
N Daily Program (time duration)
*For Detailed Items, Indicate
name of school/office,
Grade and *For IP - Ethnicity)
Subjects Taught, Advisory Sections
Class & Other Ancillary Total Actual *For additional loads from
(Enumerate DAY
Assignments sections From To Teaching JHS- please indicate the number
Minor (M/T/W/
taught) (00:00) (00:00) Minutes per of teaching minutes per week)
TH/F)
Week

First Semester:

Second Semester:

Advisory:
Ancillary Assignment/s:
Ave. Minutes per Day
First Semester:

Second Semester:

Advisory:
Ancillary Assignment/s:
Ave. Minutes per Day
First Semester:
Remarks:
N Daily Program (time duration)
*For Detailed Items, Indicate
name of school/office,
Grade and *For IP - Ethnicity)
Subjects Taught, Advisory Sections
Class & Other Ancillary Total Actual *For additional loads from
(Enumerate DAY
Assignments sections From To Teaching JHS- please indicate the number
Minor (M/T/W/
taught) (00:00) (00:00) Minutes per of teaching minutes per week)
TH/F)
Week

Second Semester:

Advisory:
Ancillary Assignment/s:
Ave. Minutes per Day
First Semester:

Second Semester:

Advisory:
Ancillary Assignment/s:
Ave. Minutes per Day
First Semester:

Second Semester:

Advisory:
Ancillary Assignment/s:
Ave. Minutes per Day
First Semester:

Second Semester:

Advisory:
Ancillary Assignment/s:
Ave. Minutes per Day
Remarks:
N Daily Program (time duration)
*For Detailed Items, Indicate
name of school/office,
Grade and *For IP - Ethnicity)
Subjects Taught, Advisory Sections
Class & Other Ancillary Total Actual *For additional loads from
(Enumerate DAY
Assignments sections From To Teaching JHS- please indicate the number
Minor (M/T/W/
taught) (00:00) (00:00) Minutes per of teaching minutes per week)
TH/F)
Week

movement of teachers and other

k to the lowest. Signature of School Head over Printed Name


rted.
Updated as of:

School Form 7, Page ___ of ________


SF 8

Department of Education
School Form 8 Learner's Basic Health and Nutrition Report for Senior High Sch
(For All Grade Levels)

School Name District Division

School ID Grade Section Track/Strand (SHS)

Learner's Name Nutritional Sta


Birthdate Weight Height Height²
No. LRN (Last Name, First Name, Age BMI
(MM/DD/YYYY) (kg) (m) (m²)
Name Extension, Middle Name) (kg/m²)
MALE

SFRT 2017
Learner's Name Nutritional Sta
Birthdate Weight Height Height²
No. LRN (Last Name, First Name, Age BMI
(MM/DD/YYYY) (kg) (m) (m²)
Name Extension, Middle Name) (kg/m²)

FEMALE

SFRT 2017
Learner's Name Nutritional Sta
Birthdate Weight Height Height²
No. LRN (Last Name, First Name, Age BMI
(MM/DD/YYYY) (kg) (m) (m²)
Name Extension, Middle Name) (kg/m²)

SUMMARY TABLE
Nutritional Status Heig
Summary Table S
SEX Severely Severely
Wasted Normal Overweight Obese TOTAL Stunted Normal
Wasted Stunted
MALE
FEMALE
TOTAL

Date of Assessment: Conducted/Assessed By: Certified Correct By:

SFRT 2017
gh School (SF8-SHS)

Region

School Year

ional Status
Height for
BMI Remarks
Age (HFA)
Category

SFRT 2017
ional Status
Height for
BMI Remarks
Age (HFA)
Category

SFRT 2017
ional Status
Height for
BMI Remarks
Age (HFA)
Category

Height for Age (HFA)


Summary Table
Tall Total

Reviewed By:

SFRT 2017

SFRT 2017

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