Learners Profile

7/16/2019 Learners Profile

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LEARNER DATA SHEET (Pupil's Profile)

School Year: 2014-2015

Learners Reference Number (LRN): S

(should be 12 d!"s and #erfed correc" from "he L$S)

%om&le"e Name: (as s"a"ed n "he NS' r"h %er"fca"e)

Las" Name rs" Name *ddle Namer"hda"e (mm+dd+,,,,): r"h&lace (ro#nce):

*o"her .on!ue: Rel!on:

%om&le"e /ddress (%urren"):

ouse No+S"ree"+S"o+uro aran!a, *unc&al",+%",

a"her3s Name: (as s"a"ed n "he NS' r"h %er"fca"e)

Las" Name rs" Name *ddle Name

*o"her3s Name: (as s"a"ed n "he NS' r"h %er"fca"e)

Las" Name rs" Name *ddle Name

a"her3s 'ccu&a"on: *o"her3s 'ccu&a"on:

Division of City SchoolsAMPARO ELEMENTARY SCHOOLCaloocan



u&l3s S!na"ure

ROSEMARIE $% MA

.eacher

aren"3s S!na"ure



X: *ale

emale

E9"enson Name

ro#nce

%on"ac" Number

%on"ac" Number



RANTAL

d#ser



#$#$2%1

School $8 1;;2Re!on N%R

School Name /*/R' ELE*EN./RY S

LRN

1 1;;20<0020 /lson6 L,nerd 7hon6 Lobo * 11+1=+0 11

2 1;;20<004 /ranas6 7ohn Ral&h *edenlla * 10+2+0 11

1;;20<0054 alon!6 /mar Laurence ra!a * 12+1=+0 10

4 1;;20<010 %aneso6 *ar arold *on"ea!udo * 2+<+04 10

5 1;;20<0104 %anlas6 7hon aulo 8el %am&o * 1+22+0 11

NAME(Las Name* $irs Name* Mi++le Name)

Se,(M/$)

-IRTH DATE(mm/++/ ####)

A.E as of s$ri+a# u"e



LRNNAME

(Las Name* $irs Name* Mi++le Name) Se,

(M/$)-IRTH DATE(mm/++/ ####)


; 1;;20<0105 %a&u"ol6 >,le rancsco * =+?+0 11

= 1;;212002< %nco6 7ohn Ra, er"os * 2+;+01 1

? 12=?;;0<004; 8a@6 8anel 8uma&ln * 12+2=+0 10

< 1;;20<01;2 8eocare@a6 erard Llo,d /momon&on * 10+1?+0 11

10 1;;20<01?0 E!o"6 >enAe Sala@ar * ?+1<+0 11

11 1;;20<01<; aban6 Earl 7ames Narcso * <+15+0 11

12 1;;20<021 re&aldeo6 %hrs"an arca * 10+20+0 11

1 10<1?0<024 Lacuar"a6 Sam *acah"o * 2+2;+01 1

14 1;;20<010 *arbb6 Le Na@arene Lma"oc * 2+5+04 10



LRNNAME


(M/$)-IRTH DATE(mm/++/ ####)


15 1;;2120<4 *a"es 7r6 Ronlo %ordero * 5+1+01 1

1; 10;=4;0<012 *orrs6 Elber" %abaccan * +2?+04 10

1= 1;;20<0; aa6 Re, enderson aslan * 4+1+02 12

1? 1;;20<0;= accaran!an6 an %arlo .los * ;+1+04 10

1< 1;;20<040 Re,es6 7ohn Bncen" 8el *undo * 4+5+04 10

20 225020<05= Saludaro6 L"o 8e&llo * 1+24+04 10

21 1;;20<045 Sand!6 7ona"han /#endo * =+2;+02 12

22 1;;20<04<? .enerfe6 7hon *ar El&edes * 12+;+0 11



LRNNAME


(M/$)-IRTH DATE(mm/++/ ####)


1 1;;20<00 /Cuno6 %hnee 7ose&hne SeCuena 1+12+04 10

2 1;500<0041 arba6 S"eff >e@a /!ular <+25+04 10

1;;20<00;4 elardo6 rana *ae 8acl"an ?+12+0 11

4 1;;20<00?; u!no"6 7a,den *ela,a 5+2?+04 10

5 1;;20<0142 8a#d6 7ule /nne .abafunda 2+2+0 11

; 1;;20<01;4 8a"era6 8esere Y#onne Es"aura 12+15+0 10

= 1;;2120044 8onarber6 7neella /ller 12+12+02 11

? 1;;210020 Es"ablo6 /al,ah La#erne on"a 12+2+0 10

< 1;;20<025? 7a!orn6 7oan /son! 2+10+04 10

10 1;;20<02; 7uane6 7enna ae .adan <+1<+0 11

11 12=?0<0?004 La!as6 8aneca u!a, <+20+00 14



LRNNAME


(M/$)-IRTH DATE(mm/++/ ####)


12 1;;20<02=? Llan6 L,a *ae %asmllo 5+<+04 10

1 1;;20<02<0 *acaln"al6 /9@elle Ross /nn allad 12+2<+02 11

14 1;;2100<4 *ende@6 Ncolle *a"aas 4+5+04 10

15 1;;20<02; *ras6 *chelle /nn /n!!o" <+2+02 12

1; 1;;20<042 Nare"6 *ar, 7erl,n ?+25+0 11

1= 1;;20<04? Nocos6 S,rel /n!el *allar 4+22+04 10

1? 1;;20<055 'mbo,6 annah Nllas +24+04 10

1< 1;;20<0=? al@a6 *a 7essabel Sa,am <+5+0 11

20 1;;20<0<1 a#a6 /ndrea 7ean .rubanos 5+2<+04 10

21 1;;20<0424 Reme!o6 Durel *erced 2+11+04 10

22 1;;20<04== Sumalno!6 Ruffa uarn ;+15+04 10



LRNNAME


(M/$)-IRTH DATE(mm/++/ ####)


2 1;;20<0501 .ernal6 %hrs"ne *ae a"on 12+10+0 10

24 1;;20<050 .e#es6 *arelle /n"hone""e - 12+?+0 11

Lis a"+ 0o+e of I"+i!aors u"+er REMAR1S !olum"

I"+i!aor 0o+e Re2uire+ I"formaio"

Tra"sferre+ Ou T/O Name of Pu3li! (P) Priae (PR) S!&ool 4 Effe!ii# Dae

Tra"sferre+ IN T/I Name of Pu3li! (P) Priae (PR) S!&ool 4 Effe!ii# Dae

Droppe+ DRP Reaso" a"+ Effe!ii# Dae

Lae E"rollme" LE Reaso" (E"rollme" 3e#o"+ s $ri+a# of u"e)



LRNNAME


(M/$)-IRTH DATE(mm/++/ ####)




S!&ool $orm (S$ ) S!&ool Reiser(This replaces Form 1, Master List & STS Form 2-Family Background and ro!ile"

8#son %/L''%/N %$.Y

''L School Year 2014-2015

RELI.ION

ADDRESS

-ara"a# Mu"i!ipali#/ 0i# Proi"!e

La!una .a!alo! Roman %a"holc ?< *abolo S. 1=< %aloocan %", *e"ro *anla

/lan .a!alo! Roman %a"holc 1?0 %aloocan %", *e"ro *anla

*e"ro *anla .a!alo! Roman %a"holc 1=< %aloocan %", *e"ro *anla


ulacan .a!alo! Roman %a"holc 1?0 %aloocan %", *e"ro *anla

-IRTH PLA0E(Proi"!e)

MOTHERTON.5E

IP(E&"i! .roup) House 6/ Sree/

Siio/Purok



RELI.ION

ADDRESS



MOTHERTON.5E


Siio/Purok


Le,"e .a!alo! Roman %a"holc 1=< %aloocan %", *e"ro *anla

*sams 'ren"al .a!alo! Roman %a"holc 1?0 %aloocan %", *e"ro *anla

/lba, .a!alo! Roman %a"holc 1=< %aloocan %", *e"ro *anla


*e"ro *anla .a!alo! Roman %a"holc 1?0 %aloocan %", *e"ro *anla


.a!alo! Roman %a"holc 1=< %aloocan %", *e"ro *anla

*e"ro *anla .a!alo! Roman %a"holc 1?; %aloocan %", *e"ro *anla



RELI.ION

ADDRESS



MOTHERTON.5E


Siio/Purok


.arlac .a!alo! Roman %a"holc 1=< %aloocan %", *e"ro *anla

%amarnes Sur .a!alo! Roman %a"holc 1=< %aloocan %", *e"ro *anla



Samar .a!alo! Roman %a"holc 1=< %aloocan %", *e"ro *anla





RELI.ION

ADDRESS



MOTHERTON.5E


Siio/Purok





.a!alo! Roman %a"holc 1?0 %aloocan %", *e"ro *anla






*sams 'ren"al .a!alo! Roman %a"holc 1=< %aloocan %", *e"ro *anla



RELI.ION

ADDRESS



MOTHERTON.5E


Siio/Purok



*e"ro *anla .a!alo! Roman %a"holc 1=? %aloocan %", *e"ro *anla




*e"ro *anla Roman %a"holc 1=< %aloocan %", *e"ro *anla



%amarnes Sur .a!alo! %hurch of od 1=< %aloocan %", *e"ro *anla




RELI.ION

ADDRESS



MOTHERTON.5E


Siio/Purok



I"+i!aor 0o+e Re2uire+ I"formaio" RE.ISTERED

00T Re!ipie" 00T 00T 0o"rol/refere"!e "um3er 4 Effe!ii# Dae MALE

-alik7Aral -/A Name of s!&ool las ae"+e+ 4 8ear $EMALE

Lear"er 9i& Dissa3ili# L9D Spe!if#TOTAL

A!!elarae+ A0L Spe!if# Leel 4 Effe!ii# Daa



RELI.ION

ADDRESS



MOTHERTON.5E


Siio/Purok



8s"rc" $

rade Le#el 5 Sec"on Emlo 7acn"o

PARENTS REMAR1S

Name Relaio"s&ip

/lson6 7hunde R $$$ Lobo6 Rosel,n $ none n+a .+'

/ranas6 Eduardo *orales 7r *edenlla6 7oll, 'bamos

alon! Sr6 /rmando /bera ra!a6 *ar"es -

%aneso6 Re,naldo 8no *on"ea!udo6 L,n La!ran

%anlas6 7mm, Yamer"o 8el 'cam&o6 Sal#acon /bra@aldo

.5ARDIAN(If "o Pare")

0o"a! Num3er ofPare" or .uar+ia"$a&er's Name (Las Name* $irs

Name* Mi++le Name)Mo&er's Mai+e" Name (Las Name*

$irs Name* Mi++le Name)(Please refer o &e lee"+

o" las pae)

PARENTS REMAR1S.5ARDIAN



PARENTS REMAR1S

Name Relaio"s&ip

(If "o Pare")




o" las pae)

%a&u"ol6 Ed!ardo olo, rancsco6 %har"o anares

%nco6 7ulus er"os6 Rena

8a@6 Raml /c"a 8uma&ln6 *ardel,n Rocero

8eocare@a6 Ro!elo Sr6 %rucllo 0<42?01;42<

E!o"6 Nodde Salbado Sala@ar6 Lu@#mnda alo&

none aban6 E#an!elne Narcso

re&aldeo6 Leb"o alon arca6 *arlene .oro

*acah"o6 *ar, /nn

*arbb6 8omnc *an@ano Lma"oc6 Leonora %alas 0<0=?1<?;4

/momon&on6 /nna L@aada,ha!




PARENTS REMAR1S

Name Relaio"s&ip

(If "o Pare")




o" las pae)

*a"es6 Ronlo *anda"o %ordero6 /rlene ere@

*orrs6 Ern aron %abaccan6 rendal, *endo@a

aa6 enr, elle@a aslan6 *a!dalena *edanaba

accaran!an6 *anol"o acan .los6 Nornafe 7amla 0<225<4?<

Re,es6 Re,naldo % del *undo6 7ose&hne /bucAo

Saludaro6 Lore"o 8olon 8e&llo6 *a,um /bo,abor

Sand!6 Nes"or 8ula, /#endo6 Beronca %aAes

.enerfe6 redde aln!asa El&edes6 a@ San"or 0<22;1225?1




PARENTS REMAR1S

Name Relaio"s&ip

(If "o Pare")




o" las pae)

/Cuno6 7ose&h anCue SeCuea6 *a Su@e""e 8an!hl

/!ular6 *a,um

elardo6 ernardo ael 8acl"an6 Blma Raru!al

u!no"6 laro %ollado *ela,a6 *aLeonora '!bac

.abafunda6 /n!le

8a"era6 Ro!e /bndan Es"aura6 *arsol 7ala,aAa,

8onarber6 /lfredo Lloren"e /ller6 7ule"a Ye&es

on"a6 Rence ernande@

7a!orn6 .eofs"o boso /son!6 *ar"a /!udes

7uane6 lber" %anaco .adan6 7llan 8onarcber

La!as6 8anlo *adredeAo u!a,6 *ar"a $"om




PARENTS REMAR1S

Name Relaio"s&ip

(If "o Pare")




o" las pae)

Llan6 erdnand 8elos San"os %asmllo6 /lfreda %u,ob

*acaln"al6 Rand, Fu"an allad6 Lene Sebas"an

*ende@6 7ose&h ra!a *a"aas6 Narcesa ar"n!n

/n!!o"6 7ela

%abalona6 7erem, .alard Nare"6 *erl,n Lareno

*allr6 E#an!elne

'mbo,6 Norber"o a"ardo Nllas6 %hrs",

al@a6 7osel"o *ena Sa,am6 7essca anasn!

a#a6 7erome Sulma .rubanos6 7ance %ons"an"no 0<0<4;5?<

Rem!o6 /rnold E *erced6 Elma

Sumalno!6 aCu"o % uarn6 Rosalnda * 0<2?01;4


(If P )



PARENTS REMAR1S

Name Relaio"s&ip

(If "o Pare")




o" las pae)

.ernal6 /leAandro %a"arnn! a"on6%ela aralde

n+a .e#es6 Rosal,n .a&el

re&ared b,: %er"fed %orrec":oSY EoSY

ROSEMARIE $% MARANTAL MARIL8N M% LA5RENO

;(S!na"ure of /d#ser o#er rn"ed Name) (S!na"ure of School ead o#er rn"ed Name)

;<oSY 8a"e: EoSY8a"e:oSY 8a"e: =</=</; EoSY8a"e:


(If P )



Name Relaio"s&ip

(If "o Pare")




o" las pae)



School $8 1;;2 School Year

Name of School /*/R' ELE*EN./RY S%

? ; @ < =

M T 9 TH $ M T

/lson6 L,nerd 7hon Lobo

/ranas6 7ohn Ral&h *edenlla

? alon!6 /mar Laurence ra!a

; %aneso6 *ar arold *on"ea!udo@ %anlas6 7hon aulo 8el %am&o

< %a&u"ol6 >,le rancsco

B %nco6 7ohn Ra, er"os

C 8a@6 8anel 8uma&ln

8eocare@a6 erard Llo,d /

LEARNER'S NAME

(Las Name* $irs Name* Mi++le Name)

LEARNER'S NAME



? ; @ < =

M T 9 TH $ M T

LEARNER S NAME(Las Name* $irs Name* Mi++le Name)

/Cuno6 %hnee 7ose&hne SeCuena

arba6 S"eff >e@a /!ular

? elardo6 rana *ae 8acl"an

; u!no"6 7a,den *ela,a

@ 8a#d6 7ule /nn .abafunda

< 8a"era6 8esere Y#onne Es"aura

B 8onarber6 7neella /ller

C Es"ablo6 /al,ah La#erne on"a

7a!orn6 7oan /son!

= 7uane6 7enna ae .adan

La!as6 8aneca u!a,

Llan6 L,a *ae %asmllo

? *acaln"al6 /9@elle Ross /nn allad

; *ende@6 Ncolle *a"aas

LEARNER'S NAME



? ; @ < =

M T 9 TH $ M T

LEARNER S NAME(Las Name* $irs Name* Mi++le Name)

0om3i"e+ TOTAL PER DA8 ;< ;< ;< ;< ;< ;< ;<

DELINES:

1 .he a""endance shall be accom&lshed dal, Refer "o "he codes for checn! learners3 a""endance

2 8a"es shall be r""en n "he columns af"er Learner3s Name

.o com&u"e "he follon!:

a ercentage o! *nrolment +Re!s"ered Learners as of end of "he

Enrolmen" as of 1s" rda, of "he scho

b 'erage )aily 'ttendance + .o"al 8al, /""endanceNumber of School 8a,s n re&or"n!

c ercentage o! 'ttendance !or the month +/#era!e dal, a""endance

Re!s"ered Learners as of end of "he

lec"ed n orm 1= and orm 1? e#er, !radn! &erod

G e!nnn! of School Year cu"-off re&or" s e#er, 1s" rda, of "he School Year

4 E#er, end of "he mon"h6 "he class ad#ser ll subm" "hs form "o "he offce of "he &rnc&al for recordn! of summar, "able n"o Scho&rnc&al6 "hs form should be re"urned "o "he ad#ser

5 .he ad#ser ll &ro#de neccessar, n"er#en"ons ncludn! bu" no" lm"ed "o home #s"a"on "o learner+s ho ere absen" for 5 condro&&n! ou"



S!&ool $orm (S$) Dail# Ae"+a"!e Repor of Lear"ers(This replaces Form 1, Form 2 & STS Form - 'senteeism and )ropout ro!ile"

2014-2015 Re&or" for "he *on"h of 7HNE

'L rade Le#el 5 S

(s ro> for +ae)

? < B C C = ? ; @ < B

9 TH $ M T 9 TH $ M T 9 TH $

(s ro> for +ae)



? < B C C = ? ; @ < B

9 TH $ M T 9 TH $ M T 9 TH $

(s ro> for +ae)



? < B C C = ? ; @ < B

9 TH $ M T 9 TH $ M T 9 TH $

;< = ;< ;< ;< ;< ;< ;< ;< ;< ;< ;< ;<

% 0ODES $OR 0HE01IN. ATTENDAN0E

% REASONS/0A5SES $OR DROPPIN. O5T

mon"h9 100

a% Domesi!7Relae+ $a!ors

ol ,ear a1 ad "o "ae care of sbln!s

a2 Earl, marra!e+&re!nanc, mon"h a aren"s3 a"""ude "oard schooln!

9 100a4 aml, &roblems

mon"h 3% I"+ii+ual7Relae+ $a!ors

b1 $llness

b2 '#era!e

b 8ea"h

b4 8ru! /buse

b5 oor academc &erformance

b; Lac of n"eres"+8s"rac"ons

b= un!er+*alnu"r"on

!% S!&ool7Relae+ $a!ors

c1 .eacher ac"or

c2 h,scal cond"on of classroom

c eer nfluence

(blan) 7 resen"J (9)- /bsen"J .ard, (half shadedK H&&er for La"e %ommer6 Loerfor %u""n! %lasses)

l orm 4 'nce s!ned b, "he

ecu"#e da,s and+or "hose a" rs of



c"on E*$L$' 7/%$N.'

/SEN. ./R8Y

= .+'6 8L% E+S6 7ul, 56 2014

=

=

==

=

=

=

=

Toal for &e Mo"&

REMAR1S ($f DROPPED O5T6 s"a"e reason6 &lease refer "o le!end number 2

$f TRANS$ERRED IN/O5T6 r"e "he name of School)

Toal for &e Mo"&

REMAR1S ($f DROPPED O5T " " l f " l d b 2



/SEN. ./R8Y

REMAR1S ($f DROPPED O5T6 s"a"e reason6 &lease refer "o le!end number 2$f TRANS$ERRED IN/O5T6 r"e "he name of School)

=

=

=

=

=

=

=

=

=

=

=

=

=

=

Toal for &e Mo"&

REMAR1S ($f DROPPED O5T s"a"e reason &lease refer "o le!end number 2



/SEN. ./R8Y

REMAR1S ($f DROPPED O5T6 s"a"e reason6 &lease refer "o le!end number 2$f TRANS$ERRED IN/O5T6 r"e "he name of School)

CB;

Mo"&:No% of Da#s of 0lasses:

Summar#

M $ TOTAL

*nrolment as o! (1st Friday o! .une" ; ;<

= = =

; ;<

100 100 100

'erage )aily 'ttendance 22 24 46

ercentage o! 'ttendance !or the month == == ==

/umer o! students asent !or 0 consecutie days = =

Drop ou = = =

Tra"sferre+ ou = = =

Tra"sferre+ i" = = =

Late *nrollment during the month(eyond cut-o!!"

5egistered Learners as o! end of the month

ercentage o! *nrolment as o! end of the month

=

S!&ool $orm ? (S$?) -ooks



S!&ool $orm ? (S$?) -ooks(This replaces Form 1 & ne

School $8 17##72 School Year

School Name 'M'58 *L*M*/T'59 S:488L rade Le#el

NO%

*/;LS4 (5*')/;" */;LS4 (L'/;<';*" FL/8 (';B'S'" FL/8

8a"e 8a"e 8a"e 8

$ssued Re"urned $ssued Re"urned $ssued Re"urned $ssued

/lson6 L,nerd 7hon Lobo 05+2;+14 ?/B/=@ 05+2;+14 05+2;+14 05+2;+14

/ranas6 7ohn Ral&h *edenlla 05+2;+14 NE 05+2;+14 05+2;+14 05+2;+14

? alon!6 /mar Laurence ra!a 05+2;+14 05+2;+14 05+2;+14 05+2;+14

; %aneso6 *ar arold *on"ea!udo 05+2;+14 05+2;+14 05+2;+14 05+2;+14

@ %anlas6 7hon aulo 8el %am&o 05+2;+14 05+2;+14 05+2;+14 05+2;+14

< %a&u"ol6 >,le rancsco 05+2;+14 05+2;+14 05+2;+14 05+2;+14

B %nco6 7ohn Ra, er"os 05+2;+14 05+2;+14 05+2;+14 05+2;+14

C 8eocare@a6 erard Llo,d / 05+2;+14 05+2;+14 05+2;+14 05+2;+14

8elman6 7ames %arl rancs Samosa 05+2;+14 05+2;+14 05+2;+14 05+2;+14

= E!o"6 >enAe Sala@ar 05+2;+14 05+2;+14 05+2;+14 05+2;+14

aban6 Earl 7ames Narcso 05+2;+14 05+2;+14 05+2;+14 05+2;+14

re&aldeo6 %hrs"an arca 05+2;+14 05+2;+14 05+2;+14 05+2;+14

LEARNER'S NAME(Las Name* $irs Name* Mi++le Name)

*/;LS4 (5*')/;" */;LS4 (L'/;<';*" FL/8 (';B'S'" FL/8



NO%8a"e 8a"e 8a"e 8



? Lacuar"a6 Sam *acah"o 05+2;+14 05+2;+14 05+2;+14 05+2;+14

;*arbb6 Le Na@arene Luma"oc

05+2;+14 05+2;+14 05+2;+14 05+2;+14

@ *a"es 7r6 Ronlo %ordero 05+2;+14 05+2;+14 05+2;+14 05+2;+14

< *orrs6 Elber" %abaccan 05+2;+14 05+2;+14 05+2;+14 05+2;+14

B aa6 Re, enderson aslan 05+2;+14 05+2;+14 05+2;+14 05+2;+14

C accaran!an6 an %arlo .los 05+2;+14 05+2;+14 05+2;+14 05+2;+14

Re,es6 7ohn Bncen" 8el *undo 05+2;+14 05+2;+14 05+2;+14 05+2;+14

= Saludaro6 L"o 8e&llo 05+2;+14 05+2;+14 05+2;+14 05+2;+14

Sand!6 7ona"han /#endo 05+2;+14 05+2;+14 05+2;+14 05+2;+14

.enerfe6 7hon *ar El&edes 05+2;+14 05+2;+14 05+2;+14 05+2;+14

.'./L 'R */LE .'./L %'$ES

*/;LS4 (5*')/;" */;LS4 (L'/;<';*" FL/8 (';B'S'" FL/8



NO%8a"e 8a"e 8a"e 8



/Cuno6 %hnee 7ose&hne SeCuena 05+2;+14 05+2;+14 05+2;+14 05+2;+14

arba6 S"eff >e@a /!ular

05+2;+14 05+2;+14 05+2;+14 05+2;+14

? elardo6 rana *ae 8acl"an 05+2;+14 05+2;+14 05+2;+14 05+2;+14

; 8a#d6 7ule /nn .abafunda 05+2;+14 05+2;+14 05+2;+14 05+2;+14

@ u!no"6 7a,den *ela,a 05+2;+14 05+2;+14 05+2;+14 05+2;+14

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; ; ; ;IDELINES: I" !ase of los/u"reur"e+ 3ooks* please proi+e i"formaio" >i& &e follo>i" !

1 ."le of oos $ssued "o each learner mus" be recorded b, "he class ad#ser

2 .he 8a"e of $ssuance and "he 8a"e of Re"urn shall be reflec"ed n "he form

.he .o"al Number of %o&es ssued a" oSY shall be reflec"ed n "he form

4 .he .o"al Number of %o&es of oos Re"urned a" "he EoSYshall be reflec"ed n "he form

A++iio"al !opies of &is form ma# 3e use+ if "ee+e+%

A% $n %olumn 8a"e Re"urned6 codes are: $MKor

-% $n %olumn Remar+/c"on .aen6 codes are: Lle""er+re&or" dul, no"ed b, School ead for subm8'M26 s20016 8'M256 s2006 8'M146 22012

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; ; ; ;

+e: Prepare+ -#:

MRS% ROSEMARIE $% MARANTAL

(S!na"ure o#er &rn"ed name)

School orm : a!e 1 of 2

e *aAeure6 TDO: .ransferred+8ro&ou"6 NE.KNe!l!ence

TRKSecured Le""er from Learner dul, s!ned b, &aren"+!uardan (for code *)6 TLTRK.eacher &re&aredson "o School ro&er", %us"odan (for code .8')6 PTLKad b, "he Learner (for code NE) References:

8a"e oSY </</=; 8a"e EoSY:

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