This document contains forms for collecting student information including personal details, medical history, family details, interests and languages spoken. It also includes a parental agreement form for parents to consent to school rules and participate in activities. Additionally, it outlines a learner's individual plan template to assess students' progress in various subjects over time through pre-and post-testing, and identify specific needs and interventions.

1. Department of Education
Region III
Schools Division of Bataan
District of Abucay
SALIAN ELEMENTARY SCHOOL
ANECDOTAL RECORDS
(Print all entries)
Name:_______________________________________________________________ Age:_______ Sex:________
(Surname) (GivenName) (Middle Name)
Address:___________________________________________________________________________________________
Birthday:_____________________________________Birthplace: ____________________________________________
Nationality:____________________________________Religion: _____________________________________________
Father’sName:__________________________________Occupation: _________________________________________
Mother’sName:__________________________________Occupation: ________________________________________
Cell phone No:_______________________________Position in the family:____________________________________
Languages/Dialectunderstoodbythe child:_____________________________________________________________
Checkthe child’sinterest:
[ ] Music [ ] Books [ ] Stories [ ] Pets [ ] Toys [ ] Drawing
[ ] Others( Please Specify) :__________________________________________________________________________
MEDICAL RECORD:
Name of the child’sDoctor: ___________________________________________________________________________
Address:___________________________________________________________________________________________
Please checkthe medical treatmentwhichyourchildhadundergone:
[ ] SeriousAccident [ ] SeriousIllness [ ] operation
[ ] Hospitalization [ ] Handicaps [ ] Allergies
[ ] Others(Please Specify)____________________________________________________________________________
Whom shouldwe call incase of emergency?______________________________________________________________
Address:________________________________________________Cell phone No.______________________________
PARENT’S QUESTIONNAIRE
State 2 reasonswhyyouwant to enroll yourchildinthisschool:
1. _________________________________________________________________________________________
2. _________________________________________________________________________________________
PARENT’S AGREEMENT:
The detailsof developingthe childtohis/herfullestpotential asa personphysically,intellectually,socially,
spiritually,andaesthetically, isajointventure of the school andhome.Asa parent’srole,the school expectsevery
parentto:
1. Become partnersinimplementingthe school program
2. Complywiththe school rulesandregulations.(refertopupil’shandbook/manual)
3. Allowtheirchildtoparticipate inschool activities.
4. Strictlyadhere punctuallyinattendance everyday.
5. To activelyparticipate inall PTA activitiesandprojects.
I, ________________________________________ parent/guardianof __________________________________ is
willingtoabide inthe afforementionedParent-School Agreement.
_______________________________________
Parent/GuardianSignature overprintedname

2. Department of Education
Region III
Schools Division of Bataan
District of Abucay
SALIAN ELEMENTARY SCHOOL
School Year 2014-2015
LEARNER’S INDIVIDUAL PLAN
PART I
Fullname Age
LRN Gender
Address Citizenship
Birthdate Religion
Birth Place Health Background
Father’s Name
Mother’s Name
Guardian
PART II PUPIL’S ASSESSMENT
Nutritional
Status
July January 4 F’s
Height Addition Subtraction Multiplication Division
Weight Pre Test
Result Post Test
Reading
Level
English Filipino Subjects Pre Post Subjects Pre Post
Pre-
test
Post
Test
Pre-
Test
Post
Test
Non
Reader
EP Hekasi
Syllabic English EPP
Slow Filipino Music
Average Science Arts
Fast Math PE
PART III SCHOOL INTERVENTION
SUBJECT Specific Needs Intervention/Strategies Monitoring
Date
Monitoring Status
Insufficient
Program
Some
Progress
Mastery
CHARITO R. MALIBIRAN
Teacher II