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School ID
School Year
Name of School
(1st row for date, 2nd row for Day: M,T,W,TH,F)
LEARNER'S NAME
(Last Name,
First Name, Middle Name)
1 Angeles, Jayvee
2 Aquino, John Paul
3 Bajarin, Rolando
4 Baybado, Reymark
5 Bueno, Jo
6 Cabie, Sony
7 Cachapero, Mark Angelo
8 Casisiempre, John Ralph
9 Datu, Jimmy
10 Dela Cruz, Bryan Dave
11 Domingo, Joshua
12 Esteban, Mark John
13 Gallarce, Mark Lourence
14 Guerrero, Mark Angelo
LEARNER'S NAME
(Last Name,
First Name, Middle Name)
15 Malinao, Mark
16 Mamaba, Dominic
17 Mangrobang, Piolo
18 Pano, Melvin John
19 Partido, Carlo
20 Primo, Dante
21 Revamonte, Larry
22 Sagun, Edmark
23 Sevilla, Nico
24 Tabilisma, Chiemte
25 Torres, John Lester
26 Valdez, Joshua
27 Verano, Alvin
28 Villa, Joshua Aaron
29 Villegas, Robert
MALE | TOTAL Per Day
30 Abad, Joebelle
31 Balquin, Alaghine
32 Celario, Beverly
33 Cruz, Laarnie Jane
34 Del Mundo, AJ
35 Dela Cruz, Marilou
36 Domingo, Princess Preah
LEARNER'S NAME
(Last Name,
First Name, Middle Name)
37 Enriquez, Jonalyn
38 Gabriel, Madelyn
39 Garcia, Marianne
40 Kho, Ysa Loraine
41 Ore, Ella May
42 Prudencio, Rica
43 Sanchez, Karylle
44 Sudaria, Mary Joy
45 Veloria, Mary Jane
46 Verano, Donabelle
47 Verano, Renalyn
48 Verano, Shiela
FEMALE | TOTAL Per Day
x 100
x 100
2. REASONS/CAUSES OF DR
a. Domestic-Related Factors
a.1. Had to take care of siblings
a.2. Early marriage/pregnancy
a.3. Parents' attitude toward sc
a.4. Family problems
b. Individual-Related Factors
4. Every End of the month, the class adviser will submit this form to the office of the principal for recording of
summary table into the School Form 4. Once signed by the principal, this form should be returned to the adviser.
5. The adviser will extend neccessary intervention including but not limited to home visitation to learner/s that committed 5 consecutive days of absences or those with potentials of
dropping out
6. Attendance performance of learner is expected to reflect in Form 137 and Form 138 every grading period
b.1. Illness
b.2. Overage
b.3. Death
b.4. Drug Abuse
b.5. Poor academic performanc
LEARNER'S NAME
(Last Name,
First Name, Middle Name)
* Beginning of School Year cut-off report is every 1st Friday of School Calendar Days
d.3. Calamities/Disasters
e. Financial-Related
e.1. Child labor, work
f. Others
M,T,W,TH,F)
Section
Total for the Month
REMARK/S (If DROPPED OUT, state reason, please refer to legend
number 2.
If TRANSFERRED IN/OUT, write the name of School.)
ABSENT
TARDY
M,T,W,TH,F)
TARDY
M,T,W,TH,F)
Present; (x)- Absent; Tardy (half shaded= Upper for Late Commer, Lower for Cutting
s)
SONS/CAUSES OF DROP-OUTS
estic-Related Factors
d to take care of siblings
ly marriage/pregnancy
ents' attitude toward schooling
idual-Related Factors
or academic performance
TARDY
Month:
No. of Days of
Classes:
(beyond
TOTAL
M,T,W,TH,F)
ck of interest/Distractions
nger/Malnutrition
ol-Related Factors
Drop out
Transferred out
Transferred in
graphic/Environmental
tance between home and school
TARDY
amities/Disasters
Attested by:
(Signature of School Head over Printed Name)