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Department of Education

Region III
Division of Pampanga
BARUYA HIGH SCHOOL
Lubao

April 5, 2017

LEONARDO D. ZAPANTA, Ed. D., CESO VI


OIC - Schools Division Superintendent
Division of Pampanga
City of San Fernando (P)

Thru Channel: Jeanie A. Lintag


Principal
Sir:
This is to inform you that I have satisfactorily settled all the property and financial obligations in
the school and that I have submitted all the required reports as listed below. May I then be granted the
Year-End Clearance for School Year 2016-2017.
Reports called for Date Submitted Recorded by:
1. Form 137-A _____________ ____________
2. Form 138 _____________ ____________
3. School Form 1 _____________ ____________
4. School Form 2 _____________ ____________
5. School Form 3 _____________ ____________
6. School Form 4 _____________ ____________
7. School Form 5 _____________ ____________
9. Grading Sheets _____________ ____________
10. Return of Unissued Cards _____________ ____________
11. CS Form 48 _____________ ____________
12. Report on School Publication
Collection (Fil & Eng) _____________ ____________
13. Inventory Report on Books _____________ ____________
14. Classroom Inventory _____________ ____________
a. Books _____________
b. electric fan :
c. furniture/ cabinet _____________
d. teacher’s table _____________
e. students’ chairs:
single detached w/ armchair____________
three-seaters _____________
15. Financial Obligations
AC/PTA Donations _____________ ____________
HR-PTA Project Report _____________ ____________
16. Lesson Plan (DLL/DLP) _____________ ____________
17. Performance Rating (CB-PAST) _____________ ____________
18. SALN as of December 2017 (Ok) _____________ ____________
19. Accomplishment/Annual Reports _____________ ____________
20. Other Reports: M/PL/Least &Most Learned __________ ____________

In the exigency of service, I am willing to report to work and attend Summer INSET for Teachers.

Present Home Address: ____________________________________________


Telephone/Cell phone Numbers: _____________________________________

_____________________________________
Printed Name and Signature of Teacher
Recommending Approval:

JEANIE A. LINTAG
Principal I

Approved:

LEONARDO D. ZAPANTA, Ed. D. CESO VI


OIC - Schools Division Superintendent

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