Republic of the Philippines

Department of Education
Region III
Schools Division of Nueva Ecija
District of Aliaga
BIBICLAT ELEMENTARY SCHOOL

ANECDOTAL RECORD
I. PUPIL’S PERSONAL INFORMATION:

Name VILORIA, ASHLY FAYE SAN ANTONIO Nick Name FAYE Grade II-SAMPAGUITA
Last Name, First Name, Middle Name
Address Bibiclat, Aliaga, Nueva Ecija Date of Birth 04-20-2011 Gender Female
Ambition LRN 105173160031
II. FAMILY INFORMATION:

Father
Name Age Occupation
Last Name, First Name, Middle Name
Salary Educational Attainment Religion
Mother
Maiden Name Age Occupation
Last Name, First Name, Middle Name
Salary Educational Attainment Religion
Guardian
Name Relationship Age
Last Name, First Name, Middle Name
Occupation Salary Educational Attainment
Business Address of Parent/Guardian
Position of the Pupil in the Family
Siblings (Eldest to Youngest)

III. ECONOMIC INFORMATION:

1. Financial Status
Excellent Good Moderate  Poor
2. Type of Dwelling
Single Attached Row Duplex Mansion Others
Owned Rented  Mortgage  others
3. Materials of the House
A. Concrete B. Wood A & B Make shift  Others
4. Facilities Available
Radio  Television Dining set Refrigerator
 Computer set Gas Stove Gadgets not on the list
5. Language or Dialect Spoken at Home:
Mother Tongue Filipino English Others pls. specify
_________________________
6. Food production activities:
Home cooked Carendiria Fast food Others pls. specify
_________________________
7. Means of transportation in going to school and vice versa
 car  tricycle bicycle Others pls. specify _________________________
8. Pilipinong Pantawid Pamilya Program (4 P’s) member:
 Yes  No
IV. NUTRITIONAL STATUS

Kinder Grade I Grade II Grade III Grade IV Grade V Grade VI

V. CUMULATIVE RECORD:

Subjects Kinder Grade I Grade II Grade III Grade IV Grade V Grade VI

Mother Tongue
Filipino
English
Mathematics
Araling Panlipunan
Edukasyon sa Pagpapakatao
M.A.PE.H

Adviser

VI. REPORTED BEHAVIOURAL CASE/ INCIDENTS

Kinder Grade I Grade II Grade III Grade IV Grade V Grade VI

VII. FINDINGS AND RECOMMENDATION

Kinder Grade I Grade II Grade III Grade IV Grade V Grade VI