Department of Education

Region V
Division of City Schools
Naga North District

NAGA CENTRAL SCHOOL II

ANECDOTAL RECORD
Name: _______________________________________ Age:_______ Gender: ____________
Date of Birth: _____________ Place of Birth: _____________ Nationality: ___________
Complete Address: _______________________________________ Tel. No. :_ ________
Father: ____________________________________ Age: ________ Occupation: __________
Educational Attainment: ______________________________ Religion: __________________
Mother: ________________________________ Age: _______Occupation: _____________
Educational Attainment: __ ___________________________ Religion: _________________
No. of Children in the Family: ____ No. of Boys:____ No. of Girls:____ Sibling Position:_______
Living with whom: ________________________________________________________
SCHOOLS ATTENDED:
SCHOOL SCHOOL YEAR GRADE & SECTION ADVISER

CRITICAL INCIDENT RECORD/BEHAVIOR REPORT:

(Filled-in by pupil-Intermediate grades, filled-in by teacher-Primary grades)
Problem/Situations Consequences What can you
Observed/Rules(which (What do you Teacher’s do to not have
Date
rule or rules were think should Decision this happen
broken) happen?) again?
GRADE I

GRADE II

GRADE III
 GRADE IV

GRADE V

GRADE VI

GRADE I
TEACHER _________________________________________________ DATE ________________
PUPIL _________________________________________________ DATE ________________
PARENT _________________________________________________ DATE ________________

GRADE II
TEACHER _________________________________________________ DATE ________________
PUPIL _________________________________________________ DATE ________________
PARENT _________________________________________________ DATE ________________

GRADE III
TEACHER _________________________________________________ DATE ________________
PUPIL _________________________________________________ DATE ________________
PARENT _________________________________________________ DATE ________________

GRADE IV
TEACHER _________________________________________________ DATE ________________
PUPIL _________________________________________________ DATE ________________
PARENT _________________________________________________ DATE ________________

GRADE V
TEACHER _________________________________________________ DATE ________________
PUPIL _________________________________________________ DATE ________________
PARENT _________________________________________________ DATE ________________

GRADE V I
TEACHER _________________________________________________ DATE ________________
PUPIL _________________________________________________ DATE ________________
PARENT _________________________________________________ DATE ________________