Republic of the Philippines

Department of Education
Region III
Division of City Schools
Science City of Muñoz
LICAONG ELEMENTARY SCHOOL

SOCIO/ACADEMIC/ANECDOTAL RECORD
GRADE III-CAMIA

Name: ______________________________________________ Birth Date:_________________________

Residence:_________________________________________________________________________________
( Barangay) (Town) (Province)
Father:___________________________Educ’l Attainment:__________________Occupation:______________
Mother:___________________________Educ’lAttainment:__________________Occupation:_____________

No. of children in the Family Boy______ Girl _____ Living with Parents: Yes_______ No_______
State if both parents are living Yes _____ No ______ If no pls. specify _________________________
Parent’s Monthly Income: __________________ Economic Status: Very Poor________ Poor __________
Average_________ High ___________

I. Elementary Education

A. ACADEMIC PROFILE

Reading 1 2 3 4
Non-Reader
Frustration
Instructional
Independent
Legend: 1 Non – Reader 2 Frustration 3 Instructional 4 Independent
Pls. check appropriate box in each applicable opposite numbers 1,2,3, or 4

Mathematics W X Y Z
Addition
Subtraction
Multiplication
Division
Problem Solving

Legend: W level of mastery is poor

X some level of mastery but needs more practice
Y just enough mastery
Z manifest excellence

B. ORAL PARTICIPATION/RECITATION

Description 1 2 3
Passive
Poor
Active
 C. ACADEMIC HONOR OBTAINED IN:
Grade I _____________________
GradeII _____________________
Grade III____________________
GradeIV ____________________
Grade V____________________
GradeVI ___________________

D. SPECIAL TALENTS/SKILLS/WINNINGS

1. Singing
2. Dancing/Rhythmic
3. Drawing/Painting
4. Dramatics
5. Speaking
a. Declamation
b. Oratorical
6. Athletics
7. Leadership
8. Others ( Pls. Specify)

Please check opposite item if applicable.

E. CASES OF SIGNIFICANT MISDEMEANOR/S

DATE CASE INTERVENTION REMARKS PARENT’S

SIGNATURE

CERTIFICATION is hereby made on the veracity of the above mentioned entries per item.

SHERYL ANN A. CINENSE MANUEL U. FERNANDEZ

Adviser Principal II