GRADE 5 CUMULATIVE RECORDS

MERCEDARIAN SCHOOL, INC
CUMULATIVE RECORDS
DIRECTION: Kindly fill in all information needed. Do not abbreviate. Do not leave any item blank. Put 'NA' if not applicable. Fields with asterisk (*) are required and must be filled out.
FULL NAME*
SURNAME, GIVEN NAME , MIDDLE NAME
NICKNAME*
GRADE LEVEL & SECTION*
LRN (LEARNING REFERENCE NUMBER)
GENDER*
BIRTH ORDER*
RELIGION*
Date of Birth*
MonthDayYear
Date
PLACE OF BIRTH*
NATIONALITY*
Tel. No.
CONTACT NUMBER (CELLPHONE NUMBER)*
EMAIL*
example@example.com
PERMANENT ADDRESS*
NAME OF PARENT/GUARDIAN*
RELATIONSHIP*
PARENT/GUARDIAN'S CONTACT NUMBER*
PARENT/GUARDIAN EMAIL ADDRESS*
example@example.com

FAMILY BACKGROUND
FATHER'S NAME*
FATHER'S DATE OF BIRTH*
MONTH-DAY-YEAR EXAMPLE AUGUST 13 1995
FATHER'S EDUCATIONAL ATTAINMENT*
OCCUPATION*
NAME OF COMPANY*
FATHER'S EMAIL ADDRESS & CONTACT NUMBER*
EXAMPLE: FATHERSEMAILADDRESS@GMAIL.COM/09555774645
MOTHER'S NAME*
MOTHER'S DATE OF BIRTH*
MONTH-DAY-YEAR EXAMPLE AUGUST 13 1995
MOTHER'S EDUCATIONAL ATTAINMENT*
MOTHER'S OCCUPATION*
NAME OF COMPANY*
MOTHER'S EMAIL ADDRESS & CONTACT NUMBER*
EXAMPLE: FATHERSEMAILADDRESS@GMAIL.COM/09555774645
Parents' Marital Status*
marriedannulledseparatedlive-inwidowed/-rOther

EDUCATIONAL BACKGROUND FOR TRANSFEREES ONLY
ANSWER
SCHOOL LAST ATTENDED
SCHOOL ADDRESS
AWARDS /HONORS RECEIVED

II. HEALTH AND PHYSICAL DEVELOPMENT*

	ANSWER
HEIGHT IN FT
WEIGHT IN KG
DO YOU HAVE PROBLEMS IN SIGHT? (YES OR NO)
DO YOU HAVE PROBLEMS IN SPPECH? (YES OR NO)
DO YOU HAVE PROBLEMS IN GENERAL HEALTH
DO YOU HAVE PROBLEMS IN HEARING (YES OR NO)
HAVE YOU EXPERIENCED ANY SERIOUS SICKNESS OR ACCIDENT IN THE PAST? (YES OR NO)
IF YES, SPECIFY WHEN AND DESCRIBE THE EFFECT ON YOU?
ANY HANDICAP/DEVELOPMENTAL CONDITION/ ALLERGY/AILMENT? IF YES PLEASE SPECIFY

III. RESIDENCE ( INDICATE YOUR PLACE OF RSIDENCE WITH A CHECK*
FAMILY HOMEGUARDIAN'S HOMEOther

	ANSWER
SUBJECT/S YOU LIKE BEST
SUBJECT/S YOU LIKE LEAST
SUBJECT/S YOU FIND DIFFICULT
SUBJECT/S WHERE YOU LEARNED MOST
SUBJECT/S WHERE YOU LEARNED LEAST
SUBJECT/S THAT WAS TAUGHT BEST
SUBJECT/S THAT WAS TAUGHT WORST
NAME OF YOUR BEST/CLOSEST FRIEND AT SCHOOL OR HOME
LIST YOUR HOBBIES, SPECIAL TALENTS, SKILLS, INTERESTS AND LEISURE TIME ACTIVITIES

SENTENCE COMPLETION: KINDLY COMPLETE THE FOLLOWING STATEMENTS*

	ANSWER
My father and my mother....
My greatest mistake.....
I wish my parents were.....
In school, my teachers....
I like y friends because....
Compared with most families, mine is .....
I have always wanted to.....
I feel that my brother/sister .....
At school I get along with .....
I use my spare time....

	1- EXCELLENT	2- VERY GOOD	3- GOOD	4 FAIR
PHYSICAL WELL-BEING (APPEARANCE, HEALTH, GROOMING)
EMOTIONAL ADAPTABILITY (STRESS MANAGEMENT & COPING)
PERSONALITY ( SELF CONFIDENCE, SOCIAL GRACES, ATTITUDE AND VALES, INTERPERSONAL SKILLS)
MENTAL ABILITY - COMPREHENSION
MENTAL ABILITY- REASONING & JUDGEMENT
MENTAL ABILITY- ALERTNESS
SPEECH IN FILIPINO
SPEECH IN ENGLISH
WRITTEN COMMUNICATION SKILLS (LEGIBILITY, NEATNESS, GRAMMAR STRUCTURE, DEPTH OF THOUGHTS, ORGANIZATION)
CHARACTER- INTEGRITY
CHARACTER- INDUSTRY & RESOURCEFULNESS
CHARACTER- OBSERVANCE OF SCHOOL RULES
CHARACTER- COOPERATION
CHARACTER- RESPONSIBILITY
CHARACTER- RESPECT FOR OTHERS

CUMULATIVE RECORDS