Republic of the Philippines
Department of Education
Region III
Division of Bulacan
FELIZARDO C. LIPANA NATIONAL HIGH SCHOOL
GUIDANCE CENTER
SARDO
STUDENT AT RISK OF DROPPING OUT
NAME: _______________________________________________
AGE: ___________
YEAR AND SECTION: ____________________________________________________
ADDRESS: _____________________________________________________________
DROP-OUT HISTORY
HOW
MANY
TIMES
LEVEL
1[
2[
3[
4[
1[
2[
3[
4[
1[
2[
3[
4[
1[
2[
3[
4[
1[
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4[
ELEM.
1ST YR.
2ND YR.
3RD YR.
4TH YR.
SCHOOL
YEAR
REASON/S
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I CONSIDER HIM/HER AS SARDO BECAUSE OF
CUTTING CLASSES / HALF DAY
ABSENTEEISM
BEHAVIOR PROBLEM, SUCH AS: __________________________________
OTHERS, SPECIFY: ______________________________________________
ACCOMPLISHED BY: __________________________________
NAME AND SIGNATURE
DATE: ___________
------------------------------------------------------THIS SPACE IS FOR GUIDANCE COUNCELOR
___ FAMILY
___ INDIVIDUAL
___ COMMUNITY
___ SCHOOL
SITUATION:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
________________________________________________
ACTION/S TO TAKE:
______________________________________________________________________________
ACTION/S TAKEN:
______________________________________________________________________________
Republic of the Philippines
Department of Education
Region III
Division of Bulacan
FELIZARDO C. LIPANA NATIONAL HIGH SCHOOL
GUIDANCE CENTER
RESULT/S:
_____________________________________________________________________________________________
_______________________________________________________________