DIVISION OF SAN PABLO CITY

Sta. Maria Magdalena Elementary School

Brgy. Sta. Maria Magdalena, San Pablo City

Year-End Teachers Clearance

School Year 2015-2016
HELEN M. ACERES
Head Teacher III
Maam:
This is to inform you that I have satisfactorily settled all the property and financial obligations in the school and
that I have submitted all the required reports as listed below. Kindly grant the undersigned the Year-End Clearance for
School Year 2015-2016.

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CHECKED BY:/Date

CHECKED BY:/Date

(Signature over printed name)

(Signature over printed name)

School Form 1: School Register _____________

School Form 2: Daily Attendance
of Learners
__________________
Grading Sheets
____________________
School Form 5: (Report on
Promotion & Level of Proficiency ______________
DepEd Form 137
____________________
DepEd Form 138
____________________
Return of Unissued Cards ____________________
CS Form 48
____________________
Guidance Form
____________________
Updated Form 212 (PDS & E-PDS)_____________
Lesson Plans/DLL
____________________
Test Notebook/Folder
____________________
Nutritional Status
(Feeding Coordinator)
____________________
Class Organizational/Rank list
(Gr. /level Adviser) ____________________
List of Retained/
Drop-Out/ Transferred In and Out/
Failures
______________
List of Students with
General Average
______________
Income Tax Return (ITR) ____________________
Library
a. Borrowed Books
____________________
b. Borrowed Materials ____________________

19. Classroom inventory and room safety

a. room keys
__________________
b. books
__________________
c. equipment
___________________
d. furniture
___________________
20. X-ray & Urine, ECG Exam __________________
21. Dental Result
__________________
22. Financial Obligations
Teachers Club Dues ____________________
Canteen Funds
____________________
Organizational Funds____________________
23. IPCRF

____________________

24. SALN as of December 2015

_______________________
25. Latest Instructional Materials Prepared
___________________
26. Accomplishment Reports _______________

In the exigency of service, I am willing to report to work and attend Summer INSET for Teachers.
Present Home Address: ____________________________________________
Telephone/Cellphone Numbers: _______________________________
______ _________________________
Printed Name and Signature of Teacher
Approved and clearance granted:
HELEN M. ACERES
Head Teacher III