Final Individual Behavior Report

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Fill in this form and forward to the Guidance School Year 20___20___

Department of Education
Region III
Schools Division of Mabalacat City INDIVIDUAL BEHAVIOR REPORT
Atlu Bola National High School
Mabalacat City, Pampanga

Name Gender Grade/Section


Address Age Adviser

INAPPROPRIATE BEHAVIOR Check the appropriate box (es).


 All times Section – 1 minor offense if committed for at
(Minor Offenses) least three times
 No I.D./ Tampering of I.D.  Gross Misconduct
 Improper Uniform (White Top Uniform is accepted)  Cheating and stealing
 Tardiness  Possession and distribution of pornographic materials
 Improper haircut and hairdo (long hair for male/colored within the school premises
hair for male and female)  Stealing school properties or attempt thereof
 Littering  Destruction of school property
 Loitering during class hours  Vandalism
 Using smartphones and other gadgets (iPads, tablets,  Act of lewdness and immodesty such as, but not limited to
and/or laptops) while class is in progress. Any item dating, kissing, and embracing inside the school premises.
mentioned will be subject to confiscation.  Drinking liquor/alcoholic beverages or entering the school
 Wearing of earrings, trinkets, ball caps, bandana among premises under the influence of the same or the
male. Wearing more than a pair of earrings, using and unauthorized possession thereof
applying cosmetics, dangling jewelries and accessories and  Smoking near, in front, or within the sight from the
nail polish and similar fashion which do not perpetuate campus or entering the school premises with the smell of
good influence for female is also prohibited. the tobacco or cigarette his/her breathe
 Exhibiting or displaying tattoos, body piercing, and even  Engaging in any form of gambling or unauthorized
deliberate skin laceration. carrying of gambling paraphernalia
 Excessive effeminacy  Brawl/fighting inside or outside the school campus
 No homework  Threatening any student or school personnel inside and
 Writing/posting on the board without permission outside the school premises
 Late submission of reply slips and other official  Preventing, threatening students or faculty members or
communication within three (3) days school authorities from discharging their duties or from
 No excuse letter attending classes or entering school premises.
 Uttering foul language, bullying, and teasing  Brawl/serious insulting any students or school personnel
 No project inside and outside of the classroom
 Staying in areas off-limits to students  Carrying and concealing deadly weapons
 Extortion or asking money from others
 Using, possessing and selling of prohibited drugs
Date of Incident: ______________________ Time: ______________
 Membership of any fraternity/sorority contrary to the
Location of Incident: _________________________________________ school’s policy or not authorized by the school
Possible Factor/s:  Hazing in any form or manner inside or outside the school
 Peer pressure  Jealousy  Emotions premises
 Get parent’s attention  Frustration  Other/s:  Going outside the campus without permission
 Avoid someone  Retaliation  Instigating, leading or participating in concerted activities
_________________
 Avoid task/activity  Intimidation leading to stoppage of classes
 Anxiety/Fear  Hyperactivity _________________
 Forging or tampering with school records or transfer forms
Comments/ Description of Behavior: _______________________________
This is the student’s 1st 2nd 3rd 4th minor major
_____________________________________________________________
offense.
_____________________________________________________________
_____________________________________________________________
Date: ______________
_____________________________________________________________
_____________________________________________________________ ________________________ ________________________
Name & Signature of Student Name & Signature of Parent
The student named above is hereby reported for inappropriate behavior as indicated in
this report. I/we have taken the following action:
 Verbal reminder/warning ________________________ ________________________
 Held conference with student Name & Signature of Teacher/Adviser Name & Signature of
Grade Leader
 Assigned remedial work
 Parent notification
 Held conference with parent/ guardian _______________________________ DIANA M. DELA CRUZ
 Referred to the Discipline Committee Name & Signature of Designated Guidance Officer
Discipline Committee Member
 Referred to the Designated Guidance Counselor
 Required the student attend redirection session
 Community service for 5 days
ISMAEL S. DELOS REYES
Specify:________________________ Inclusive Dates: __________________ Name & Signature of School Head
 *Suspension for 3 days Inclusive Dates: __________________
 *Change of environment
(Major Offenses)
__ class/section ____________________________ __ school

*not approved without Principal’s signature

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