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Leaving Certificate Form

This document is a student performance review form from the Sri Lanka Department of Education. It requests information such as the student's name, date of birth, religion, parents' names and occupation, home address, school name and admission/leaving dates. It asks the principal to provide details of the student's academic performance, discipline, medical issues, extracurricular activities and competencies. The principal must sign and date the completed form, which is kept by the school and given to the student's guardian when they leave. Remarks at the bottom provide instructions for accurately completing the form.

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Joshua Rose
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14K views

Leaving Certificate Form

This document is a student performance review form from the Sri Lanka Department of Education. It requests information such as the student's name, date of birth, religion, parents' names and occupation, home address, school name and admission/leaving dates. It asks the principal to provide details of the student's academic performance, discipline, medical issues, extracurricular activities and competencies. The principal must sign and date the completed form, which is kept by the school and given to the student's guardian when they leave. Remarks at the bottom provide instructions for accurately completing the form.

Uploaded by

Joshua Rose
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Sri Lanka Department of Government Press

2711

Department of Education
Student Performance Review

Education B 59
(N 4*) 1/44

(This Performance Review should be kept in the custody of the Principal of the school where the student pursues
studies and the Principal should himself/herself fill and hand over the same to the legal guardian of the student when
the student leaves school. Make sure that the content you enter in the Performance Review is accurate in all
respects)
Full Name of the Student:
Date of Birth:

Religion:

Full Name of the father or the guardian:


Occupation of the father or the guardian:
Permanent Address of the father or the guardian:

Name of the School:


Date of Admission:
Date of leaving school:

Admission Number:
Reason for leaving:

Immediate Examination passed by the student: Sinhala medium


Tamil/English medium:
Learning content of the last class in:
(State in which medium the subject content was taught)
Discipline:
Deficiencies, if any, observed at the medical examination:
Sport performances and other Skills:
Special Competences:
Date:
Principal:

Signed:Official Stamp:-

Name of the School:


Date of Admission:

Admission Number:

Date of leaving school:

Reason for leaving:

Immediate Examination passed by the student: Sinhala medium:


Tamil/English medium:

Learning content of the last class in: ..


(State in which medium the subject content was taught)
Discipline:
Deficiencies, if any, observed at the medical examination:

Sport performances and other Skills:

Special Competences:

Date:
Principal:

Signed: Official Stamp:-

Remark:
1.
2.
3.
4.
5.

Immediate Examination passed by the student should be mention in written form.


If a student has converted into a new religion, such date and such religion should also be mentioned. Yet, the
previous note should not be struck out.
Name of a guardian should only be mentioned only if the students parents are deceased or if they are not
responsible of the students education.
If the student performed well at a sport or held a position in any association, it should be mentioned under Sport
Performances and other Skills.
The full name included in the form should be the same in the Birth Certificate of the student.

I,...of ..
., being a duly appointed
Sworn
Translator of the Ministry of Justice of the Democratic Socialist Republic of Sri Lanka , do hereby certify that
the above foregoing is a true translation of the original copy of the Student Performance Review bearing No:2711.

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