House #/

Street/ Sitio/
Purok
Relationship
M
Christian
ity
M
Christian
ity
M
Christian
ity
M
Christian
ity
M
Christian
ity
M
Christian
ity
F
Christian
ity
Indicator Code BoSY
6.
1
7
School Form 1 (SF 1) School Register
(This replaces Form 1, Master List & STS Form 2-Family Background and Profile)
School ID 189527 Region VII Division Negros Oriental District Vallehermoso
Section MULTIGRADE 3-5
LRN
NAME
(Last Name, First Name, Middle Name)
S
e
x

(
M
/
F
)
BIRTH DATE
(mm/dd/yyyy)
AGE as
of 1st
Friday
June
MOTHER
TONGUE
(Grade 1
to 3 Only)
IP
(Ethnic
Group)
RELIGION
School Name Bairan Primary School School Year 2014 - 2015 Grade Grade 3
ADDRESS PARENTS
GUARDIAN
(if Not Parent)
Contact
Number of
Parent or
Guardian Barangay
Municipality/
City
Province
Father's Name
(Last Name, First
Name, Middle
Name)
Mother's Maiden
Name (Last Name,
First Name,
Middle
Name
189527110002.
DA-AROL, STEPHEN
TOMARONG
08-30-2006 7. Cebuano BAIRAN
VALLEHERM
OSO
NEGROS
ORIENTAL
,
DA-
AROL,CHARIT
O TOMARONG
189527110004. LANGUIDO, NIO ABENDAN 03-24-2006 8. Cebuano
189527100005. LARIOSA, ARNIE ALQUISOLA 11-04-2005 8. Cebuano
BULUANGA
N
SAN
CARLOS
CITY
NEGROS
OCCIDENTAL
BULUANGA
N
SAN
CARLOS
CITY
NEGROS
OCCIDENTAL
LANGUIDO,
DIONESIO
ABENDAN,
MARICRIS
LARIOSA,
ANGELO
CANTUTAY
ALQUISOLA,M
ARIA LORENA
189527110005.
MONTUYA, JOVANIE LANGUIDO
JR
12-14-2006 7. Cebuano
189527100014. RIM, JOHN LEE PATIGA 01-21-2005 9. Cebuano BAIRAN
VALLEHERM
OSO
NEGROS
ORIENTAL
BULUANGA
N
SAN
CARLOS
CITY
NEGROS
OCCIDENTAL
MONTUYA,
JOVANIE
APOLO SR
LANGUIDO,SA
RAH
RIM, LORETO PATIGA,LINDA
117786130050. VILLEGAS, JOHN GREG INDINO 12-29-2005 8. Cebuano
6 <=== TOTAL MALE
BULUANGA
N
SAN
CARLOS
CITY
NEGROS
OCCIDENTAL
VILLEGAS,
JUANITO
INDINO,FELISA
189527110008. SALADO, NAOMI LAYAN 12-28-2006 7. Cebuano
1 <=== TOTAL FEMALE
BAIRAN
VALLEHERM
OSO
NEGROS
ORIENTAL
SALADO,
EUSEBIO
INDINO
LAYAN,MARINA
FERNANDEZ
7 <=== COMBINED
List and Code of Indicators under REMARKS column
Code Required Information Indicator Required Information REGISTERED EoSY
Prepared by; Certified Correct:
Transfered Out
Transfered In
Dropped
T/O
T/I
DRP
LE
Name of Public (P) Private (PR) School &
Effectivity Date
Name of Public (P) Private (PR) School &
Effectivity Date
Reason and Effectivity Date
Reason (Enrollment beyond 1st Friday of
CCT Receipient
Balik Aral
Learner With
Disability
Accelerated
CCT
B/A
LWD
ACL
Revision 4
BoSY Date: EoSY Date: BoSY Date: EoSY Date:
Generated on: Wednesday, August 13, 2014 8:50:08 AM
CCT Control/reference number & Effectivity Date
Name of school last attended & Year
Specify
Specify Level & Effectivity Data
MALE
JENEFFER LAYAN SALADO JENEFFER LAYAN SALADO
FEMALE
(Signature of Adviser over Printed Name) (Signature of School Head over Printed Name)
TOTAL
School Form 1 (SF 1) School Register
(This replaces Form 1, Master List & STS Form 2-Family Background and Profile)
Vallehermoso
MULTIGRADE 3-5
REMARKS
(Please refer to
the legend on last
page)
Certified Correct:
EoSY Date:
Generated on: Wednesday, August 13, 2014 8:50:08 AM
JENEFFER LAYAN SALADO
(Signature of School Head over Printed Name)