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Enclosure No. 2 to DepEd Order No. 4, s.

2012

Form 1

DEPARTMENT OF EDUCATION
EARLY REGISTRATION FORM
School ID: 124961
Region : IX, Zamboanga Peninsula Division: Zamboanga del Sur
School Name: Dinas Central ES
District : Dinas
_____________________
Kindergarten/Grade Level
No

LRN

Name

S
e
x

Age

Birth date

Address

CATEGORY/
W/DISABILITY
(for Children
and Youth with
Disabilities only)

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.

Remarks :
1. For Grade 1 Registrants: Has Attended/not attended Kindergarten class
2. For ALS: Information whether the child/youth prefers to learn through the ADM = alternative
delivery mode (MISOSA, e- IMPACT, DORP) or ALS = alternative learning system
Category of C/Y with Disability** : Visual Impairment, Intellectual Disability, Learning Disability,
Speech/Language Impairment, Serious Emotional Disturbance, Autism, Orthopedic Impairment, Special
Health Problem, Multiple Disabilities.

Prepared by :
Submitted by :
________________________
Teacher

___________________
School Head

Remarks

Enclosure No. 3a to DepEd Order No. 4, s. 2012


FORM 2A

School Plan to Address Needs


Name of Elementary School: _____________________
Division:
Zamboanga del Sur___
Date Accomplished :
_____________________

Region: ___IX___

Please indicate additional inputs needed.


Grade Level

Tentative
Enrolment

A. Additional Inputs Needed


Classroom

Teachers

( Pls. indicate number)


Textbooks

Seats

1. Kindergarten
2. Grade 1
3. Grade 2
4. Grade 3
5. Grade 4
6. Grade 5
7. Grade 6
Total
Learners
under
ADMs/ALS
Age 9
Age 10
Age 11
Age 12 and above
TOTAL

the Tentative Enrolment

Categories of Disability
Children with Visual Impairment
Hearing Impairment
Intellectual Disability
Speech/Language Impairment
Serious Emotional Disturbance
Autism
Orthopaedic Impairment
Special Health Problems
Multiple Disabilities
TOTAL

Tentative
Enrolment

B. Inputs Needs
Teacher-Facilitator
Modules

C. Additional Inputs Needed (Please indicate number)


Classroom
Teachers
Textbooks
Seats

D.
Proposed
Differentiated
Program E. Assistance Needed
Intervention
1. Formal Delivery System:
0
2. ADMs/ALS
0
3. Special Education in Inclusive Setting:
0
Submitted by:
_________________________
Name and Signature of School Head
____________________
Designation
Cell Phone Number: ________________
E-mail address : ___________________

Enclosure No. 3a to DepEd Order No. 4, s. 2012


FORM 2A

School Plan to Address Needs


Name of Elementary School: __Bacawan ES
Division:
Zamboanga del Sur___
Date Accomplished :
___January 30, 2014____

School ID: 124959


Region: ___IX___

Please indicate additional inputs needed.


Grade Level

Tentative
Enrolment

A. Additional Inputs Needed


Classroom
0
0
0
0
0
0
0
0

1. Kindergarten
2. Grade 1
3. Grade 2
4. Grade 3
5. Grade 4
6. Grade 5
7. Grade 6
Total

10
12
9
8
8
9
12
68

Learners
under
ADMs/ALS
Age 9
Age 10
Age 11
Age 12 and above
TOTAL

the Tentative Enrolment

Categories of Disability
Children with Visual Impairment
Hearing Impairment
Intellectual Disability
Speech/Language Impairment
Serious Emotional Disturbance
Autism
Orthopaedic Impairment
Special Health Problems
Multiple Disabilities
TOTAL

0
0
0
0
0
Tentative
Enrolment
0
0
0
0
0
0
0
0
0
0

Teachers
1
1
1
3

( Pls. indicate number)

Textbooks
10
12
9
8
8
9
12
68

Seats
0
0
0
0
0
0
0
0

B. Inputs Needs
Teacher-Facilitator
Modules
0
0
0
0
0
0
0
0
0
0

C. Additional Inputs Needed (Please indicate number)


Classroom
Teachers
Textbooks
Seats
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

D.
Proposed
Differentiated
Program E. Assistance Needed
Intervention
1. Formal Delivery System:
0
2. ADMs/ALS
0
3. Special Education in Inclusive Setting:
0
Submitted by:
JULIET M. MACARATE_____
Name and Signature of School Head
____________________
Designation
Cell Phone Number: ___09076195159
E-mail address : ___________________