Department of Education

ALTERNATIVE LEARNING SYSTEM

MASTERLIST OF MAPPED AND POTENTIAL LEARNERS (AF1)

District BARAS SOUTH Division: CATANDUANES Region V(BICOL) Calendar Year 2018

COMPLETE HOME ADDRESS PARENTS REMARKS

Contact Last Grade

Sex (M/F)

NAME IP
Date of Birth Mother Number of Level Date Mapped
(Last Name, First Name, Name Age (Yes or Religion
(mm/dd/yyyy) Tongue House Father's Name (Last Mother's Maiden Name Learner Completed in (mm/dd/yyyy) Interested in If Yes,
Extension, Middle Name) No)
No./Street/ Barangay Municipality/ City Province Name, First Name, Middle (Last Name, First (if available) Formal School ALS? Preferred
Sitio/ Purok Name) Name, Middle Name) Yes or No Program
MAPPED LEARNERS as of (MM/DD/YY) ENROLLED LEARNERS as of Prepared By:
(MM/DD/YY)

Signature of Facilitator over Printed Name

MALE MALE

FEMALE FEMALE

Certified Correct: Signature of PSDS over Printed Name

TOTAL TOTAL
RKS

If already enrolled
in ALS, provide date
of first attendance
(DOFA) and LRN
SFRT 2017
AF2 Republic of the Philippines
Department of Education
ALTERNATIVE LEARNING SYSTEM
ALS ENROLMENT FORM (AF2)
Learner's Basic Profile

Date : LRN (if available) :

Personal Information (Part I)

Last Name First Name Middle Name Name Extension

• Address:
House No./Street/Sitio Barangay Municipality/City Province
• Birthdate (mm/dd/yyyy): _____/_____/________ Place of Birth (Municipality/City)

• Sex: □Male □Female • Civil Status: □Single □Married □Widow/er □Separated □Solo Parent
• Religion: ____________• IP (Specify ethnic group) : ______________ • Mother Tongue : _______________ PWD: □Yes □No
• Name of Father/Legal Guardian

Last Name First Name Middle Name Occupation

• Mother's Maiden Name

Last Name First Name Middle Name Occupation

Educational information (Part II)

• Last grade level completed
Elementary : □K □G-1 □G-2 □G-3 □G-4 □G-5 □G-6
Secondary : □G-7 □G-8 □G-9 □G-10
• Why did you drop out of school? (For OSY only)
□No school in Barangay □School too far from home □Needed to help family
□Unable to pay for miscellaneous and other expenses Others:

• Have you attended ALS learning sessions before? □YES □NO

If Yes:
Name of the Program: _____________________________________________ Level of Literacy: □Basic □Elem. □Sec. □InfEd
Year Attended: ___________ Have you completed the Program? (Yes/No) _______
If NO, state the reason:

Accessibility and Availability (Part III)

• How far is it from your home to your Learning Center? in kms in hours and mins.
• How do you get from your home to your Learning Center? □Walking □Motorcycle □Bicycle □Others (Pls. Specify) ___________
• When can you attend your Learning Session?

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

What specific time

can you be at your
Learning Center?

_______________________________________ _____________________________
Facilitator: Signature and Date Learner: Signature and Date
 Republic of the Philippines
Department of Education
ALTERNATIVE LEARNING SYSTEM
MASTERLIST OF ENROLLED LEARNERS WITH END OF PROGRAM/CY STATUS
District Division Region

Type of
Name of CLC Barangay
CLC

NON FO
PROGRAM ENROLLED Assessment for Basic
Literacy (ABL)

PIS Score
Sex (M/F)
NAME
Birthdate First Date of
LRN (Last Name, First Name, Middle Age
(mmddyyyy) Attendance

Basic Literate

Post Literate
Neo Literate
Name, Name Extension)
Type of
Mode of Program Delivery
Program

8/19/1997 21.6667
12/13/2000 18.3333

<=== TOTAL MALE

<=== TOTAL FEMALE
<=== COMBINED

Learners Enrolled
Learners Enrolled by Program Male Female Total
by Program Delivery
Male Female Total

BLP Face to Face

A&E Elem. Independent Learning
A&E Sec. Radio-based Instruction
InFED Computer-based Instruction

Learners Enrolled in BLP

by Level
Male Female Total Enrolled Learners Male Female Total
Basic Literate Number of 4P's Learners
Neo Literate Percent of Enrolled 4P's Learners
Post Literate
 AF-3

STATUS (AF-3)
Calendar Year

City/Municipality

NON FORMAL EDUCATION

Functional Literacy Assessment (FLT) Score

End of
Program/ Remarks
CY Status
Listening & Overall
Reading Numeracy Writing
Speaking Score
Prepared By:

Signature of Facilitator over Printed Name

Certified Correct By:

Signature of PSDS over Printed Name

 Republic of the Philippines
Department of Education
ALTERNATIVE LEARNING SYSTEM
MASTERLIST OF A&E REGISTRANTS (AF-4)
District Division Region

Place of Registration Center

(Name of School/Center, Barangay, Municipality)
(Testing Center) (Barangay) (Municipality/City)

NAME CLC DETAILS

Sex (M/F)

Birthdate
A&E Test Level Date
LRN CLC
(Last Name, First Name, Middle Registered Registered
CLC Name Barangay Municipal
Name, Ext) Type

<=== TOTAL MALE

<=== TOTAL FEMALE

<=== COMBINED

Registered Male Female Total Prepared By:

Elementary Signature of Facilitator over Printed Name
Secondary
 Taker Male Female Total Certified Correct By:
Elementary
Secondary Signature of PSDS/DC over Printed Name
 AF-4

y/City)

Date of
Examination

ed Name
ed Name
 Republic of the Philippines
Department of Education
ALTERNATIVE LEARNING SYSTEM

LEARNER'S PERMANENT RECORD (AF-5)

DISTRICT: DIVISION: REGION:

LEARNER'S INFORMATION LRN:_________________

___
LAST NAME: FIRST NAME: _____________________ NAME EXTENSION: ______ MIDDLE NAME: ___________

ADDRESS:
HOUSE NO./ SITIO / ST. BARANGAY MUNICIPALITY/CITY PROVINCE

BIRTHDATE: MONTH _____/ DATE__________ / YEAR______________ SEX: Male Female

LEARNER'S EDUCATIONAL STATUS

Program Enrolled : Program Enrolled :
Delivery Mode : Delivery Mode :
CLC Name : CLC Name :
CLC Address : CLC Address :
Name of Facilitator : Name of Facilitator :
Calendar Year : Calendar Year :

Score Score
ASSESSMENT RESULTS ASSESSMENT RESULTS
Pre Post Pre
PIS Score PIS Score
Assesment for Basic Literacy (ABL) Pre Post Assesment for Basic Literacy (ABL) Pre
Basic Literate Basic Literate
Neo Literate Neo Literate
Post Literate Post Literate
Functional Literacy Assessment Pre Post Functional Literacy Assessment Pre
FLT Score in Reading FLT Score in Reading
FLT Score in Numeracy FLT Score in Numeracy
FLT Score in Writing FLT Score in Writing
FLT Score in Listening & Speaking FLT Score in Listening & Speaking
Overall Score 0 0 Overall Score 0
InfEd Remarks InfEd Remark

A & E STATUS Remarks A & E STATUS

Program Status Program Status
Test Taken Test Taken
Date of Examination Date of Examination
Testing Center Testing Center
Location of Testing Center Location of Testing Center
Accreditation and Equivalency (A&E) Test Result Accreditation and Equivalency (A&E) Test Result

Certificate of Transfer Certificate of Transfer

Eligible for Admission to : Eligible for Admission to :
 Certificate of Good Moral Character Certificate of Good Moral Character
This is to certify that the above-named is a learner of good moral character. This is to certify that the above-named is a learner of good moral charac
This certification is issued upon request of the concerned individual due to This certification is issued upon request of the concerned individual due
his/her desire to pursue formal schooling/other CLC or for employment. his/her desire to pursue formal schooling/other CLC or for employment.

Prepared By: Certified Correct By: Prepared By: Certified Correct By:

Facilitator PSDS/District Coordinator/EPSA Facilitator PSDS/District Coordinato

 AF-5

______________

___________________

CE

Female

Score
Post

Post

Post

0
Remarks

Remarks
racter
moral character.
dividual due to
mployment.

Coordinator/EPSA