DepEd – DIVISION OF QUEZON

Sitio Fori, Brgy. Talipan, Pagbilao, Quezon QUALITY

ASSURED
COMPANY
Cell # 09175824627 or at www.depedquezon.com.ph ISO 9001

“Creating Possibilities, Inspiring Innovations” Registration Number:

QAC/R63/0216

REQUEST for CORRECTION OF LEARNER PROFILE

(Email Subject: <Type of Request> <School ID> <Name of Learner>)

Basic Information
Old Data New Data
Last Name

First Name

Middle Name

Extension name

Birthdate

Gender

LRN

Checklist of Documents to Be Submitted

 Birth Certificate (PSA/NSO or Local Civil Registrar) or Barangay Certificate or Baptismal Certificate
 Previous SF9/10 (Form 137/138) or other equivalent documents such as but not limited to A&E/PEPT/PVT
Result
 Request for Correction of Learner Profile Template
Reason/s for CORRECTING Basic Profile
Reason/s:

Certified True and Correct

Signature

Printed Name

Designation Class Adviser School Head

Contact Number
(if available)
*Fill out all boxes completely and legibly.

DEPEDQUEZON-SGO-PAR-04-028-001
Email address: quezon@deped.gov.ph
Comments: Txt HELEN – 09178902327 (Smart/Sun/TalknTxt) 2327 (Globe and TM)
Cell No: 09175824629
This form is a property of SCHOOLS DIVISION OFFICE - QUEZON PROVINCE. Therefore, unauthorized use is strictly prohibited unless otherwise
permitted by the Schools Division Superintendent.