Department of Education

ALTERNATIVE LEARNING SYSTEM

MASTERLIST OF MAPPED AND POTENTIAL LEARNERS (AF1)

District Division: Region Calendar Year

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 If already enrolled in
(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) ALS, provide date
No./Street/ Barangay Municipality/ City Province Name, First Name, Middle (Last Name, First (if available) Formal School ALS? Preferred
of first attendance
Sitio/ Purok Name) Name, Middle Name) Yes or No Program
(DOFA) and LRN

MAPPED LEARNERS as of (MM/DD/YY) ENROLLED LEARNERS as of (MM/DD/YY) Prepared By:

Signature of Facilitator over Printed Name

MALE MALE

FEMALE FEMALE
 Certified Correct: Signature of PSDS over Printed Name
TOTAL TOTAL
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
SFRT 2017
 Republic of the Philippines
AF-3
Department of Education
ALTERNATIVE LEARNING SYSTEM
MASTERLIST OF ENROLLED LEARNERS WITH END OF PROGRAM/CY STATUS (AF-3)
District Division Region Calendar Year

Type of
Name of CLC Barangay City/Municipality
CLC

NON FORMAL EDUCATION

PROGRAM ENROLLED Assessment for Basic Literacy
Functional Literacy Assessment (FLT) Score
(ABL)

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

Basic Literate

Post Literate
Neo Literate
Name, Name Extension) CY Status
Type of Listening & Overall
Mode of Program Delivery Reading Numeracy Writing
Program Speaking Score

<=== TOTAL MALE

<=== TOTAL FEMALE

<=== COMBINED

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

BLP Face to Face Prepared By:

A&E Elem. Independent Learning
A&E Sec. Radio-based Instruction
InFED Computer-based Instruction Signature of Facilitator over Printed Name

Learners Enrolled in BLP

by Level
Male Female Total Enrolled Learners Male Female Total Certified Correct By:
Basic Literate Number of 4P's Learners
Neo Literate Percent of Enrolled 4P's Learners
Signature of PSDS over Printed Name
Post Literate
AF-3
 Republic of the Philippines AF-4
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)

CLC DETAILS

Sex (M/F)

Birthdate
NAME
A&E Test Level Date of
LRN (Last Name, CLC Registered
Date Registered
Examination
First Name, Middle Name, Ext) CLC Name Barangay Municipal
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
F-4
 Republic of the Philippines AF-5
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 Post
PIS Score PIS Score
Assesment for Basic Literacy (ABL) Pre Post Assesment for Basic Literacy (ABL) Pre Post
Basic Literate Basic Literate
Neo Literate Neo Literate
Post Literate Post Literate
Functional Literacy Assessment Pre Post Functional Literacy Assessment Pre Post
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 0
InfEd Remarks InfEd Remarks

A & E STATUS Remarks A & E STATUS Remarks

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 character.
This certification is issued upon request of the concerned individual due to This certification is issued upon request of the concerned individual due to
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 Coordinator/EPSA

F-5