Republic of the Philippines

Department of Education
Region II – Cagayan Valley
Division of Cauayan City

LIST OF HOUSEHOLD-RECIPIENTS OF RADIO GADGET (PER SCHOOL DATA)

School ID:
School Name:

With Children Studying in Other School

(If Yes, put a check mark under the column of the
Name of Household Head corresponding level; No-just put N/A)
Address
(Last Name, Full Name, MI)
ELEMENTARY JUNIOR HS SENIOR HS
Public Private Public Private Public Private
Dela Cruz, Juan M. Turayong Cauayan City / /

Submitted by:

(School Head)