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ICT TECHNICAL ASSISTANCE (TA) FORM

CLIENT INFORMATION Short Description of your Request/Problems


First Name: Alvin Encountered:
Last Name: Novencido ____________________________________________________________
Office/School: Naguilian National High School ____________________________________________________________
Date of Request: May 20, 2020 ____________________________________________________________
Time of Request: 6:00 Pm ____________________________________________________________
If Applicable: ____________________________________________________________
District/Cluster: Naguilian ____________________________________________________________
School Head: Orlando B. Nicolas ____________________________________________________________
Contact No.: ________________________ ____________________________________________________________
ICT Coordinator: Genevev Reyes ____________________________________________________________
Contact No.: ________________________ ____________________________________________________________
For DepED Email Creation/Reset/Suspension/Deletion: ____________________________________________________________
Middle Name: Agonoy ____________________________________________________________
DepED Email: alvin. novencido@deped.gov ____________________________________________________________
Recovery Information: ____________________________________________________________
Personal E-Mail: __________________________________ ____________________________________________________________
Permanent Mobile No.: _09057871428 ___________________________________

---for the ICT Unit---

NATURE Hardware Software Network Others


1. Printer 4. Internal 7. OS 10. Installation 13. LAN Configuration 16. DCP
OF
2. System Unit 5. Peripherals 8. Drivers 11. Update 14. Router/Cables
REQUEST 3. Monitor/Display 6. Connectors/Plugs/Power 9. Malware 12. Files/Data 15. Internet
ITEM DESCRIPTION SERIAL NO. PROBLEM/ISSUE
FINDINGS

(Property Number) (Please specify) (Please specify)


ACTION
TAKEN

STATUS/RECOMMENDATION:
( ) GOOD/RETURNED ( ) CHECK FOR AUTHORIZED SERVICE CENTER ( ) FOR PART REPLACEMENT ( ) UNSERVICEABLE

CLIENT FEEDBACK (SDO Client): Client (SDO Proper)/ Noted/Processed by:


Excellent
(4)
Very
Good
Good
(2)
Satisfactorily
(1)
School Head (Schools):
(3)

ORLANDO L. NICOLAS, JR.


Date Finished: ________________________
Signature Over Printed Name
Time Finished: ________________________
Information Technology Officer I
Alibagu, City of Ilagan, Isabela 3300 deped-isabela.com.ph
(078) 323-0281; (078) 323-2015 Sdo Isabela
isabela@deped.gov.ph
Doc Code: FM-SDS-ICT-001 Rev: 01
As of: Sept 12, 2019 Page: 1

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