BASIC PROFILE One letter per box. DATA PROCESSING:
Learner Reference Number (LRN) : Date of Registration: FAMILY NAME FIRST NAME MIDDLE NAME Registration In-charge DATE OF BIRTH GENDER m m d d y y y y (M/F) Date of Entrance: ADDRESS : STATUS Other Details: Regular Mother Tongue : 4Ps Class Adviser Transferee Religion : IPs Balik - Aral Ethnicity : ECD Date Encoded in L.I.S.: Repeater Dialect : PWD
ENROLMENT PROFILE L.I.S. In-charge
Previous Enrolment Remarks: School ID No.: Grade Level: PWD , State below: Name of School: Name of Adviser:
PARENT'S / GUARDIAN INFORMATION Documents Submitted:
Father's Name Birth Certificate FAMILY NAME: NSO Copy FIRST NAME: LCR Copy MIDDLE NAME: DepED Form 137
Mother' Maiden Name DepED Form 138
FAMILY NAME: Good Moral Cert. FIRST NAME: Clearance MIDDLE NAME: Guardian Name Other Notes: FAMILY NAME: FIRST NAME: MIDDLE NAME: RELATIONSHIP: MOBILE PHONE NUMBER : Certified True and Correct : Attested by:
Thumb Mark, if cannot sign. Signature over Printed Name Date Signed Class Adviser dohly.bucarile@deped.gov.ph