Republika ng Pilipinas

Kagawaran ng Edukasyon
Rehiyon IX
Zamboanga del Sur
Sangay ng Lungsod ng Guipos
LITAN ELEMENTARY SCHOOL
GUIPOS DISTRICT 1

LEARNER’S PROFILE
School Year: 2021 - 2022

Complete Name: ____________________________________________ Grade & Section: ___________

(Surname, First Name, Middle Name)
Date of Birth: ______________________ Age: ________ Gender: MALE FEMALE
Religion: _______________________ 4Ps Member? YES NO
Vaccinated? YES NO No. of Family Members: _____________

Comorbidities: ________________________________ Contact Number/s: __________________

Complete Home Address: _______________________________ Owned Renter
Length of Stay: __________________
Mode of Transportation in Going to School:
(Public) Tricycle Private owned vehicle PUJ
By walking Habal-Habal Others (Specify) ______________

Living with:
Both Parents Father Only Grandparents
Mother Only Relatives

Who assist in studying? ______________________

Parents/Guardian’s Profile:
Mother: ________________________________ Vaccinated? YES NO
(Surname, First Name, Middle Name)

Occupation: __________________________

Father: __________________________________ Vaccinated? YES NO

(Surname, First Name, Middle Name)

Occupation: __________________________

Guardian: ________________________________ Vaccinated? YES NO

(Surname, First Name, Middle Name)
Occupation: __________________________
Previous School Attended (if transferee): _____________________________________________
Previous School Address: ___________________________________________________________

___________________________________________
PANGALAN UG PIRMA SA GINIKANAN
Petsa: __________________________