School Form 1 (SF 1) School Register

(This replaces Form 1, Master List & STS Form 2-Family Background and Profile)

School ID 104310 Region II Division Quirino District Diffun II

School Name Pallutan ES School Year 2021 - 2022 Grade Level Grade 4 Section GRADE IV

GUARDIAN
AGE ADDRESS PARENTS
(if Not Parent)
as of MOTHER Contact

Sex (M/F)
IP
LRN
NAME BIRTH DATE 1st TONGUE
(Ethnic
RELIGIO Number of
(Last Name, First Name, Middle Name) (mm/dd/yyyy) Frida (Grade 1 N Mother's Maiden Parent or
Group) House #/ Father's Name (Last
y to 3 Only) Municipality/ Name (Last Name, Guardian
Street/ Sitio/ Barangay Province Name, First Name, Name Relationship
City First Name, Middle
June Purok Middle Name)
Name)

LUNAG, ADHAYON,IRE
LUNAG,CRISTOPHER, Ifugao, Christiani
104310170007 M 03-21-2012 9 Ifugao LIWAYWAY DIFFUN QUIRINO ROGELIO NE,GAMDUTO
ADHAYON Tuwali ty
ADHAYON N,

MUNTICINO,
MUNTICINO,ERNESTO, JR Ifugao, Christiani BUHONG,ZENA
104310170008 M 09-30-2011 9 Ifugao LIWAYWAY DIFFUN QUIRINO ERNESTO
BUHONG Tuwali ty IDA,BAGALA,
BUHONG SR
PINKIHAN,
PINKIHAN,FRANCIS RYAN, Ifugao, Christiani BATTANG,JOA
104310170009 M 07-11-2011 9 Ifugao LIWAYWAY DIFFUN QUIRINO SAMUEL
BATTANG Tuwali ty NA,DULNUAN,
CABBIGAT

POLAHON,
POLAHON JR,MICHAEL ERIC, Ifugao, Christiani PUGONG,ROWE
104310170010 M 11-15-2011 9 Ifugao LIWAYWAY DIFFUN QUIRINO MICHAEL ERIC
PUGONG Tuwali ty NA,DULNUAN,
CALINGAYAN

UMILA,
Ifugao, Christiani PUGONG,GRAC
104310170011 UMILA,KENNY, PUGONG M 05-05-2011 10 Ifugao LIWAYWAY DIFFUN QUIRINO RESTER
Tuwali ty E,DULNUAN,
AMBOJNON
YAB-OD, DULLAWON,JO
YAB-OD,JAYVERSON BRICKS, Ifugao, Christiani
104310160001 M 12-17-2010 10 Ifugao LIWAYWAY DIFFUN QUIRINO JAYSON VELYN,CALAP
DULLAWON Tuwali ty
NAUNGAN ANG,

6 <=== TOTAL MALE

BU-
BAQUIRAN,RAIZA MAE, BU- Ifugao, Christiani BAQUIRAN,
104310170003 F 11-21-2011 9 Ifugao LIWAYWAY DIFFUN QUIRINO UCAN,MYRNA,
UCAN Tuwali ty SAMY BALISI
BUYUCCAN,
PINAO-
Ifugao, Christiani BUHONG, AN,MARY
104310170002 BUHONG,ROXANE, PINAO-AN F 09-18-2011 9 Ifugao LIWAYWAY DIFFUN QUIRINO
Tuwali ty ROGER P JANE,DULNUA
N,
GENITIANO, KIMMAYONG,
GENITIANO,ARIANE MAE, Ifugao, Christiani
104310170004 F 09-10-2011 9 Ifugao LIWAYWAY DIFFUN QUIRINO ARMANDO ABEGAIL,BUG
KIMMAYONG Tuwali ty
VALDEZ GAYAO,

3 <=== TOTAL FEMALE

9 <=== COMBINED

List and Code of Indicators under REMARKS column

Indicator Code Required Information Indicator Code Required Information REGISTERED BoSY EoSY Prepared by; Certified Correct:

Transfered Out T/O Name of Public (P) Private (PR) School & Effectivity CCT Receipient CCT CCT Control/reference number & Effectivity Date ARMANDO O. ZONIO
Date MALE 6
Balik Aral B/A Name of school last attended & Year MICHELLE GUIMMIN (Signature of School Head over Printed Nam
Transfered In T/I Name of Public (P) Private (PR) School & Effectivity
Date Learner With LWD Specify
Disability
Dropped DRP Reason and Effectivity Date Accelerated ACL Specify Level & Effectivity Data
 Diffun II

GRADE IV

REMARKS

Learning
Modality (Please refer to
the legend on last
page)

Modular
(print)

Modular
(print)

Modular
(print)

Modular
(print)

Modular
(print)

Modular
(print)

Modular
(print)

Modular
(print)

Modular
(print)

O O. ZONIO

ead over Printed Name)

Transfered Out T/O Name of Public (P) Private (PR) School & Effectivity CCT Receipient CCT CCT Control/reference number & Effectivity Date
Date
Balik Aral B/A Name of school last attended & Year (Signature of School Head over Printed Nam
Transfered In T/I Name of Public (P) Private (PR) School & Effectivity
Date Learner With LWD Specify (Signature of Adviser over Printed Name)
FEMALE 3
Disability
Dropped DRP Reason and Effectivity Date Accelerated ACL Specify Level & Effectivity Data
Late Enrollment LE Reason (Enrollment beyond 1st Friday of June) BoSY Date: EoSY Date:
TOTAL 9
BoSY Date: EoSY Date:

Generated thru LIS

Generated on: Wednesday, September 29, 2021

ead over Printed Name)

EoSY Date:

d thru LIS