ICTS - U

Learner Information System (LIS)

Na
Template for Unenrollm

Service Request Type : Unenrolment of Learner

Submit to : Division Planning Officer, Schools Governance and Operations Division
Note : Endorsement of School Head is required (signed and scanned). Please use w

Present and Correct Enrolment Learner's

Region Division School School ID Grade Section Date of First LRN
Attendance
(MM/DD/
YYYY)
III Nueva Ecija San Andres I 501857 10 10-GARNET08/23/2021 1.056271E+11

Requeste
d by Teacher/ICT Coordinator Name of School School ID

Sara Jane D. Purificacion San Andres I Integrated School 501857

Note for school:

1. Fill-up the form correctly and completely
2. Attach this form as Excel file.
3. Attach a scanned copy of the form with School Head signature
4. Attach the following copies:
a. Birth Certificate
b. Form 137 and/or Form 138

Note for Division Planning Officer:

1. Consolidate requests by school by issue
2. Submit to Regional Planning Officer for encoding in the online form
 ICTS - User Support Division
Learner Information System (LIS) and Basic Education Information System (BEIS)
National Helpdesk
Template for Unenrollment of Learner (Request Form 15)

nance and Operations Division

(signed and scanned). Please use worksheet/excel format for the matrix.

Learner's Personal Information Unenro

First Name Middle Name Last Name Ext Name Date of Birth Gender Region Division
(MM/DD/
YYYY)

CHRISTIAN DAVE CALIZ AQUINO 02/19/2003 Male III Nueva Ecija

School ID Division Region Date Endorsed by

School Head
501857 Nueva Ecija III 4/28/2022
 Unenroled From Reason for
School School ID Grade Section School Year Unenrolment

San Andres I 501857 10 10-GARNET2021-2022 Eronously Tag

Endorsed by Signature
School Head
Name DEBORAH C. MANUEL