ICTS - User Support Division

Learner Information System (LIS) and Basic Education Information System (BEIS)
National Helpdesk
Template for Unenrollment of Learner (Request Form 15)

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 worksheet/excel format for the matrix.

Present and Correct Enrolment Learner's Personal Information Unenroled From

Date of First
Reason for
Region Division School School ID Grade Section Attendance
LRN
First Name Middle Name Last Name Ext Name
Date of Birth
(MM/DD/YYYY)
Gender Region Division School School ID Grade Section School Year Unenrolment
(MM/DD/YYYY)

Promoted to Grade 11
through the Certification
Masbate Masbate
Masbate September 01, Masbate from ALS-CLC indicating
V Southeastern 403781 Grade 11 Plato 113809100035 JOVELYN CAPATAN-PATAN PAPA N/A 12/21/2004 FEMALE V Southeastern 403781 Grade 8 Arbutos 2021-2022
Province 2021 Province the successful
Institute Institute
Presentation Portfolio
Assessment.

Requested Teacher/ICT Coordinator Name of School School ID Division Region Date Signature
Endorsed by
by Masbate Southeastern Institute 403781
REYMART D. TAGALOG Masbate Province V May 17, 2022 School Head Name ARTURO S. ESPENILLA JR.

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