Republic of the Philippines

Department of Education
REGION IV-A CALABARZON
DIVISION OF BATANGAS
DISTRICT OF BALETE
MALABANAN ELEMENTARY SCHOOL

LEARNER’S PROFILE
Name:________________________________________________________________________
(Last Name First Name Middle Name Extension Name

Birthday:______________________________ Age:_________________ Sex: __________________

Religion:_____________________________ Nationality:_________________ Contact No.____________
Address:_______________________________________________________________________________
Father’s Name: _________________________________Age:_____ Occupation: ____________________
Mother’sName:________________________________Age:_____Occupation: _____________________
Name of Guardian:_____________________________________ Relation: _________________________
No. of Children in the Family: ___________ No. of Boys: ____________ No. of Girls: ____________
Sibling Position: ________________________________________________________________________
Date of entry (Grade ): _________ 4Ps / CCT Recipient: Yes: ________ No: ________
Date of Measurement: Height (m): Weight (kg):
Vaccinated: Yes No Date of Vaccination: First:_____________ Second:____________
Allergy/s:______________________________________________________________________________

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Yes No Pls. specify
Resides within the municipality?

Can you walk your way to school?

Are you using private transport to go to school?
Are you using public transport to go to school?
Do you have comorbidities?

Do you have parents/Guardians that can help you at home? If yes, who?

Do you have other health problems? If yes, what

kind of health problems?

Malabanan, Balete, Batangas

(043)7418464
09162910121/09617738888
malabanan107254@gmail.com
 Republic of the Philippines
Department of Education
REGION IV-A CALABARZON
DIVISION OF BATANGAS
DISTRICT OF BALETE
MALABANAN ELEMENTARY SCHOOL

Do you need assistive devices such as wheelchairs, If yes, what

cane, walkers and others kind of assistive device?

Do you need modules in braille, mother-tongue If yes, pls. specify

languages, and usage of Filipino Sign Language

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Please put a check inside the box if the learner is:
a. indigent children
b. out-of-school youth
c. physically and mentally handicapped
d. distressed individuals and families, including
internally displaced persons (IDPs)
e. low resourced students
f. abandoned and neglected children
g. street children
h. children of former rebels
i. children living in conflict-affected areas and
vulnerable communities (CVAS)
j. children from Geographically Isolated and
Disadvantaged Areas

List down your friends and neighbor who live within the same area .
No. Name Grade
1
2
3
4

Malabanan, Balete, Batangas

(043)7418464
09162910121/09617738888
malabanan107254@gmail.com
 Republic of the Philippines
Department of Education
REGION IV-A CALABARZON
DIVISION OF BATANGAS
DISTRICT OF BALETE
MALABANAN ELEMENTARY SCHOOL
5
6
7
8
9
10

Malabanan, Balete, Batangas

(043)7418464
09162910121/09617738888
malabanan107254@gmail.com