Republic of the Philippines

DEPARTMENT OF EDUCATION
Region I
Division of Pangasinan II
District of Pozorrubio I
MALASIN ELEMENTARY SCHOOL
Pozorrubio

LEARNER PROFILE

Learners Reference Number (LRN): _________________________

PART I
Name
Surname First Name Middle Name
Date of Birth
Month Day Year
Address
Barangay City/Municipality Province
Father
Surname First Name Middle Name

Date of Birth Occupation Contact Number

Mother
Surname First Name Middle Name

Date of Birth Occupation Contact Number

Guardian
Surname First Name Middle Name

Date of Birth Occupation Contact Number

PART II
Height Weight
Height-For- Body Mass Index
Age
Do you have Yes No Specify:
ailments?
(Attach medical
records/certificates)
PART III
Level School School Year Teacher
Kinder
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6

Accomplished by: ________________________________

(Signature over printed name)