School ID : 108123

School Name : KAONG ELEMENTARY SCHOOL

E-mail Address : depedcavite.kaonges@gmail.com
Contact Number : 09684922020
Date : September 22, 2022

Form 2. CHANGE REQUEST FORM

(ENROLMENT WITH GAP / ENROLMENT OF INELIGIBLE / CORRECTION OF GRADE LEVEL)
Instructions: 1. Fill up the LRN and the necessary details in the Learner's Name Columns.
2.Indicate the appropriate level (Elementary or Secondary) of the learner.

1
For Proof of Grade Level:
Present a photocopy of any of the following per learner:
- SF10 (Last School Year Attended) - PEPT Result
- SF9 (Last School Year Attended) - Notarized Affidavit of Undertaking
- Certificate of Completion (Last Grade Level Completed) - A&E Result

Legend in Remarks Column:

A = Approved DA = Disapproved NLR = No LIS Request INC(NPGL) - Incomplete Attachment (No / Wrong Proof of Grade Level)

Learner's Name To be filled up by

Level Proof of Division Personnel
LRN (Elem / Grade
Extension Secondary) Level 1
Last name First Name Middle Name Name Remarks

107939170245 YECYEC ALEXIS LLOU Elementary ✘

108123180068 BAGUAL TRISTAN MORLAN BOBADILLA Elementary ✘

Requested by: Processed by:

JENIFER M. SOTTO
Signature over Printed Name Planning & Research Unit
School Representative

Document Reference Code:

DOC-PAR-FR-003
Revision No.:
Rev.04
 To be filled up by
Learner's Name Level Proof of Division Personnel
LRN (Elem / Grade
Last name First Name Middle Name Extension Secondary) Level 1 Status
Name

Requested by: Processed by:

JENIFER M. SOTTO
Signature over Printed Name Planning & Research Unit
School Representative

Document Reference Code:

DOC-PAR-FR-003
Revision No.:
Rev.04