Definition: is a process of resolving issues that does not fall into any Re

Submit to: Division Planning Officer, Schools Governance and Operatio

Note: Endorsement of School Head is required (signed and scanne

Region-Division School Name School ID

Teacher/ICT Coordinator
Requested by
Position/Designation

Note for School:

1. Fill-up all the applicable information correctly
2. Attach this form as Excel file.
3. Attach a scanned copy of the form with School Head signa
 4. Attach the following copies, if applicable:
a. Birth Certificate
b. Form 137/School Form 10 and/or Form 138/School For
5. If system error, provide screenshot

Note for Division Planning Officer:

1. Consolidate requests by school by issue
 ICTS - Us
Learner Information System (LIS) an
Nati
Inc

at does not fall into any Request Forms

Governance and Operations Division
quired (signed and scanned). Please use worksheet/excel format for the matrix.

Details of Affected Data

LRN First Name Middle Name

oordinator School's Email Address

ion correctly

m with School Head signature

plicable:

nd/or Form 138/School Form 9

by issue
 ICTS - User Support Division
Learner Information System (LIS) and Basic Education Information System (BEIS)
National Helpdesk
Incident Report

Date of Birth
Last Name Ext Name Sex
(MM/DD/YYYY)

School's Contact Number School Head/System Admin Username

 School Class Calendar

Mother's Maiden Start Date End Date

Name (MM/DD/YYYY) (MM/DD/YYYY)

Date Requested Endorsed by Signature

School Head Name
 Code
1. Elementary
2. Secondary Description of Issue
3. SHS 1st Sem
4. SHS 2nd Sem