Republic of the Philippines

Department of Education
ALTERNATIVE LEARNING SYSTEM

LEARNER'S PERMANENT RECORD (AF-5)

DISTRICT: «District» DIVISION: General Santos City REGION: XII

LEARNER'S INFORMATION LRN: Jr.

LAST NAME: «LAST» FIRST NAME: «FIRST» NAME EXTENSION: «E MIDDLE NAME: «MIDDLE»
ADDRESS: «House__Sitio_Street» «Brgy1» XT
«Municipality1» «Province»
HOUSE NO./ SITIO / ST. BARANGAY MUNICIPALITY/CITY PROVINCE
BIRTHDATE: MONTH « / DATE «D / YEAR «Yea SEX: Male Female
M ay r»
LEARNER'S EDUCATIONAL STATUS
Program Enrolled : «Program» Program Enrolled :
Delivery Mode : «Delivery_Mode» Delivery Mode :
CLC Name : «CLC» CLC Name :
CLC Address : «CLC_Address» CLC Address :
Name of ALS Teacher/Community Name of ALS Teacher/Community
ALS Implementor/Learning Facilitator : «ALS_Teacher» ALS Implementor/Learning Facilitator :
School Year : «SY» School Year :
Score Score
ASSESSMENT RESULTS ASSESSMENT RESULTS
Pre Post Pre Post
PIS Score «P «P PIS Score
Assesment for Basic Literacy (ABL) RE
Pre O
Post Assesment for Basic Literacy (ABL) Pre Post
Neo Literate «B
_P « Neo Literate
Post Literate LP
IS
«B «PN Post Literate
Functional Literacy Assessment (FLT) LP
Pre_» os
Post Functional Literacy Assessment (FLT) Pre Post
LS 1 - Communication Skills (English) N
_P
«P «P LS 1 - Communication Skills (English)
Multiple Choice eo
RE
os « O« Multiple Choice
Writing M«»
_L
t» ST
M« Writing
Listening/Speaking S1
«S
W
ul _L
«S
Wul Listening/Speaking
LS 1 - Communication Skills (Filipino) «P
_E
pe
tip
ri «L
S1
pe
tip
ri LS 1 - Communication Skills (Filipino)
Multiple Choice RE
ng
ak
«
tin
le S1
_E
ak«
tin
le Multiple Choice
Pagsulat _L
M
lis
in
_C
g1« _P
ng
Min
_C
g3« Pagsulat
Pakikinig/Pagsasalita S1
h»
g_
W
«S
ul
ho» lis
ul
O
«S
g_
W
ho» Pakikinig/Pagsasalita
LS 2 - Scientific Literacy and Critical Thinking Skills _F
tip
Lis
pe
ri
ic
«P tip
h»
ST
pe
Lis
«Pri
ic LS 2 - Scientific Literacy and Critical Thinking Skills
LS 3 - Mathematical and Problem Solving Skills ili
tin
ak
te
le
e»
«P
RE _F
le
tin
ak
te
e2
O
«P LS 3 - Mathematical and Problem Solving Skills
LS 4 - Life and Career Skills pi
_C
g2
ni
in
«P
RE
_L _C
ili
g4
in
ni
«P
ST
O» LS 4 - Life and Career Skills
LS 5 - Understanding the Self and Society no
ho
«P
ng
g_
»
RE
S2
_L ho
pi
«P
g_
ng
O
_L
ST» LS 5 - Understanding the Self and Society
LS 6 - Digital Citizenship RE
«P»
Lis
ic
_L
S3 no
ic
«P
Lis
2»
O
ST
S2
_L LS 6 - Digital Citizenship
Overall Score e1
RE
_L
te
«P
S4 » e2
ST
te
O
«P
_L
»
S3 Overall Score
PRESENTATION PORTFOLIO ASSESSMENT S5
_L
ni
RE» ST
_L
ni
S4
O
»
Remarks PRESENTATION PORTFOLIO ASSESSMENT Remarks
S6
ng _» ng
S5
_L
ST»
Date of Assessment: «Date_of_Assessm Date of Assessment
1»
O » ent» 3»
S6
»
_
Presentation Portfolio Assessment Score «P Presentation Portfolio Assessment Score
ve »
O
Final Assessment P Final Assessment
ral ve
LS 1 - Communication Skills (English) «L LS 1 - Communication Skills (English)
l_ ral
LS 1 - Communication Skills (Filipino) «L
S1 LS 1 - Communication Skills (Filipino)
Sc l_S1
LS 2 - Scientific Literacy and Critical Thinking Skills or «L
_E LS 2 - Scientific Literacy and Critical Thinking Skills
Sc_F
LS 3 - Mathematical and Problem Solving Skills S2
«L
ng LS 3 - Mathematical and Problem Solving Skills
e» orili
LS 4 - Life and Career Skills »
S3
lis
«L LS 4 - Life and Career Skills
e»pi
LS 5 - Understanding the Self and Society «L
»
h»
S4 LS 5 - Understanding the Self and Society
LS 6 - Digital Citizenship no
S5
«L
» LS 6 - Digital Citizenship
TOTAL SCORE »
«T
S6 TOTAL SCORE
Inter-District Revalida ot
» Inter-District Revalida
Revalida of Presentation Portfolio «R Revalida of Presentation Portfolio
Reading «R
ev Reading
Writing «
ea Writing
Remark «Remark» W Remark

Certificate of Transfer Certificate of Transfer

Eligible for Admission : «Eligible_for_Admission»
Certificate of Good Moral Character
This is to certify that the above-named is a learner of good moral character.
This certification is issued upon request of the concerned individual due to
his/her desire to pursue formal schooling/other CLC or for employment.
Eligible for Admission to :
Certificate of Good Moral Character
This is to certify that the above-named is a learner of good moral character.
This certification is issued upon request of the concerned individual due to
his/her desire to pursue formal schooling/other CLC or for employment.

Prepared By: Certified Correct By: Prepared By: Certified Correct By:

«ALS_Teacher»
CHESTER C. DOMINGO JULIET F. LASTIMOSA
ALS Teacher
Teacher
ALS Division ALS Focal Person ALS Teacher Division ALS Focal Person