PERSONAL DATA SHEET OF LEARNER

Grade ONE- 12

(Last Name, First Name Middle Name)

Complete name of
Learner:
Date of Birth: Age:

Religion:
(Please check your answer)
4P’s Beneficiary: YES ( ) NO ( )

Complete Address:

Father’s Name:

Occupation:

Active Contact Number:

Mother’s Name:

Occupation:

Active Contact Number:

Guardian’s Name:

Occupation:

Active Contact Number:

LENOVO TABLET SERIAL #:

(Please check your answer)
STATUS OF TABLET: SERVICEABLE ( ) SLIGHTLY DAMAGE ( ) UNSERVICEABLE ( ) LOSS ( )

APRIL JOYME V. FELICIANO

Adviser