DATA CORRECTION REQUEST ON

Instructions:
1. Copy and paste all names of students, mother’s maiden name, and name of father as appeared in LIS generated S
2. Copy all mother’s maiden name, and name of father as appeared in the birth certificate.
3. Use red font entry as appeared in SF-1 if inconsistent with the birth certificate.

MALE

Name of student in SF-1

(LN, FN, MN)

No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24

FEMALE
Name of student in SF-1

(LN, FN, MN)

No.
 (LN, FN, MN)
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28

_______________________ _________ Date: ______________________

Signature over printed name
DATA CORRECTION REQUEST ON LEARNER’S OTHER DATA
GRADE
SECTION
SEMESTER
SCHOOL YEAR
ADVISER

me, and name of father as appeared in LIS generated SF-1.

eared in the birth certificate.
he birth certificate.

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERT

Mother’s Maiden Name Name of Father Mother’s Maiden Name
(LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERTI

Mother’s Maiden Name Name of Father Mother’s Maiden Name
 (LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

______________
D IN THE BIRTH CERTIFICATE
Name of Father
(LN, FN, MN)

D IN THE BIRTH CERTIFICATE

Name of Father
(LN, FN, MN)
 DATA CORRECTION REQUEST ON

Instructions:
1. Copy and paste all names of students, mother’s maiden name, and name of father as appeared in LIS generated S
2. Copy all mother’s maiden name, and name of father as appeared in the birth certificate.
3. Use red font entry as appeared in SF-1 if inconsistent with the birth certificate.

MALE

Name of student in SF-1

(LN, FN, MN)

No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24

FEMALE
Name of student in SF-1

(LN, FN, MN)

No.
 (LN, FN, MN)
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28

_______________________ _________ Date: ______________________

Signature over printed name
DATA CORRECTION REQUEST ON LEARNER’S OTHER DATA
GRADE
SECTION
SEMESTER
SCHOOL YEAR
ADVISER

me, and name of father as appeared in LIS generated SF-1.

eared in the birth certificate.
he birth certificate.

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERT

Mother’s Maiden Name Name of Father Mother’s Maiden Name
(LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERTI

Mother’s Maiden Name Name of Father Mother’s Maiden Name
 (LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

______________
D IN THE BIRTH CERTIFICATE
Name of Father
(LN, FN, MN)

D IN THE BIRTH CERTIFICATE

Name of Father
(LN, FN, MN)
 DATA CORRECTION REQUEST ON

Instructions:
1. Copy and paste all names of students, mother’s maiden name, and name of father as appeared in LIS generated S
2. Copy all mother’s maiden name, and name of father as appeared in the birth certificate.
3. Use red font entry as appeared in SF-1 if inconsistent with the birth certificate.

MALE

Name of student in SF-1

(LN, FN, MN)

No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24

FEMALE
Name of student in SF-1

(LN, FN, MN)

No.
 (LN, FN, MN)
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28

_______________________ _________ Date: ______________________

Signature over printed name
DATA CORRECTION REQUEST ON LEARNER’S OTHER DATA
GRADE
SECTION
SEMESTER
SCHOOL YEAR
ADVISER

me, and name of father as appeared in LIS generated SF-1.

eared in the birth certificate.
he birth certificate.

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERT

Mother’s Maiden Name Name of Father Mother’s Maiden Name
(LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERTI

Mother’s Maiden Name Name of Father Mother’s Maiden Name
 (LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

______________
D IN THE BIRTH CERTIFICATE
Name of Father
(LN, FN, MN)

D IN THE BIRTH CERTIFICATE

Name of Father
(LN, FN, MN)
 DATA CORRECTION REQUEST ON

Instructions:
1. Copy and paste all names of students, mother’s maiden name, and name of father as appeared in LIS generated S
2. Copy all mother’s maiden name, and name of father as appeared in the birth certificate.
3. Use red font entry as appeared in SF-1 if inconsistent with the birth certificate.

MALE

Name of student in SF-1

(LN, FN, MN)

No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24

FEMALE
Name of student in SF-1

(LN, FN, MN)

No.
 (LN, FN, MN)
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28

_______________________ _________ Date: ______________________

Signature over printed name
DATA CORRECTION REQUEST ON LEARNER’S OTHER DATA
GRADE
SECTION
SEMESTER
SCHOOL YEAR
ADVISER

me, and name of father as appeared in LIS generated SF-1.

eared in the birth certificate.
he birth certificate.

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERT

Mother’s Maiden Name Name of Father Mother’s Maiden Name
(LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERTI

Mother’s Maiden Name Name of Father Mother’s Maiden Name
 (LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

______________
D IN THE BIRTH CERTIFICATE
Name of Father
(LN, FN, MN)

D IN THE BIRTH CERTIFICATE

Name of Father
(LN, FN, MN)
 DATA CORRECTION REQUEST ON

Instructions:
1. Copy and paste all names of students, mother’s maiden name, and name of father as appeared in LIS generated S
2. Copy all mother’s maiden name, and name of father as appeared in the birth certificate.
3. Use red font entry as appeared in SF-1 if inconsistent with the birth certificate.

MALE

Name of student in SF-1

(LN, FN, MN)

No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24

FEMALE
Name of student in SF-1

(LN, FN, MN)

No.
 (LN, FN, MN)
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28

_______________________ _________ Date: ______________________

Signature over printed name
DATA CORRECTION REQUEST ON LEARNER’S OTHER DATA
GRADE
SECTION
SEMESTER
SCHOOL YEAR
ADVISER

me, and name of father as appeared in LIS generated SF-1.

eared in the birth certificate.
he birth certificate.

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERT

Mother’s Maiden Name Name of Father Mother’s Maiden Name
(LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERTI

Mother’s Maiden Name Name of Father Mother’s Maiden Name
 (LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

______________
D IN THE BIRTH CERTIFICATE
Name of Father
(LN, FN, MN)

D IN THE BIRTH CERTIFICATE

Name of Father
(LN, FN, MN)
 DATA CORRECTION REQUEST ON

Instructions:
1. Copy and paste all names of students, mother’s maiden name, and name of father as appeared in LIS generated S
2. Copy all mother’s maiden name, and name of father as appeared in the birth certificate.
3. Use red font entry as appeared in SF-1 if inconsistent with the birth certificate.

MALE

Name of student in SF-1

(LN, FN, MN)

No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24

FEMALE
Name of student in SF-1

(LN, FN, MN)

No.
 (LN, FN, MN)
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28

_______________________ _________ Date: ______________________

Signature over printed name
DATA CORRECTION REQUEST ON LEARNER’S OTHER DATA
GRADE
SECTION
SEMESTER
SCHOOL YEAR
ADVISER

me, and name of father as appeared in LIS generated SF-1.

eared in the birth certificate.
he birth certificate.

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERT

Mother’s Maiden Name Name of Father Mother’s Maiden Name
(LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERTI

Mother’s Maiden Name Name of Father Mother’s Maiden Name
 (LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

______________
D IN THE BIRTH CERTIFICATE
Name of Father
(LN, FN, MN)

D IN THE BIRTH CERTIFICATE

Name of Father
(LN, FN, MN)
 DATA CORRECTION REQUEST ON

Instructions:
1. Copy and paste all names of students, mother’s maiden name, and name of father as appeared in LIS generated S
2. Copy all mother’s maiden name, and name of father as appeared in the birth certificate.
3. Use red font entry as appeared in SF-1 if inconsistent with the birth certificate.

MALE

Name of student in SF-1

(LN, FN, MN)

No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24

FEMALE
Name of student in SF-1

(LN, FN, MN)

No.
 (LN, FN, MN)
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28

_______________________ _________ Date: ______________________

Signature over printed name
DATA CORRECTION REQUEST ON LEARNER’S OTHER DATA
GRADE
SECTION
SEMESTER
SCHOOL YEAR
ADVISER

me, and name of father as appeared in LIS generated SF-1.

eared in the birth certificate.
he birth certificate.

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERT

Mother’s Maiden Name Name of Father Mother’s Maiden Name
(LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERTI

Mother’s Maiden Name Name of Father Mother’s Maiden Name
 (LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

______________
D IN THE BIRTH CERTIFICATE
Name of Father
(LN, FN, MN)

D IN THE BIRTH CERTIFICATE

Name of Father
(LN, FN, MN)
 DATA CORRECTION REQUEST ON

Instructions:
1. Copy and paste all names of students, mother’s maiden name, and name of father as appeared in LIS generated S
2. Copy all mother’s maiden name, and name of father as appeared in the birth certificate.
3. Use red font entry as appeared in SF-1 if inconsistent with the birth certificate.

MALE

Name of student in SF-1

(LN, FN, MN)

No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24

FEMALE
Name of student in SF-1

(LN, FN, MN)

No.
 (LN, FN, MN)
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28

_______________________ _________ Date: ______________________

Signature over printed name
DATA CORRECTION REQUEST ON LEARNER’S OTHER DATA
GRADE
SECTION
SEMESTER
SCHOOL YEAR
ADVISER

me, and name of father as appeared in LIS generated SF-1.

eared in the birth certificate.
he birth certificate.

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERT

Mother’s Maiden Name Name of Father Mother’s Maiden Name
(LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERTI

Mother’s Maiden Name Name of Father Mother’s Maiden Name
 (LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

______________
D IN THE BIRTH CERTIFICATE
Name of Father
(LN, FN, MN)

D IN THE BIRTH CERTIFICATE

Name of Father
(LN, FN, MN)
 DATA CORRECTION REQUEST ON

Instructions:
1. Copy and paste all names of students, mother’s maiden name, and name of father as appeared in LIS generated S
2. Copy all mother’s maiden name, and name of father as appeared in the birth certificate.
3. Use red font entry as appeared in SF-1 if inconsistent with the birth certificate.

MALE

Name of student in SF-1

(LN, FN, MN)

No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24

FEMALE
Name of student in SF-1

(LN, FN, MN)

No.
 (LN, FN, MN)
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28

_______________________ _________ Date: ______________________

Signature over printed name
DATA CORRECTION REQUEST ON LEARNER’S OTHER DATA
GRADE
SECTION
SEMESTER
SCHOOL YEAR
ADVISER

me, and name of father as appeared in LIS generated SF-1.

eared in the birth certificate.
he birth certificate.

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERT

Mother’s Maiden Name Name of Father Mother’s Maiden Name
(LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERTI

Mother’s Maiden Name Name of Father Mother’s Maiden Name
 (LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

______________
D IN THE BIRTH CERTIFICATE
Name of Father
(LN, FN, MN)

D IN THE BIRTH CERTIFICATE

Name of Father
(LN, FN, MN)
 DATA CORRECTION REQUEST ON

Instructions:
1. Copy and paste all names of students, mother’s maiden name, and name of father as appeared in LIS generated S
2. Copy all mother’s maiden name, and name of father as appeared in the birth certificate.
3. Use red font entry as appeared in SF-1 if inconsistent with the birth certificate.

MALE

Name of student in SF-1

(LN, FN, MN)

No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24

FEMALE
Name of student in SF-1

(LN, FN, MN)

No.
 (LN, FN, MN)
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28

_______________________ _________ Date: ______________________

Signature over printed name
DATA CORRECTION REQUEST ON LEARNER’S OTHER DATA
GRADE
SECTION
SEMESTER
SCHOOL YEAR
ADVISER

me, and name of father as appeared in LIS generated SF-1.

eared in the birth certificate.
he birth certificate.

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERT

Mother’s Maiden Name Name of Father Mother’s Maiden Name
(LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERTI

Mother’s Maiden Name Name of Father Mother’s Maiden Name
 (LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

______________
D IN THE BIRTH CERTIFICATE
Name of Father
(LN, FN, MN)

D IN THE BIRTH CERTIFICATE

Name of Father
(LN, FN, MN)
 DATA CORRECTION REQUEST ON

Instructions:
1. Copy and paste all names of students, mother’s maiden name, and name of father as appeared in LIS generated S
2. Copy all mother’s maiden name, and name of father as appeared in the birth certificate.
3. Use red font entry as appeared in SF-1 if inconsistent with the birth certificate.

MALE

Name of student in SF-1

(LN, FN, MN)

No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24

FEMALE
Name of student in SF-1

(LN, FN, MN)

No.
 (LN, FN, MN)
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28

_______________________ _________ Date: ______________________

Signature over printed name
DATA CORRECTION REQUEST ON LEARNER’S OTHER DATA
GRADE
SECTION
SEMESTER
SCHOOL YEAR
ADVISER

me, and name of father as appeared in LIS generated SF-1.

eared in the birth certificate.
he birth certificate.

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERT

Mother’s Maiden Name Name of Father Mother’s Maiden Name
(LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERTI

Mother’s Maiden Name Name of Father Mother’s Maiden Name
 (LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

______________
D IN THE BIRTH CERTIFICATE
Name of Father
(LN, FN, MN)

D IN THE BIRTH CERTIFICATE

Name of Father
(LN, FN, MN)
 DATA CORRECTION REQUEST ON

Instructions:
1. Copy and paste all names of students, mother’s maiden name, and name of father as appeared in LIS generated S
2. Copy all mother’s maiden name, and name of father as appeared in the birth certificate.
3. Use red font entry as appeared in SF-1 if inconsistent with the birth certificate.

MALE

Name of student in SF-1

(LN, FN, MN)

No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24

FEMALE
Name of student in SF-1

(LN, FN, MN)

No.
 (LN, FN, MN)
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28

_______________________ _________ Date: ______________________

Signature over printed name
DATA CORRECTION REQUEST ON LEARNER’S OTHER DATA
GRADE
SECTION
SEMESTER
SCHOOL YEAR
ADVISER

me, and name of father as appeared in LIS generated SF-1.

eared in the birth certificate.
he birth certificate.

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERT

Mother’s Maiden Name Name of Father Mother’s Maiden Name
(LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERTI

Mother’s Maiden Name Name of Father Mother’s Maiden Name
 (LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

______________
D IN THE BIRTH CERTIFICATE
Name of Father
(LN, FN, MN)

D IN THE BIRTH CERTIFICATE

Name of Father
(LN, FN, MN)
 DATA CORRECTION REQUEST ON

Instructions:
1. Copy and paste all names of students, mother’s maiden name, and name of father as appeared in LIS generated S
2. Copy all mother’s maiden name, and name of father as appeared in the birth certificate.
3. Use red font entry as appeared in SF-1 if inconsistent with the birth certificate.

MALE

Name of student in SF-1

(LN, FN, MN)

No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24

FEMALE
Name of student in SF-1

(LN, FN, MN)

No.
 (LN, FN, MN)
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28

_______________________ _________ Date: ______________________

Signature over printed name
DATA CORRECTION REQUEST ON LEARNER’S OTHER DATA
GRADE
SECTION
SEMESTER
SCHOOL YEAR
ADVISER

me, and name of father as appeared in LIS generated SF-1.

eared in the birth certificate.
he birth certificate.

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERT

Mother’s Maiden Name Name of Father Mother’s Maiden Name
(LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERTI

Mother’s Maiden Name Name of Father Mother’s Maiden Name
 (LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

______________
D IN THE BIRTH CERTIFICATE
Name of Father
(LN, FN, MN)

D IN THE BIRTH CERTIFICATE

Name of Father
(LN, FN, MN)
 DATA CORRECTION REQUEST ON

Instructions:
1. Copy and paste all names of students, mother’s maiden name, and name of father as appeared in LIS generated S
2. Copy all mother’s maiden name, and name of father as appeared in the birth certificate.
3. Use red font entry as appeared in SF-1 if inconsistent with the birth certificate.

MALE

Name of student in SF-1

(LN, FN, MN)

No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24

FEMALE
Name of student in SF-1

(LN, FN, MN)

No.
 (LN, FN, MN)
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28

_______________________ _________ Date: ______________________

Signature over printed name
DATA CORRECTION REQUEST ON LEARNER’S OTHER DATA
GRADE
SECTION
SEMESTER
SCHOOL YEAR
ADVISER

me, and name of father as appeared in LIS generated SF-1.

eared in the birth certificate.
he birth certificate.

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERT

Mother’s Maiden Name Name of Father Mother’s Maiden Name
(LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERTI

Mother’s Maiden Name Name of Father Mother’s Maiden Name
 (LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

______________
D IN THE BIRTH CERTIFICATE
Name of Father
(LN, FN, MN)

D IN THE BIRTH CERTIFICATE

Name of Father
(LN, FN, MN)
 DATA CORRECTION REQUEST ON

Instructions:
1. Copy and paste all names of students, mother’s maiden name, and name of father as appeared in LIS generated S
2. Copy all mother’s maiden name, and name of father as appeared in the birth certificate.
3. Use red font entry as appeared in SF-1 if inconsistent with the birth certificate.

MALE

Name of student in SF-1

(LN, FN, MN)

No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24

FEMALE
Name of student in SF-1

(LN, FN, MN)

No.
 (LN, FN, MN)
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28

_______________________ _________ Date: ______________________

Signature over printed name
DATA CORRECTION REQUEST ON LEARNER’S OTHER DATA
GRADE
SECTION
SEMESTER
SCHOOL YEAR
ADVISER

me, and name of father as appeared in LIS generated SF-1.

eared in the birth certificate.
he birth certificate.

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERT

Mother’s Maiden Name Name of Father Mother’s Maiden Name
(LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERTI

Mother’s Maiden Name Name of Father Mother’s Maiden Name
 (LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

______________
D IN THE BIRTH CERTIFICATE
Name of Father
(LN, FN, MN)

D IN THE BIRTH CERTIFICATE

Name of Father
(LN, FN, MN)
 DATA CORRECTION REQUEST ON

Instructions:
1. Copy and paste all names of students, mother’s maiden name, and name of father as appeared in LIS generated S
2. Copy all mother’s maiden name, and name of father as appeared in the birth certificate.
3. Use red font entry as appeared in SF-1 if inconsistent with the birth certificate.

MALE

Name of student in SF-1

(LN, FN, MN)

No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24

FEMALE
Name of student in SF-1

(LN, FN, MN)

No.
 (LN, FN, MN)
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28

_______________________ _________ Date: ______________________

Signature over printed name
DATA CORRECTION REQUEST ON LEARNER’S OTHER DATA
GRADE
SECTION
SEMESTER
SCHOOL YEAR
ADVISER

me, and name of father as appeared in LIS generated SF-1.

eared in the birth certificate.
he birth certificate.

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERT

Mother’s Maiden Name Name of Father Mother’s Maiden Name
(LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERTI

Mother’s Maiden Name Name of Father Mother’s Maiden Name
 (LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

______________
D IN THE BIRTH CERTIFICATE
Name of Father
(LN, FN, MN)

D IN THE BIRTH CERTIFICATE

Name of Father
(LN, FN, MN)
 DATA CORRECTION REQUEST ON

Instructions:
1. Copy and paste all names of students, mother’s maiden name, and name of father as appeared in LIS generated S
2. Copy all mother’s maiden name, and name of father as appeared in the birth certificate.
3. Use red font entry as appeared in SF-1 if inconsistent with the birth certificate.

MALE

Name of student in SF-1

(LN, FN, MN)

No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24

FEMALE
Name of student in SF-1

(LN, FN, MN)

No.
 (LN, FN, MN)
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28

_______________________ _________ Date: ______________________

Signature over printed name
DATA CORRECTION REQUEST ON LEARNER’S OTHER DATA
GRADE
SECTION
SEMESTER
SCHOOL YEAR
ADVISER

me, and name of father as appeared in LIS generated SF-1.

eared in the birth certificate.
he birth certificate.

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERT

Mother’s Maiden Name Name of Father Mother’s Maiden Name
(LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERTI

Mother’s Maiden Name Name of Father Mother’s Maiden Name
 (LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

______________
D IN THE BIRTH CERTIFICATE
Name of Father
(LN, FN, MN)

D IN THE BIRTH CERTIFICATE

Name of Father
(LN, FN, MN)
 DATA CORRECTION REQUEST ON

Instructions:
1. Copy and paste all names of students, mother’s maiden name, and name of father as appeared in LIS generated S
2. Copy all mother’s maiden name, and name of father as appeared in the birth certificate.
3. Use red font entry as appeared in SF-1 if inconsistent with the birth certificate.

MALE

Name of student in SF-1

(LN, FN, MN)

No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24

FEMALE
Name of student in SF-1

(LN, FN, MN)

No.
 (LN, FN, MN)
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28

_______________________ _________ Date: ______________________

Signature over printed name
DATA CORRECTION REQUEST ON LEARNER’S OTHER DATA
GRADE
SECTION
SEMESTER
SCHOOL YEAR
ADVISER

me, and name of father as appeared in LIS generated SF-1.

eared in the birth certificate.
he birth certificate.

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERT

Mother’s Maiden Name Name of Father Mother’s Maiden Name
(LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERTI

Mother’s Maiden Name Name of Father Mother’s Maiden Name
 (LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

______________
D IN THE BIRTH CERTIFICATE
Name of Father
(LN, FN, MN)

D IN THE BIRTH CERTIFICATE

Name of Father
(LN, FN, MN)
 DATA CORRECTION REQUEST ON

Instructions:
1. Copy and paste all names of students, mother’s maiden name, and name of father as appeared in LIS generated S
2. Copy all mother’s maiden name, and name of father as appeared in the birth certificate.
3. Use red font entry as appeared in SF-1 if inconsistent with the birth certificate.

MALE

Name of student in SF-1

(LN, FN, MN)

No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24

FEMALE
Name of student in SF-1

(LN, FN, MN)

No.
 (LN, FN, MN)
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28

_______________________ _________ Date: ______________________

Signature over printed name
DATA CORRECTION REQUEST ON LEARNER’S OTHER DATA
GRADE
SECTION
SEMESTER
SCHOOL YEAR
ADVISER

me, and name of father as appeared in LIS generated SF-1.

eared in the birth certificate.
he birth certificate.

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERT

Mother’s Maiden Name Name of Father Mother’s Maiden Name
(LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERTI

Mother’s Maiden Name Name of Father Mother’s Maiden Name
 (LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

______________
D IN THE BIRTH CERTIFICATE
Name of Father
(LN, FN, MN)

D IN THE BIRTH CERTIFICATE

Name of Father
(LN, FN, MN)
 DATA CORRECTION REQUEST ON

Instructions:
1. Copy and paste all names of students, mother’s maiden name, and name of father as appeared in LIS generated S
2. Copy all mother’s maiden name, and name of father as appeared in the birth certificate.
3. Use red font entry as appeared in SF-1 if inconsistent with the birth certificate.

MALE

Name of student in SF-1

(LN, FN, MN)

No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24

FEMALE
Name of student in SF-1

(LN, FN, MN)

No.
 (LN, FN, MN)
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28

_______________________ _________ Date: ______________________

Signature over printed name
DATA CORRECTION REQUEST ON LEARNER’S OTHER DATA
GRADE
SECTION
SEMESTER
SCHOOL YEAR
ADVISER

me, and name of father as appeared in LIS generated SF-1.

eared in the birth certificate.
he birth certificate.

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERT

Mother’s Maiden Name Name of Father Mother’s Maiden Name
(LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERTI

Mother’s Maiden Name Name of Father Mother’s Maiden Name
 (LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

______________
D IN THE BIRTH CERTIFICATE
Name of Father
(LN, FN, MN)

D IN THE BIRTH CERTIFICATE

Name of Father
(LN, FN, MN)
 DATA CORRECTION REQUEST ON

Instructions:
1. Copy and paste all names of students, mother’s maiden name, and name of father as appeared in LIS generated S
2. Copy all mother’s maiden name, and name of father as appeared in the birth certificate.
3. Use red font entry as appeared in SF-1 if inconsistent with the birth certificate.

MALE

Name of student in SF-1

(LN, FN, MN)

No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24

FEMALE
Name of student in SF-1

(LN, FN, MN)

No.
 (LN, FN, MN)
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28

_______________________ _________ Date: ______________________

Signature over printed name
DATA CORRECTION REQUEST ON LEARNER’S OTHER DATA
GRADE
SECTION
SEMESTER
SCHOOL YEAR
ADVISER

me, and name of father as appeared in LIS generated SF-1.

eared in the birth certificate.
he birth certificate.

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERT

Mother’s Maiden Name Name of Father Mother’s Maiden Name
(LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

AS APPEARED IN SF-1 AS APPEARED IN THE BIRTH CERTI

Mother’s Maiden Name Name of Father Mother’s Maiden Name
 (LN, FN, MN) (LN, FN, MN) (LN, FN, MN)

______________
D IN THE BIRTH CERTIFICATE
Name of Father
(LN, FN, MN)

D IN THE BIRTH CERTIFICATE

Name of Father
(LN, FN, MN)
 DATA CORRECTION REQUEST ON LEARNER’S OTHER DATA
GRADE 12
SECTION TVLCSS-B
SEMESTER SECOND
SCHOOL YEAR 2019-2020
ADVISER DANIELLE MAE C. TUGARE
Instructions:
1. Copy and paste all names of students, mother’s maiden name, and name of father as appeared in LIS generated SF-1.
2. Copy all mother’s maiden name, and name of father as appeared in the birth certificate.
3. Use red font entry as appeared in SF-1 if inconsistent with the birth certificate.

MALE

Name of student in SF-1 AS APPEARED IN SF-1

Mother’s Maiden Name Name of Father
(LN, FN, MN)
No. (LN, FN, MN) (LN, FN, MN)
1 ADAY,TEODORO JR BASCOS BASCOS,ELY,ORINES, ADAY, TEODORO BIALA

2 ANCHETA,OJIMAR FERNANDEZ FERNANDEZ,JING,S, ANCHETA, MARVIN V.

3 APELADO,RYAN JOSUA GARABINA GARABINA,DELIA,C., APELADO, JESUSITO M.

4 BALDONADE,MIGUEL OBISPO OBISPO,MA. ELENA,E. OBISPO,MA. ELENA,E.

5 BASCOS,EDERSON MARIANE MARIANE,JULIETA,A, BASCOS, ERDIE P

6 BELMORO,FERRIE JOHN MADRONIO MADRONIO,MARISSA,N, BELMORO, FRED E

7 CARIAZO,JOHN EROLL DE GUZMAN DE GUZMAN,DAISY,D., CARIAZO, BUTCH R.

8 ENSOMO,JAMES PAUL ARANGCO ARANGCO,CECILLE,R., ENSOMO, JEORGE Y.

9 GADIAZA,MC GAFFY GUARINO GUARINO,MARIENETH,-, GADIAZA, GREGORIO B.

10 GONZALES,PAUL JOHN LESTER PEREZ PEREZ,TERESITA,SABALZA, GONZALEZ, MARIO NACINO

11 LOPEZ,JULIE JR DOLLENTE DOLLENTE,SUSAN,U., LOPEZ, JULIE V. SR

12 LORENZO,JOHN DAVE CONDE CONDE,JOSEPHINE,C., LORENZO, EDGAR U.

13 MAINES,IVAN RENZO DE GUZMAN DE GUZMAN,GINA,-, MAINES, LORENZO -

14 MANDAP,MIKE EDRIAN GONATICE GONATICE,MYLENE,BUGAYONG, MANDAP, RENE RONQUILLO

15 MANRIQUE,XERXES RYAN BASCOS BASCOS,VANESSA,IBAY, MANRIQUE, DAN RYAN RABARA

16 MARI,ROLDAN GALVEZ GALVEZ,RHODORA,-, MARI, RONALD O.

17 MEJIA,VINCE IAN EVANGELISTA EVANGELISTA,IRYN,MORTERA, MEJIA, CARLO VINCENT GUEVARRA

18 MENDOZA,JOHN WILLIAM BELMONTE BELMONTE, MICHCILLE A. MENDOZA, WILLIAM B

19 MONES,DEAN REY MORTERA MORTERA,LORNA,B., MONES, ORLANDO M.

20 MONES,RAYMUND OVIVIER OVIVIER,CONCEPCION,G., MONES, ROBERTO R.

21 MOTEA,MICHAEL JAY - MOTEA,MARISA,VALDEZ, TABANAO, EDGAR CANILO

22 NATIVIDAD,CARL LITO - NATIVIDAD,JENNIFER,DE GUZMAN, SOLIS, LITO NABLO

23 OBILLO,JUVILLE PADILLA PADILLA,LEA,C., OBILLO, JIMMY M. JR

24 OLAY,JOHN PATRICK SATPARAM SATPARAM,FLORDELIZA,S., OLAY, FRIENTLY GAMBOA

25 OLIVERAS,CHARLES MAPA MAPA,DOLORES,I., OLIVERAS, CORNELIO D.

26 OLIVERAS,RONIE BULATAO BULATAO,MARINA,S., OLIVERAS, ROGELIO G.

27 ORDANZA,PATRICK DORIA DORIA,SUSANA,D., ORDANZA, RICARDO V.

28 QUIRONA,KIAN CHARLES BERNABE BERNABE,MARILOU,B., QUIRONA, ANASTACIO N

29 RABANG,MARC ALLEN MARQUEZ MARQUEZ,ROSE,R., RABANG, VIRGILIO M.

30 RAGADI,MARK JOSEPH NARIO NARIO,FLORDELIZA,F, RAGADI, ANTONIO A

31 RAPOSAS,JAN MARK GARCIA GARCIA,MARILOU,G., RAPOSAS, CARLOS O.

32 SALVATERA,ALEXANDER MEIM MEIM,JESIBEL,ORDONIO, SALVATERA, ALEX MILLARES

33 SANTOS,LUIS CRESENCIO DUATIN DUATIN,LUCITA,VERGONIA, SANTOS, CRESENCIO PANGILINAN

34 SEVIDAL JR,REYNALDO PLACIDO PLACIDO,LYDIA,SALAZAR, SEVIDAL, REYNALDO VILLEGAS SR

35 SULA,ANGIELO RAMOLETE RAMOLETE,GINA,ESTANOCO, SULA, LEONARDO IBAY

FEMALE
Name of student in SF-1 AS APPEARED IN SF-1
Mother’s Maiden Name Name of Father
(LN, FN, MN)
No. (LN, FN, MN) (LN, FN, MN)
1 ALBERTO,MIA HAIRA LACONICO LACONICO,HAIDEE,DE LOS SANTOS, ALBERTO, MICHAEL COSTALES

2 CALICDAN,LYSSA NICOLE PAREDES PAREDES,EDEN,SANTOS, CALICDAN, RICKY ANTONIO

3 CANILLAS,MARICRIZ OLINARES OLINARES,MARILYN,ABALOS, CANILLAS, CHRISTOPHER SEVILLEJO

4 CONCEPCION,ANGELINE SANDOVAL SANDOVAL,SALLY,, CONCEPCION, ANTONIO B.

5 CRUZ,ME-ANN CORPUZ CORPUZ,ANALYN,-, CRUZ, ELMER -

6 DIAZ,ANGELA AGACETA AGACETA,ALONA,RABOY, DIAZ, SALVADOR DIAZ

7 ELIAS,SHAHARA SHENN GASMIN GASMIN,SYLVIA,FLORIDA, ELIAS, RENE LAURETA

8 LAGMAY,RENZ JOY BUSTILLOS BUSTILLOS,MARIE JOY,, LAGMAY, ARSENIO JR T

9 MEJIA,FARRAH JANE MACARANAS MACARANAS,FLORIDA,A, MEJIA, RAYMUNDO S

10 MENDOZA,MARYJOY BRUAN BRUAN,MARGIELYN,MENDOZA, MENDOZA, SALVADOR VIERNES

11 MOTEA,MARIVIC BRUAN BRUAN,VIRGINIA,M., MOTEA, DOMINGO O.

12 OLINARES,IRISH FLORES FLORES,IRENE,B., OLINARES, SAMMY A.

13 ORDOÑO,SHAIRA KATE TORABE TORABE,MILVA,S, ORDOÑO, WILFREDO -

14 PALMA,MONETTE PALMA,YOLANDA,MANUGUID,

15 RAGUDO,RICA BASCONCILLO BASCONCILLO,ELVIE,B., RAGUDO, RICHARD M.

16 SABADO,ROSEMARIE - SABADO,LUZVIMINDA,P, UNDTOHAN, LEOPOLDO -

17 SAPINOSO,EIZEL GONATICE GONATICE,JUANITA,BUGAYONG, SAPINOSO, EDUARDO PANGILINAN

18 TEAÑO,EURIKA LYKA JANDOC JANDOC,GINA,S., TEAÑO, EDWIN T.

19 TUMBAGA,ARLENE LABRADOR LABRADOR,MARILOU,M., TUMBAGA, DANNY T.

_______________________ _________ Date: ______________________

Signature over printed name
’S OTHER DATA

AS APPEARED IN THE BIRTH CERTIFICATE

Mother’s Maiden Name Name of Father
(LN, FN, MN) (LN, FN, MN)
BASCOS,ELY,ORINES, ADAY, TEODORO BIALA

FERNANDEZ,JING,S, ANCHETA, MARVIN V.

GARABINA,DELIA,C., APELADO, JESUSITO M.

OBISPO,MA. ELENA,E. BALDONADE, JESSIE N.

MARIANE,JULIETA,A, BASCOS, ERDIE P

MADRONIO,MARISSA,N, BELMORO, FRED E

DE GUZMAN,DAISY,D., CARIAZO, BUTCH R.

ARANGCO,CECILLE,R., ENSOMO, JEORGE Y.

GUARINO,MARIENETH,-, GADIAZA, GREGORIO B.

PEREZ,TERESITA,SABALZA, GONZALEZ, MARIO NACINO

DOLLENTE,SUSAN,U., LOPEZ, JULIE V. SR

CONDE,JOSEPHINE,C., LORENZO, EDGAR U.

DE GUZMAN,GINA,-, MAINES, LORENZO -

GONATICE,MYLENE,BUGAYONG, MANDAP, RENE RONQUILLO

BASCOS,VANESSA,IBAY, MANRIQUE, DAN RYAN RABARA

GALVEZ,RHODORA,-, MARI, RONALD O.

EVANGELISTA,IRYN,MORTERA, MEJIA, CARLO VINCENT GUEVARRA

BELMONTE, MICHCILLE A. MENDOZA, WILLIAM B

MORTERA,LORNA,B., MONES, ORLANDO M.

OVIVIER,CONCEPCION,G., MONES, ROBERTO R.

MOTEA,MARISA,VALDEZ, TABANAO, EDGAR CANILO

NATIVIDAD,JENNIFER,DE GUZMAN, SOLIS, LITO NABLO

PADILLA,LEA,C., OBILLO, JIMMY M. JR

SATPARAM,FLORDELIZA,S., OLAY, FRIENTLY GAMBOA

MAPA,DOLORES,I., OLIVERAS, CORNELIO D.

BULATAO,MARINA,S., OLIVERAS, ROGELIO G.

DORIA,SUSANA,D., ORDANZA, RICARDO V.

BERNABE,MARILOU,B., QUIRONA, ANASTACIO N

MARQUEZ,ROSE,R., RABANG, VIRGILIO M.

NARIO,FLORDELIZA,F, RAGADI, ANTONIO A

GARCIA,MARILOU,G., RAPOSAS, CARLOS O.

MEIM,JESIBEL,ORDONIO, SALVATERA, ALEX MILLARES

DUATIN,LUCITA,VERGONIA, SANTOS, CRESENCIO PANGILINAN

PLACIDO,LYDIA,SALAZAR, SEVIDAL, REYNALDO VILLEGAS SR

RAMOLETE,GINA,ESTANOCO, SULA, LEONARDO IBAY

AS APPEARED IN THE BIRTH CERTIFICATE

Mother’s Maiden Name Name of Father
(LN, FN, MN) (LN, FN, MN)
LACONICO,HAIDEE,DE LOS SANTOS, ALBERTO, MICHAEL COSTALES

PAREDES,EDEN,SANTOS, CALICDAN, RICKY ANTONIO

OLINARES,MARILYN,ABALOS, CANILLAS, CHRISTOPHER SEVILLEJO

SANDOVAL,SALLY,, CONCEPCION, ANTONIO B.

CORPUZ,ANALYN,-, CRUZ, ELMER -

AGACETA,ALONA,RABOY, DIAZ, SALVADOR DIAZ

GASMIN,SYLVIA,FLORIDA, ELIAS, RENE LAURETA

BUSTILLOS,MARIE JOY,, LAGMAY, ARSENIO JR T

MACARANAS,FLORIDA,A, MEJIA, RAYMUNDO S

BRUAN,MARGIELYN,MENDOZA, MENDOZA, SALVADOR VIERNES

BRUAN,VIRGINIA,M., MOTEA, DOMINGO O.

FLORES,IRENE,B., OLINARES, SAMMY A.

TORABE,MILVA,S, ORDOÑO, WILFREDO -

PALMA,YOLANDA,MANUGUID,

BASCONCILLO,ELVIE,B., RAGUDO, RICHARD M.

SABADO,LUZVIMINDA,P, UNDTOHAN, LEOPOLDO -

GONATICE,JUANITA,BUGAYONG, SAPINOSO, EDUARDO PANGILINAN

JANDOC,GINA,S., TEAÑO, EDWIN T.

LABRADOR,MARILOU,M., TUMBAGA, DANNY T.