ICTS - User Support Division

Learner Information System (LIS) and Basic Education Information System (BEIS)
National Helpdesk
Unenrollment of Learner (Request Form 09)

Definition: is a process of removing ineligible learners from the masterlist.

Submit to: Division Planning Officer, Schools Governance and Operations
Note: Endorsement of School Head is required (signed and scanned). Please use worksheet/excel format for

Present and Correct Enrollment Learner's Personal Information Unenrolled From Reason for Unenrollment

1. Incorrect Grade Level (SHS)

2. 1st Sem Declined
3. Multiple Enrollment
Date of First 4. Mistakenly Enrolled
Date of Birth Semester 5. No Appearance Since BOSY
Region-Division School Name School ID Grade Section Attendance LRN First Name Middle Name Last Name Ext Name Sex Region-Division School Name School ID Grade Section School Year
(MM/DD/YYYY) (For SHS only) 6. System Error
(MM/DD/YYYY) 7. PEPT/ALS Passer
8.Tagging of Temporary Enrollment
9. Others

IX Sindangan SPED Center 195535 2 Grace August 29, 2023 124770220375 ANGELO SIGABON VILLALUNA September 01, 2013 Male IX Sindangan SPED Center 195535 2 GRACE 2023-2024 4. Mistakenly enrolled

Teacher/ICT Coordinator School's Email Address School's Contact Number

School Head/System Admin Username
Date Requested Endorsed by Signature
Requested by
EVELYN R. VIDAL 195535@deped.gov.ph 9778330135 MINDALYN M. ARIP 1/8/2023 School Head Name ARIEL B. CRAMPATANTA EdD
Position/Designation Teacher III

Note for school:

1. Fill-up the form correctly and completely
2. Attach this form as Excel file.
3. Attach a scanned copy of the form with School Head signat
4. Attach the following copies:
a. Birth Certificate
b. Form 137/School Form 10 and/or Form 138/School Form
5. Encode the correct codes
6. If system error, provide screenshot

Note for Division Planning Officer:

1. Consolidate requests by school by issue
If Others, please
specify: