Department of Education ALTERNATIVE LEARNING SYSTEM
LEARNER'S PERMANENT RECORD (AF-5)
DISTRICT: DIVISION: REGION:
LEARNER'S INFORMATION LRN:__________________________
LAST NAME: FIRST NAME: _____________________ NAME EXTENSION: ______MIDDLE NAME: _______________ ADDRESS: HOUSE NO./ SITIO / ST. BARANGAY MUNICIPALITY/CITY PROVINCE BIRTHDATE: MONTH _____/ DATE__________ / YEAR______________ SEX: Male Female PORTFOLIO CERTIFICATE NUMBER.: LEARNER'S EDUCATIONAL STATUS Program Enrolled : Program Enrolled : Delivery Mode : Delivery Mode : CLC Name : CLC Name : CLC Address : CLC Address : Name of ALS Teacher/Community Name of ALS Teacher/Community ALS Implementor/Learning Facilitator : ALS Implementor/Learning Facilitator : School Year : School Year : Score Score ASSESSMENT RESULTS ASSESSMENT RESULTS Pre Post Pre Post PIS Score PIS Score Assesment for Basic Literacy (ABL) Pre Post Assesment for Basic Literacy (ABL) Pre Post Neo Literate Neo Literate Post Literate Post Literate Functional Literacy Assessment (FLT) Pre Post Functional Literacy Assessment (FLT) Pre Post LS 1 - Communication Skills (English) LS 1 - Communication Skills (English) Multiple Choice Multiple Choice Writing Writing Listening/Speaking Listening/Speaking LS 1 - Communication Skills (Filipino) LS 1 - Communication Skills (Filipino) Multiple Choice Multiple Choice Pagsulat Pagsulat Pakikinig/Pagsasalita Pakikinig/Pagsasalita LS 2 - Scientific Literacy and Critical Thinking Skills LS 2 - Scientific Literacy and Critical Thinking Skills LS 3 - Mathematical and Problem Solving Skills LS 3 - Mathematical and Problem Solving Skills LS 4 - Life and Career Skills LS 4 - Life and Career Skills LS 5 - Understanding the Self and Society LS 5 - Understanding the Self and Society LS 6 - Digital Citizenship LS 6 - Digital Citizenship Overall Score Overall Score PRESENTATION PORTFOLIO ASSESSMENT Remarks PRESENTATION PORTFOLIO ASSESSMENT Remarks Date of Assessment Date of Assessment Work Sample Score Work Sample Score LS 1 - Communication Skills (English) LS 1 - Communication Skills (English) LS 1 - Communication Skills (Filipino) LS 1 - Communication Skills (Filipino) LS 2 - Scientific Literacy and Critical Thinking Skills LS 2 - Scientific Literacy and Critical Thinking Skills LS 3 - Mathematical and Problem Solving Skills LS 3 - Mathematical and Problem Solving Skills LS 4 - Life and Career Skills LS 4 - Life and Career Skills LS 5 - Understanding the Self and Society LS 5 - Understanding the Self and Society LS 6 - Digital Citizenship LS 6 - Digital Citizenship TOTAL SCORE TOTAL SCORE Inter-District Revalida Inter-District Revalida Oral Reading Oral Reading Writing Writing Interview Interview Final Score Percentage Grade Final Score Percentage Grade
Eligible for Admission
Certificate of Transfer Certificate of Transfer : Eligible for Admission to : to Certificate of Good Moral Character Certificate of Good Moral Character This is to certify that the above-named is a learner 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 This certification is issued upon request of the concerned individual due to his/her desire to pursue formal schooling/other CLC or for employment. his/her desire to pursue formal schooling/other CLC or for employment.