To be accomplished at CLC Level To be submitted to the DISTRICT OFFICE (DALSC) All information are required.

DEPARTMENT OF EDUCATION BUREAU OF ALTERNATIVE LEARNING SYSTEM MIS-002-LEARNERS' PROFILE

Accomplished by Position Date Accomplished Year Geographic ID Region Province City/Municipality Barangay _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ Date Submitted Received by Signature

Division District Sitio/Zone/Purok CLC Service Provider

_________________________________ _________________________________ _________________________________ _________________________________ _________________________________ Program (BLP, A&E Elementary, A&E Secondary, Specify if enrolled in special Program) Position (MT / IM/ Facilitator/ DALSC etc.) Status FLT Scores (Completed or Not (Write actual Completed ALS score) Program) Status after Program Completion (Continue to A&E Program, Set-up Business, etc)

Last Name

First Name

Middle Name

Birthdate (Month-Day-Year)

Gender

Date Enlisted

Assigned MT/Facilitator/IM (Specify Name)

To be accomplished by CLC To be submitted to the DISTRICT OFFICE All information are required.

DEPARTMENT OF EDUCATION BUREAU OF ALTERNATIVE LEARNING SYSTEM MIS-003-A&E TEST REGISTRANTS

Accomplished by Position Date Accomplished Year Geographic ID Region Province City/Municipality Barangay _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ Date Submitted Received by Signature

Division District Sitio/Zone/Purok CLC Service Provider

_________________________________ _________________________________ _________________________________ _________________________________ _________________________________

EXAM DATE: October 17, 2010

Last Name First Name Middle Name Birthdate Gender Program (BLP, A&E Elementary, A&E Secondary) Mode of Delivery A & E Test (e-eskwela, BALS Scores Radio, etc.) Status Pass / Fail Status after Test (enroll in formal education/TESDA, Setup own buiness, etc.)

To be accomplished by CLC To be submitted to the DISTRICT OFFICE All information are required. DEPARTMENT OF EDUCATION BUREAU OF ALTERNATIVE LEARNING SYSTEM MIS-004-PROFILE OF COMMUNITY
Accomplished by Position Date Accomplished Year Geographic ID Region Province City/Municipality Barangay No. of Males Date Submitted Received by Signature

Division District Sitio/Zone/Purok CLC Service Provider No. of Females

40-49 50-59 60 & above 14 & below 15-19 20-24 25-29 30-39 40-49 50-59 60 & above

POPULATION

14 & below

15-19

20-24

25-29

30-39

Cultural Programs

Museum

Science Centrum

Sports Program

Informal Educ.

Media Pogram

1 2 3 4 5
Types of CLC
TYPE 1 TYPE 2 TYPE 3 TYPE 4 TYPE 5 simple, temporary (make-shift) meeting place with tables and chairs, chalkboard e.g. chapel or any open multi-purpose area in the barangay or any private property temporarily loaned for learning purposes a semi-concrete structure mostly made out of light materials such as nipa, soft wood, etc., dedicated to ALS learning sessions and related activities, equipped with basic furniture and learning equipment such as electric fan a typical barangay learning center, concrete and secured, mostly made out of cement and other concrete building materials, dedicated to ALS learning sessions and related activities, equipped with basic furniture and learning equipment, e.g. chairs, tables, chalkboard, library corner, basic appliances such as electric fan, cassette recorder, etc. a two or three-storey building fully equipped with basic furniture and advanced ICT equipment for learning, dedicated to ALS learning sessions and related activities, other type that does not fall to any of the 4 types, please describe using a separate sheet of paper. ALS and other learning materials are being utilized by learners and other members of the community, the materials are either being transported from house to house or borrowed by individual interested community members from the CLC for literacy and continuing education purposes

Elementary

Pre-School

Secondary

Post Secondary

Tertiary

Name of Learning Institutions

1 2 3 4 5

TechVoch

Type (Please Tick) Public Private

Types of Programs Offered/Conducted (Please tick) Others (Specify)

Others, specify

A&E

BLP

GOs

NGOs

LGU

Total

Computer Program

Name of Community Learning Center (CLC)

With functional mobile library

Type of Community Learning Center (Please tick)

No. of partner agencies utilizing/supporting CLC

Types of Programs & Projects Conducted/Held (Please tick)

To be accomplished by CLC To be submitted to the DISTRICT OFFICE All information are required. DEPARTMENT OF EDUCATION BUREAU OF ALTERNATIVE LEARNING SYSTEM MIS-005-PROFILE OF CLC / SERVICE PROVIDERS
Accomplished by Position Date Accomplished Year Geographic ID Region Province City/Municipality Barangay ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ Date Submitted Received by Signature Name of Community Learning Center Address Head No. of Years as CLC : : : : _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________

COMMUNITY LEARNING CENTER

Name of MTs, IMs, Facilitators Position (MT, IM, DALSC,etc.) M.I. M No. of Learners per Kind of ALS Program Delivered BLP F A&E - Elem. M F A&E - Sec. M F Informal Education M F Curriculum Used (Please tick) Total DepED Others, Specify Learning Material Used (Please Tick) BALS produced OTHERS Allowances Received

Last Name 1 2 3 4 5 6 7 8 9 10

First Name

Amount

Source

SERVICE PROVIDERS for the CLC

Service Provider TYPE (Refer to legend below.) M No. of Learners per Kind of ALS Program Delivered BLP F A&E - Elem. M F A&E - Sec. M F Informal Education M F Curriculum Used (Please tick) Total DepED Others, Specify Learning Material Used (Please Tick) BALS produced OTHERS Funds Used

Name of Service Provider 1 2 3 4 5 6 7 8 9 10

Name of Head of Service Provider

Amount

Source

Type

Government Organization (GO), Non-Government Organization (NGO), Church/Faith Based Organization, Foreign Donor Agency Assisted, Community Learning Center (CLC)