School Level Only

SCHOOL NAME
SCHOOL ID

INDIVIDUAL REGISTRATION FORM GRADE

BASIC PROFILE One letter per box. DATA PR

Learner Reference Number (LRN) : Date of Registr
FAMILY NAME
FIRST NAME
MIDDLE NAME Registrat
DATE OF BIRTH GENDER
m m d d y y y y (M/F) Date of Entran
ADDRESS :
STATUS Other Details:
Regular Mother Tongue : 4Ps Clas
Transferee Religion : IPs
Balik - Aral Ethnicity : ECD Date Encoded i
Repeater Dialect : PWD

ENROLMENT PROFILE L.I.S.

Previous Enrolment Remarks:
School ID No.: Grade Level:
Name of School:
Name of Adviser:

PARENT'S / GUARDIAN INFORMATION Documents Sub

Father's Name
FAMILY NAME:
FIRST NAME:
MIDDLE NAME:

Mother' Maiden Name

FAMILY NAME:
FIRST NAME:
MIDDLE NAME:
Guardian Name Other Notes:
FAMILY NAME:
FIRST NAME:
MIDDLE NAME:
RELATIONSHIP:
MOBILE PHONE NUMBER :
created by: d.bucarile - 0919-992-0872

Certified True and Correct : Attested by:

Thumb Mark, if
cannot sign. Signature over Printed Name Date Signed Class Advis
HOOL NAME
SCHOOL ID

GRADE

DATA PROCESSING:
Date of Registration:

Registration In-charge

Date of Entrance:

Class Adviser

Date Encoded in L.I.S.:

L.I.S. In-charge
Remarks:
PWD , State below:

Documents Submitted:
Birth Certificate
NSO Copy
LCR Copy
DepED Form 137

DepED Form 138

Good Moral Cert.
Clearance

Other Notes:

Class Adviser