RICARDO M.

TEJERAS EPS, DepED RO-V-BICOL

ANABEL P UNCAD EPSA-DEPED DAVAO DEL SUR -RO-XI
RANDOLPH ELIZER G. SIMON DALSC-DIVISION OF CAGAYAN RO-2
MARIA DAPHHNIE T. DANO EPS-II-ALS
KRISTINE LEE S. LUMANOG EPSA-NCR-CALOOCAN
JOSEPHINE C. INTINO SEPS-DEPED CO- PASIG CITY
MARICEL S. LANGAHID EPS-RO-XI
ELENAR B. OPENA PSDS, QUEZON PROVINCE
ELEONOR D. MAGPANTAY EPS- SDO, SAN JOSE CITY, NE-REGION 3
REUBEN C. HERRERA EPS-II-ALS, SDO PALAWAN
HELEN A. ARANCON EPS-ALS-DAVAO DEL SUR-ROXI
ELSON C. JAMERO ITO, DEPED CAMIGUIN-ROX
 Republic of the Philippines
Department of Education
ALTERNATIVE LEARNING SYSTEM
AF-1 (MASTER LIST OF MAPPED LEARNERS)
Region: School Division: District:

Docu COMPLETE ADDRESS PARENTS

ment
NAME BIRTH
Sex (M/F)

Refer Contact Last Grade

(Last Name, First DATE Mother IP Date Mapped
Number of
(mm/dd/ Age (Birth
ence Tongue (Yes or Religion Father's Name Mother's Maiden Level
Name, Middle Name, Street/ Learner (mmddyyyy)
No) Completed
Barangay Municipality/
Ext) yyyy) (Last Name, First Name (Last Name, (if available)
Certifi Sitio/ Province
City Name, Middle First Name,
cate) Purok Name) Middle Name)

Jamero, Epipanio,
Jamero, Elson, Cabantac Jr. M 8/24/1978 39.5 Cebuano Yes Catholic Madasigon Binatubo Mahinog Camiguin Cabantac, Juana, Pagaran 9175372184 G-III 5/23/2017
Feniza
8

Prepared by:
MAPPED LEARNERS ENROLLED LEARNERS
(Signature of Facilitator over Printed Name
MALE MALE

FEMALE FEMALE
TOTAL TOTAL Certified Correct: (Signature of PSDS over Printed Name)
 AF-1

REMARKS

Interested
in ALS? Yes Enrolled in
ALS
or No
put code for mapped prospective learners
Yes /

NO / 2 alpha and 8 numeric

Region I ba00000001
2nd alpha region

Name)
me)
 ALS ENROLLMENT FORM
Region : Municipal :
City/Province : Barangay :
Date : LRN (if available) :

1) : Personal information (Part I)

Last name First name Middle Name Ext. Name

• Address :
House #/Street/Sitio Barangay Municipality/City Province
• Birth date (mm/dd/yyyy): _____/_____/________ Place of Birth (Municipality/City) _________________________

• Sex:  Male  Female • Civil status:  Single  Married  Widow/er  Separated  Solo Parent  Common Law

• Religion: ____________• IP (Specify ethnic group) : ______________ • Mother Tongue : _______________ PWD: Yes No

• Name of Father/Legal Guardian

Last name First name Middle Name Occupation

• Mother's Maiden Name

Last name First name Middle Name Occupation

2) : Educational information (Part II)

• Last grade level completed
Elementary : K  G-I  G-II  G-III  G-IV  G-V  G-VI 
Secondary : G-7  G-8  G-9  G-10 
• Why did you drop out of school? (For OSY only)
No school in Barangay  School too far from home  Needed to help family 
Unable to pay for miscellaneous and other expenses  Others :

• Have you attended ALS learning sessions before? YES  NO 

If YES, name of the Program: Level of literacy: : Basic  Elem.  Sec.  InfEd 

If YES, have you completed the program? YES  NO  If NO, state the reason:

3) : Learning Center information (Part III)

• How far is it from your home to your Learning Center? km hours and mins.
• How do you get from your home to your Learning Center? Walking  Motorcycle  Bicycle  Others (Pls Specify)  _________
• When can you attend your Learning session?
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
What specific
time can you
be at your
Learning
Centre?

_______________________________________ _____________________________
Facilitator: Signature and Date Learner: Signature and Date
 Republic of the Philippines
Department of Education
ALTERNATIVE LEARNING SYSTEM
AF-3 (MASTER LIST OF ENROLLED AND STATUS OF LEARN
City/Municipality Name of
Barangay

NAME NONFORMAL EDUCATION

Assesment for Basic Functional Literacy Assesment
Literacy (ABL)

Sex (M/F)

PIS Score
Birthdate Age First Date of
LRN Age
Last First Middle mmddyyyy Group Attendance

Basic Literate

Post Literate
Ext

Neo Literate
Name Name Name

(71-99)
(0-70)

(100)
FLT Score in FLT Score in FLT Score in
Reading Numeracy Writing

<=== TOTAL MALE

<=== TOTAL FEMALE
<=== COMBINED

Learners Enrolled by Learners Enrolled by Program

Program Male Female Total Delivery Male Female

BLP Face to Face

A&E Elem. Independent Learning
A&E Sec. Radio-based Instruction
InFED Computer-based Instruction

Learners Enrolled in BLP Male Female

by level Male Female Total
Enrolled Learners 10 15
Basic Literate Number of 4P's Learners 5 10
Neo Literate Percent of Enrolled 4P's Learners
Post Literate

Status of Learner Male Female

 AF-3

F LEARNERS)
Name of Facilitator
Position

ON
PROGRAM ENROLLED
Assesment
Status InfEd 4Ps beneficiary
(Completer/No (Specify (YES/NO)
n-Completer course)
FLT Score in Type of Mode of Program
Overall
Listening &
Speaking Score Program Delivery
Total
Prepared by:

(Signature of Facilitator over Printed Name)

Total
25 Certified Correct:
15
60 (Signature of PSDS over Printed Name)

Total
 Republic of the Philippines AF-4
Department of Education
ALTERNATIVE LEARNING SYSTEM
AF-4 (MASTER LIST OF A&E REGISTRANTS)
Region
School Division

CLC ADDRESS

Sex (M/F)

Birthdate
(Last Name, First Name, A&E Test Level Date Registered Date of
LRN Middle Name, Ext) Registered Examination
Barangay Municipal

<=== TOTAL MALE

<=== TOTAL FEMALE

<=== COMBINED
 Republic of the Philippines
Department of Education
ALTERNATIVE LEARNING SYSTEM
LEARNER'S PERMANENT RECORD
LEARNER'S INFORMATION LRN:__________________
___
LAST NAME: FIRST NAME: __________________ MIDDLE NAME: ______________ EXT NAME: _

ADDRESS:
HOUSE # / SITIO / ST. BARANGAY MUNICIPALITY/CITY PROVINCE

DATE OF BIRTH (mm/dd/yyyy): MONTH _____/ DATE__________ / YEAR___________SEX: Male Female

REGION: DIVISION:

LEARNER'S EDUCATIONAL STATUS

Program Enrolled : Program Enrolled :
Delivery Mode : Delivery Mode :
CLC Name : CLC Name :
District : District :
CLC Address : CLC Address :
Name of Facilitator : Name of Facilitator :
Calendar Year : Calendar Year :
Score Score
ASSESSMENT RESULTS Pre Post
ASSESSMENT RESULTS Pre
PIS Score PIS Score
Assesment for Basic Literacy (ABL) Pre Post Assesment for Basic Literacy (ABL) Pre
Basic Literate Basic Literate
Neo Literate Neo Literate
Post Literate Post Literate
Functional Literacy Assesment Pre Post Functional Literacy Assesment Pre
FLT Score in Reading FLT Score in Reading
FLT Score in Numeracy FLT Score in Numeracy
FLT Score in Writing FLT Score in Writing
FLT Score in Listening & Speaking FLT Score in Listening & Speaking
Overall Score 0 0 Overall Score 0
InfEd Remarks InfEd Remarks

A & E STATUS Remarks A & E STATUS

Program Status Program Status
Test Taker Test Taker
Date of Examination Date of Examination
Testing Center Testing Center
Place of Testing Center Place of Testing Center
Accreditation and Equivalency (A&E) Test Result Accreditation and Equivalency (A&E) Test Result
Total number of years in school/CLC to date : Total number of years in school/CLC to date :

Certificate of Transfer Certificate of Transfer

Eligible for Admission to Eligible for Admission to
: :
Grade Grade
Certificate of Good Moral Character Certificate of Good Moral Character
This is to certify that the aboved-name is a learner of good moral character. This is to certify that the aboved-name is a learner of good moral charact
This certification is issued upon request of the concerned individual for This certification is issued upon request of the concerned individual for
his/her desire to trasfer to another school or for employment. his/her desire to trasfer to another school or for employment.

Prepared by: Certified Correct: Prepared by: Certified Correct:

Facilitator PSDS Facilitator PSDS

 AF-5

______________

XT NAME: ______

PROVINCE

Female

BLP/A&E Elementary/A&E Secondary

Score
Post

Post

Post

0
Remarks (if applicable)

Remarks

haracter
 moral character.
ndividual for
nt.

PSDS