REQUEST FOR LEARNER INFORMATION SYSTEM (LIS) DATA CORRECTION

District:
School Name: School ID:
Name of School Head: Position.:

A. Please check the type of data correction(s) needed:

_____ Correction of Learner Profile _____ Merging of LRN
_____ Correction of Grade Level _____ Request for Unenrol
_____ Correction of 1st Date of Attendance for Transfer-In _____ Deactivation of LRN
_____ LRN Approval _____ Enrolment of Ineligible
_____ Enrolment of w/ Gap

B. Learner Details:

Last Name: LRN:

First Name: Grade Level:
Middle Name: Section:

C. Please state the nature of request.

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D. Attached supporting documents:

_____ Scanned Copy of Birth Certificate _____ ECD Assessment Result

_____ Scanned Copy of School Form 05 _____ Certification
_____ Scanned Copy of School Form 10 (F-137) _____ Others (specify)
_____ Scanned Copy of School Form 09 (F-138)

Requested by: Noted:

Name of Class Adviser School Head

Contact #: Contact #: