Enrollment Form

Enrollment Requirements
 
A. GRADE LEVEL AND SCHOOL INFORMATION
A1. School Year
 
A2. Check the appropriate boxes only
No LRN
With LRN
A3. Returning (Balik-Aral)
A4. Grade Level to enroll:
A5. Last grade level completed:
A6. Last school year completed:
A7. Last School Attended:
A8. Last School ID:
A9. School Address:
A10. School Type:
Public
Private
A11. School to enroll in:
A12. School ID:
A13. School Address:
FOR SENIOR HIGH SCHOOL ONLY:
A14. Semester:
1st Sem
2nd Sem
A15. Track:
A16. Strand (if any):
A17. Others (specify):
B. STUDENT INFORMATION
B1. PSA Birth Certificate No. (if available upon enrolment):
B2. Learner Reference Number (LRN)
B3. LAST NAME
B4. FIRST NAME
B5. MIDDLE NAME
B6. EXTENSION NAME e.g. Jr., III (if applicable)
B7. Date of Birth (Month/Day/Year)
B8. Age
B9. Sex
Male
Female
B10. Belonging to Indigenous Peoples (IP) Community/Indigenous Cultural Community?
Y
N
B11. If yes, please specify:
B12. Mother Tongue:
B13. Religion:
For Learners with Special Education Needs
B14. Does the learner have special education needs?
Y
N
B15. If yes, please specify:
B16. Do you have any assistive technology devices available at home? (i.e. scree reader, Braille, DAISY)
Y
N
B17. If yes, please specify:
ADDRESS
B18. House Number and Street
B19. Barangay
B20. City/ Municipality
B21.Province
B22.Region
C. PARENT’S/GUARDIAN’S INFORMATION
Primary Contact Email address
FATHER
C1. Full Name (surname, full name, middle name)
C2. Highest Educational Attainment
Elementary graduate
High School graduate
College graduate
Vocational
Master’s/Doctorate degree
Did not attend school
C3. Employment Status
Fulltime
Part time
Self-employed (i.e. family business)
Unemployed due to ECQ
Not working
C4. Working from home due to ECQ?
Yes
No
C5. Contact number/s (cellphone/ telephone)
MOTHER
C7. Full Maiden Name (surname, full name, middle name)
C2. Highest Educational Attainment
Elementary graduate
High School graduate
College graduate
Vocational
Master’s/Doctorate degree
Did not attend school
C3. Employment Status
Fulltime
Part time
Self-employed (i.e. family business)
Unemployed due to ECQ
Not working
C4. Working from home due to ECQ?
Yes
No
C5. Contact number/s (cellphone/ telephone)
GUARDIAN
C13. Full Name (surname, full name, middle name)
C2. Highest Educational Attainment
Elementary graduate
High School graduate
College graduate
Vocational
Master’s/Doctorate degree
Did not attend school
C3. Employment Status
Fulltime
Part time
Self-employed (i.e. family business)
Unemployed due to ECQ
Not working
C4. Working from home due to ECQ?
Yes
No
C5. Contact number/s (cellphone/ telephone)
D. HOUSEHOLD CAPACITY AND ACCESS TO DISTANCE LEARNING
D1. How does your child go to school? Choose all that applies.
walking
public commute (land/ water)
family-owned vehicle
school service
D2. How many of your household members (including the enrollee) are studying in School Year 2020-2021? Please specify each.
Kinder
Grade 4
Grade 8
Grade 12
Grade 1
Grade 5
Grade 9
Others(ie college, vocational, etc)
Grade 2
Grade 6
Grade 10
Grade 3
Grade 7
Grade 11
D3. Who among the household members can provide instructional support to the child’s distance learning? Choose all that applies.
parents/ guardians
elder siblings
grandparents
extended members of the family
others (tutor, house helper)
none
able to do independent learning
D4. What devices are available at home that the learner can use for learning? Check all that applies.
cable TV
non-cable TV
basic cellphone
smartphone
tablet
radio
desktop computer
laptop
none
others
D5. Do you have a way to connect to the internet?
Yes
No (If NO, proceed to D7)
D6. How do you connect to the internet? Choose all that applies.
own mobile data
own broadband internet (DSL, wireless fiber, satellite)
computer shop
other places outside the home with internet connection (library, barangay/ municipal hall, neighbor, relatives)
none
D7. What distance learning modality/ies do you prefer for your child? Choose all that applies.
online learning
television
radio
modular learning
combination of face to face with other modalities
others:
D8. What are the challenges that may affect your child’s learning process through distance education? Choose all that applies.
lack of available gadgets/ equipment
insufficient load/ data allowance
unstable mobile/ internet connection
existing health condition(s)
difficulty in independent learning
conflict with other activities (i.e., house chores)
high electrical consumption
distractions (i.e., social media, noise from community/neighbor)
others:
 

I hereby certify that the above information given are true and correct to the best of my knowledge and I allow the Department of Education to use my child’s details to create and/or update his/her learner profile in the Learner Information System. The information herein shall be treated as confidential in compliance with the Data Privacy Act of 2012.

 
Parent Initial
Initial Date
 
Picture (Max size: 256Kb Formats: .jpg,.gif,.png,.jpeg)
  • Sized such that the head is between 1 inch and 1 3/8 inches (between 25 and 35 mm) from the bottom of the chin to the top of the head
  • Taken within the last 6 months to reflect your current appearance
  • Taken in front of a plain white or off-white background
  • Taken in full-face view directly facing the camera
  • With a neutral facial expression and both eyes open
  • Taken in clothing that is formal or NA Uniform.