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Republic of the Philippines

DEPARTMENT OF EDUCATION
Region 02
SCHOOLS DIVISION OF CAGAYAN

DATA REQUEST FORM


Control Number: ___________________ Date:_______________________
CLIENT INFORMATION Inventory of Teachers

Name:____________________________________ Level: ( ) Kindergarten ( ) Elementary

Position/designation:________________________ ( ) Junior HS ( ) Senior HS

School/Agency/Office:_______________________ School/s: ________________________________

Contact Number:___________________________ District: _________________________________

E-mail Address:____________________________ Municipality: _____________________________


School Year: _____________________________
DATA REQUEST
Performance Indicators
Purpose:___ ______________________________________ Sector: ( ) Public ( ) Private
__________________________________________________ Level: ( ) Elementary ( ) Secondary

Enrolment Indicators:
Sector: ( ) Public ( ) Private ( ) Apparent/Net Intake Rate
Level: ( ) Kindergarten ( ) Elementary ( ) Cohort Survival Rate
( ) Junior HS ( ) Senior HS ( ) Gross Enrolment Rate
School/s: ______________________________ ( ) Net Enrolment Rate
School District: ________________________ ( ) Promotion Rate
Municipality: __________________________
( ) Repetition Rate
Congressional District: __________________
( ) Retention Rate
School Year: ___________________________
( ) School Leaver Rate
Masterlist of Schools
( ) Simple Dropout Rate
Sector: ( ) Public ( ) Private
Level: ( ) Kindergarten ( ) Elementary ( ) Transition Rate
( ) Junior HS ( ) Senior HS Others (Please specify):
District: _______________________________ _____________________________________________
Municipality: __________________________ _____________________________________________
School Year: ___________________________ _____________________________________________
(For Planning Officer’s use only)
Masterlist of School Heads
Level: ( ) Elementary ( ) Secondary REMARKS/ ACTION TAKEN
District: ______________________________ _________________________________________
Municipality: __________________________ _________________________________________
School Year: ___________________________ _________________________________________
Date Acted: _______________________________________
Contact Number of School Heads
School Name: __________________________________ Received/Acted by:

School District: _________________________________ EDLYNNE QAE A. CALAYAN


Name of School Head:___________________________ Others (please specify):
Planning_____________________
Officer III
FM-SGO-PLA-002 ____________________________________________
Rev. 00
_____________________________________________
___________________________________________
Republic of the Philippines
DEPARTMENT OF EDUCATION
Region 02-Cagayan Valley
SCHOOLS DIVISION OF CAGAYAN

TECHNICAL ASSISTANCE FORM FOR EBEIS & LIS

Control Number: ___________________ Date:_______________________

CLIENT INFORMATION For LIS:


USER ACCOUNT MANAGEMENT
Name:____________________________________
Position/Designation:________________________ Password Reset
School ID and Name:________________________ School Head Username:___________________
Contact Number:___________________________ Desired Password:_______________________
E-mail address: ____________________________ System Admin Username: __________________

For EBEIS: Desired Password: _______________________

UPDATING OF SCHOOL PROFILE Change/Reassignment of School Head


Name of New School Head: ________________
Curricular Offering Classification TIN (New School Head): __________________
Old Classification:_______________________ Date of Birth: ___________________________
New Classification: ______________________ Name of Prev. School Head: _______________
Reopening/Closing of a school TIN (Prev. School Head): __________________
School ID:______________________________ Date of Birth: ___________________________
Reason/s for Closing/Reopening: ___________ Others (Please specify): ___________________
_________________________________________ _________________________________________
Date of Closing/Reopening: _______________ _________________________________________
Updating of Integrated Schools: _________________________________________
Old School Type: ________________________ _________________________________________
New School Type: _______________________ _________________________________________
Renaming of School:
Old Name: _____________________________ (For Planning Officer’s use only)

New Name: _____________________________ REMARKS/ ACTION TAKEN


Updating of School Head Name & Position: _________________________________________
_________________________________________
Name: _________________________________
_________________________________________
Position: _______________________________ Date Acted: _______________________________________
Contact No.: ____________________________ Received/Acted by:

Email Address: __________________________ EDLYNNE QAE A. CALAYAN


Planning Officer III

FM-SGO-PLA-003 Rev. 00
Republic of the Philippines
DEPARTMENT OF EDUCATION
Region 02-Cagayan Valley
SCHOOLS DIVISION OF CAGAYAN

LIS CHANGE REQUEST AND ISSUANCE OF LRN FORM

Control Number: ___________________ Date:_______________________


CLIENT INFORMATION CHANGE REQUEST
Enrolment with gap
Name:____________________________________
Reason/s for the gap (pls specify) ___________
Position/Designation:________________________
_________________________________________
School ID and Name:________________________
_________________________________________
Contact Number:___________________________
_________________________________________
E-mail address: ____________________________
Enrolment of ineligible
ISSUANCE OF NEW LRN
Erroneously tag EOSY/no status
Name of the learner: ________________________
Correct status: _________________________
Section: __________________________________
Reason for the correction:_________________
Reasons for not having LRN:
_________________________________________
1. From accredited/recognized school
_________________________________________
School year last attended: _________________
Others (pls specify): ________________________
School last attended: _____________________
2. Undergone catch-up program and assessed _________________________________________
school readiness _________________________________________
Result of the assessment: __________________ _________________________________________
_______________________________________ _________________________________________
3. From not accredited local school
Certification/Accreditation/Equivalency Exam: (For Planning Officer’s use only)
a. PEPT Certificate no. _______________
Approved Disapproved
b. PVT Certificate no. ________________
4. From foreign/Philippine school abroad REMARKS/ ACTION TAKEN
_________________________________________
Last school year attended: _________________
_________________________________________
Last school attended: _____________________
_________________________________________
Country: _______________________________ _________________________________________
5. From ALS _________________________________________
Certification/Accreditation/Equivalency Exam: Date Acted: _______________________________________

a. PEPT Certificate no. _________________


Received/Acted by:
b. PVT Certificate no. _________________
6. Others (pls specify) ___________________ EDLYNNE QAE A. CALAYAN
___________________________________ Planning Officer III

FM-SGO-PLA-001 Rev. 00

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