Академический Документы
Профессиональный Документы
Культура Документы
A4. Grade Level to enroll: A7. Last School Attended: A8. School ID: A11. School to enroll in: A12. School ID:
_______________________ ____________________________________ ___________________ ________________________________________ __________________
A5. Last grade level completed: A9. School Address: A13. School Address:
_______________________ ___________________________________________________________ _______________________________________________________________
A6. Last school year completed: A10. School Type:
_______________________ Public Private
B. STUDENT INFORMATION
B3.
LA
ST
NA
ME
B4.
FI
RS
T
NA
ME
B5.
MI
DD
LE
NA
ME
B6. EXTENSION NAME e.g. Jr., III (if applicable) __________________________________________________
B8.
B9. Mal
Ag Female
Sex e
e
B1 Yes No
0.
Bel
ong
ing
to
Indi
gen
ous
Pe
opl
es
(IP)
Co
mm
unit
y/In
dig
eno
us
Cul
tura
l
Co
mm
unit
y
B1
1. If
yes
,
ple
ase
spe
cify
:
___
___
___
___
___
_
B12. Mother Tongue: ____________________________________
C2. Highest Educational Attainment C7. Highest Educational Attainment C12. Highest Educational Attainment
Did not attend school Did not attend school Did not attend school
Self-employed (i.e. family business) Self-employed (i.e. family business) Self-employed (i.e. family business)
Unemployed due to community quarantine Unemployed due to community quarantine Unemployed due to community quarantine
C4. Working from home due to community quarantine? C9. Working from home due to community quarantine? C14. Working from home due to community quarantine?
C5. Contact number/s (cellphone/ telephone) C10. Contact number/s (cellphone/ telephone) C15. Contact number/s (cellphone/ telephone)
Yes No
D2. How many of your household members (including the D3. Who among the household members can provide
enrollee) are studying in School Year 2020-2021? Please specify instructional support to the child’s distance learning? Choose all
each. that applies.
parents/ guardians others (tutor, house helper)
Kinder Grade 4 Grade 8 Grade 12 elder siblings none
_______ ______ ______ ______ able to do independent
Grade 1 Grade 5 Grade 9 Others (ie grandparents
learning
_______ ______ ______ college, vocational,
etc) _______ extended members of the
Grade 2 Grade 6 Grade 10 family
_______ ______ ______
Grade 3 Grade 7 Grade 11
_______ ______ ______
D4. What devices are available at home that D5. Do you have a way to D6. How do you connect to the internet? Choose
the learner can use for learning? Check all connect to the internet? all that applies.
that applies. own mobile data
Yes own broadband internet (DSL, wireless fiber,
cable TV radio satellite)
non-cable TV desktop computer No computer shop
basic cellphone laptop (If NO, proceed to D7) other places outside the home with internet
smartphone none connection (library, barangay/ municipal hall,
tablet others: __________ neighbor, relatives)
none
D7. What distance learning modality/ies do you D8. What are the challenges that may affect your child’s learning process
prefer for your child? Choose all that applies. through distance education? Choose all that applies.
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.
Grade
Track (for SHS)
Level