Required*
A. Grade Level Information
Old/New Student
*
Choose...
New Student
Old Student
Grade Level to Enroll
*
Choose...
Grade One
Grade Two
Grade Three
Grade Four
Grade Five
Grade Six
Learner Reference Number
*
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Old School Information
Last School Attended
*
School Address
School Type
*
Choose...
Public
Private
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B. Student information
Student's Complete Name (as appearing in PSA Birth Certificate)
First Name
*
Middle Name
Last Name
*
Extension Name
Birth Date
*
Gender
*
Choose...
Male
Female
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B. Student information
Belonging to any Indigenous Peoples (IP) Community/Indigenous Cultural Community?
*
Yes
No
If Yes, please specify
Mother Tongue
*
Religion
*
Seventh-Day Adventist
If SDA, are you baptized?
Yes
No
Date of Baptism
Church Membership
Roman Catholic
Iglesia ni Cristo
Jehovah's Witness
Baptist
Born Again Christian
The Church of Jesus Christ of Latter-day Saints
Others
Facebook Name
*
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B. Student information
Complete Home Address
House Number & Street
*
Barangay
*
City/Municipality
*
Province
*
Country
*
Other Home Address
House Number & Street
Barangay
City/Municipality
Province
Country
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C. Parent/Guardian Information
Father’s Name (Last Name, First Name, Middle Name)
*
Father’s Facebook Name
*
Highest Educational Attainment
*
Choose...
No Formal Schooling
No Formal Schooling but able to read and write
Elementary Level
Elementary Graduate
High School Level
High School Graduate
After High School Education (College/Post Grad) or Technical/Vocational
Cellphone Number(09123456789)
*
Mother’s Maiden Name (Last Name, First Name, Middle Name)
*
Mother’s Facebook Name
*
Highest Educational Attainment
*
Choose...
No Formal Schooling
No Formal Schooling but able to read and write
Elementary Level
Elementary Graduate
High School Level
High School Graduate
After High School Education (College/Post Grad) or Technical/Vocational
Additional Cellphone Number(09123456789)
Guardian’s Name (Last Name, First Name, Middle Name)
*
Guardian’s Facebook Name
*
Highest Educational Attainment
*
Choose...
No Formal Schooling
No Formal Schooling but able to read and write
Elementary Level
Elementary Graduate
High School Level
High School Graduate
After High School Education (College/Post Grad) or Technical/Vocational
Additional Cellphone Number(09123456789)
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D. Household Capacity and Access to Distance Learning
How many of your household members (including the enrollee) are studying in School Year 2024-2025? Please specify each.
Kinder
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
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E. Limited Face to Face
Is the learner vaccinated against Covid-19?
*
Yes
No
If Yes, Date of 1st Shot
If Yes, Date of 2nd Shot
I want my child to stay in the SCHOOL DORMITORY.
*
Yes
No
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.
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