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Learner Individual Registration Form

This document is an individual registration form for a student containing their basic profile information such as name, date of birth, gender, address, enrollment status, religion, ethnicity, previous school information, and parent/guardian contact details. It also lists the documents submitted for registration like birth certificate, clearance, and good moral certificate. The form is signed and dated by the registration in-charge to certify the information is true and correct.

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JulietteOrigenes
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99 views3 pages

Learner Individual Registration Form

This document is an individual registration form for a student containing their basic profile information such as name, date of birth, gender, address, enrollment status, religion, ethnicity, previous school information, and parent/guardian contact details. It also lists the documents submitted for registration like birth certificate, clearance, and good moral certificate. The form is signed and dated by the registration in-charge to certify the information is true and correct.

Uploaded by

JulietteOrigenes
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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School Level On

NAME OF SCHOOL
SCHOOL ID

INDIVIDUAL REGISTRATION FORM GRADE

BASIC PROFILE One letter per box. DATA PROCESSING:


Learner Reference Number (LRN Date of Registration:
FAMILY NAME
FIRST NAME
MIDDLE NAME Registration In-charge
DATE OF BIRTH GENDER
m m d d y y y y (M/F) Date of Entrance:
ADDRESS :
STATUS Other Details:
Regular Mother Tongue : 4Ps Class Adviser
Transferee Religion : IPs
Balik - Aral Ethnicity : ECD Date Encoded in L.I.S.:
Repeater Dialect : PWD

ENROLMENT PROFILE L.I.S. In-charge


Previous Enrolment Remarks:
School ID No.: Grade Level: PWD S, tate below:
ame of School:
me of Adviser:

PARENT'S / GUARDIAN INFORMATION Documents Submitted:


Father's Name Birth Certificate
FAMILY NAME: NSO Copy
FIRST NAME: LCR Copy
MIDDLE NAME: DepED Form 137

Mother' Maiden Name DepED Form 138


FAMILY NAME: Good Moral Cert.
FIRST NAME: Clearance
MIDDLE NAME:
Guardian Name Other Notes:
FAMILY NAME:
FIRST NAME:
MIDDLE NAME:
RELATIONSHIP:
MOBILE PHONE NUMBER :
Certified True and Correct : Attested by:

Thumb Mark, if cannot sign.

Signature over Printed Name Date Signed Class Adviser


[email protected]

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