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Jhs Enrollment Form

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48 views2 pages

Jhs Enrollment Form

Uploaded by

jhen Agetyeng
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Diocese of Baguio - Schools

SAINT LOUIS SCHOOL OF PACDAL, INC.


Siapno Road, Pacdal Circle, Baguio City 2600, Philippines
E-mail: Phone. No. (074) 661-4223
Life-Transforming and Christ’s Disciple Forming Educational Community

LEARNER ENROLLMENT FORM


JUNIOR HIGH SCHOOL
Instructions:
1. This enrollment form shall be answered by the student with the presence of his/her parent or guardian.
2. Please read the questions carefully and fill-up in all applicable spaces and write your answers legibly in CAPITAL LETTERS. For items
not applicable, write N/A
3. For questions/clarifications, please as for the assistance of the teacher/ person-in-charge.

A. GRADE LEVEL AND SCHOOL INFORMATION .

A1. School Year A2. No LRN With LRN A3. Returning Student
-
A4. Grade Level to enroll: A7. Last School Attended: A8. School ID:

A5. Last grade level completed A9. School Address:


General Average last school year:
A6. Last School year completed: A10. School Type:
Public Private

B. STUDENT INFORMATION .

B1. PSA Birth Certificate No. B2. LEARNER REFERENCE


(If available upon enrollment) NUMBER (LRN)
B3. LAST NAME:

B4. GIVEN NAME:

B5. MIDDLE NAME:

B6. EXTENSION (JR, SR, III, etc.)

B7. DATE OF BIRTH (Month-Day-Year) For Learners with Special Education Needs.
- -
B14. Does the learner have special education needs?
Yes No
B8. AGE B9. SEX MALE FEMALE B15. If yes, please specify:

B10. Belonging to Indigenous Peoples (IP) Yes No B16. Do you have any assistive technology devices available
Community/Indigenous Cultural Community at home? (i.e screen reader, Braille, DAISY)
B11. If yes, Please specify: Yes No

B12. Mother Tongue: B17. If yes, please specify:

B13. Religion:

ADDRESS .
B18. House Number and Street B19. Barangay

B20. City/Municipality B21. Province B22. Region


C. PARENT/ GUARDIAN INFORMATION .

FATHER MOTHER GUARDIAN


C1. Full Name C7. Full Name C13. Full Name
(surname, full name, middle name) (surname, full name, middle name) (surname, full name, middle name)

C2. Highest Educational Attainment C8. Highest Educational Attainment C14. Highest Educational Attainment
Elementary Elementary Elementary
High School graduate High School graduate High School graduate
College graduate College graduate College graduate
Vocational Vocational Vocational
Master’s/Doctorate degree Master’s/Doctorate degree Master’s/Doctorate degree
Did not attend school Did not attend school Did not attend school
C3. Employment Status C9. Employment Status C15. Employment Status
Full time Full time Full time
Part time Part time Part time
Self-employed (i.e family Self-employed (i.e family Self-employed (i.e family business)
business) Unemployed due to ECQ business) Unemployed due to ECQ Unemployed due to ECQ
Not working Not working Not working
C4. Working from home due to ECQ? C10. Working from home due to ECQ? C16. Working from home due to ECQ?
Yes No Yes No Yes No
C5. Contact number/s C11. Contact number/s C17. Contact number/s
(cellphone/telephone) (cellphone/telephone) (cellphone/telephone)

C6. Email Address: C12. Email Address: C18. Email Address:

D. HOUSEHOLD CAPACITY AND ACCESS TO DISTANCE LEARNING .


D1. How does your child go to school? Choose all that applies.
Walking Public commute 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 3 Grade 7 Grade 10 Grade 12
Grade 1 Grade 4 Grade 8 Grade 11
Grade 2 Grade 5 Grade 9 Other (college, vocational)
D3. Who among the household members can provide instructional support to the child’s distance learning? Choose all that applies
Parents/ Guardians Grandparents
Elder siblings Extended members of the family
Grandparents Others (tutor, household helper)
Able to do independent learning
D4. What devices are available at home that the D5. Do you have a way to connect to the internet?
learner can use for learning? Check all that applies.
Yes No (proceed to D7)
Cable TV
D6. How do you connect to the internet? Choose all that
Non cable TV Radio
applies. Own mobile data
Basic Cellphone Desktop computer
Own broadband (DSL, Wireless fiber, satellite)
Smartphone Laptop
Computer shop
Tablet None
Other places outside the home with internet connection
Others:
(Library, Barangay, neighbor, relatives)
D7. What distance learning modality/ies do you prefer Other
for your child? Choose all that applies
D8. What are the challenges that may affect your child’s learning
Online learning Modular learning process through distance education? Choose all that applies.
Television Combination of face to Lack of available gadget
Conflict with other activities (i.e
Radio face with other modalities Insufficient load/data allowance
household chores)
Unstable data/ internet connection
High electrical consumption
Existing health condition
Distraction (i.e social medias, noise)
Difficulty in independent learning

I hereby certify that the above information given are true and correct to the best of my knowledge and I allow
Saint Louis School of Pacdal, Inc. 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 Data Privacy Act of 2012.
Note: That the reservation fee is deductible to the whole down payment but non-refundable.

Signature over Printed Name of Parent/Guardian Date

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