Does the

learner
already
have a Is the Last school
Last grade
registered learner a year Last School
Grade level level School
School Year LRN? (Ang returning completed Attended School ID
to enroll completed Address
Timestamp (Taong mag-aaral student? (Huling (Huling (ID ng
(Baitang na (Huling (Adres ng
Panuruan) ba ay may (Ang mag- natapos na paaralang Paaralan)
nais ipatala) baitang na Paaralan)
nakarehistr aaral ba ay taon sa pinasukan)
natapos)
o nang LRN Balik-aral?) paaralan)
sa
### 2020 - 202No (Hindi)
kasalukuya
No (Hindi) Grade 1 Kindergart 2019 - 202Our Lady o 409090 Phase 1 bl
### 2020 - 202Yesn?) (Oo) Yes (Oo) Grade 1 Kindergart 2019 - 202Cachapero 402112 block 7 lot
### 2020 - 202No (Hindi) No (Hindi) Grade 1 Kindergart 2019 - 202Cachapero
### 2020 - 202No (Hindi) No (Hindi) Grade 1 Kindergart 2019 - 202Groeien Lea B14 lot 20
### 2020 - 202Yes (Oo) Yes (Oo) Grade 1 Kindergart 2019 - 202St. Hilary S Medicion I
### 2019 - 202No (Hindi) Yes (Oo) Grade 1 Kindergart 2019 - 202Gabriel Arc 409146 Lancaster
### 2020 - 202No (Hindi) No (Hindi) Grade 1 Kindergart 2019 - 202Damascus E Cattleya Su
### 2020 - 202Yes (Oo) No (Hindi) Grade 1 Kindergart 2019 - 202Our Lady o 409090 ACM 1 ALA
### 2020 - 202No (Hindi) No (Hindi) Grade 1 Kindergart 2019 - 202Damascus E2019035 Blk. 1 Lt.
 PSA
School to CERTIFACT
enroll in E NUMBER
School School LEARNER
(Paaralan School ID (Numero na LAST
Type (Uri Address Semester Strand (if REFERENC
kung saan (ID ng Track nakalagay NAME
ng (Adres ng (Semestre) any) E NUMBER
nais i-enroll Paaralan) sa Sertipiko (Apelyido)
Paaralan) Paaralan) (LRN)
ang mag- ng
aaral) Kapangana
kan)
Private (P Tinabunan Pag-asa 1,1st 20134634 Pasia
Private (P Tinabunan 107,989 pag-asa1 im 20143706 4.02E+11 Francisco
Private (P Tinabunan De Leon
Private (P Tinabunan 1st Ignacio
Private (P Tinabunan PAG ASA1 Patling
Private (P Tinabunan 409,146 Landcaster 102 4.09E+11 Calinagan
Private (P Tinabunan 1st Buñales
Private (P Tinabunan 107,989 PAG ASA 1 4457 4.09E+11 LUMAGBA
Private (P Tinabunan 107,989 Advincula 4397 Gendibe
 Belonging
to
Indigenous
People (IP)
Community
If yes,
/Indigenous
Extension Date of please
MIDDLE Cultural Mother
FIRST name (if Birth (Petsa specify
NAME Sex Community tongue Religion
NAME applicable/k ng Age (Edad) (Kung oo,
(Gitnang (Kasarian) (Nabibilang (Kinagisnan (Relihiyon)
(Pangalan) ung Kapangana saang
Pangalan) sa g wika)
mayroon) kan) grupo
katutubong
nabibilang)
grupo/
Christeen Longhas 9/27/2013 6 Female (B No (Hindi)
Komunidad Tagalog Roman Cath
ng
Yssabelle Barracas 8/21/2014 5 Female (B No (Hindi)
Katutubong Tagalog Catholic
Lucas MiguDe Guzma 11/7/2014 Kultural)
5 Male (LalakNo (Hindi) tagalog / ERoman Cath
Sofia Loui Natividad 2/14/2014 6 Female (B No (Hindi) Tagalog Christian
Calix EnveSarmiento ### 6 Male (LalakNo (Hindi) Tagalog Catholic
Sophia Ma 3/16/2014 6 Female (B No (Hindi) Tagalog Catholic
Marionne AEspeña 5/8/2014 6 Female (B No (Hindi) Filipino Born Again
JHENICA ATENCIO 9/28/2013 6 Female (B No (Hindi) TAGALOGCATHOLIC
Meshach Ne
Pableo 5/23/2014 6 Male (LalakNo (Hindi) Tagalog Born again
 Does this
learner
have
Do you
special
have any
education
assistive
needs? If yes,
technology
(Ang mag- please Highest
devices
aaral ba ay specify Educational
available at House City/Munici
nangangail (Kung Father's Attainment
home? Number pality Province
angan ng MAYROON, Region name (Pinakamat
(May (Numero ng Barangay (Lungsod/ (Probinsiya/
espesyal na isulat kung (Rehiyon) (Pangalan aas na
nagagamit bahay at Munisipalid Lalawigan)
tulong sa ano ang ng Ama) antas na
bang kalye) ad)
pag-aaral? natatanging natapos sa
“assistive
(hal.: sa kalagayan pag-aaral)
technology
Nopisikal,
(Wala) ng bata) No (Wala)
devices” sa
Block 5 LotCarsadangImus Cavite Region 4-APasia, John
High Schoo
mental,
No (Wala)
kondisyong Noinyong
(Wala) Block8 Lot Pag-asa1 Imus City Cavite Region 4a Francisco, College Gr
bahay?)
medical,
No (Wala) No (Wala) carsadang imus cavite 4A De Leon WiCollege Gr
bukod sa
Noiba(Wala)
pa)) No (Wala) Block 5 Lo Alapan 1-AImus Cavite 4A Ignacio PaCollege Gr
No (Wala) No (Wala) 15 Pag asaPag asa 1 Imus Cavite 4 PATLING Vocational
No (Wala) Yes (MayroBlk 4 lot 6 San sebastKawit Cavite 4104
Yes (MayroMahina an No (Wala) Blk 10, LotPag-Asa II Imus Cavite IV Buñales, MHigh Schoo
No (Wala) No (Wala) B 1 L 6 CARSADAN IMUS CAVITE IV- A LUMAGBAS College Gr
No (Wala) No (Wala) BLK 5-A LtPag-asa 2 Imus Cavite CalabarzonGendibe, ACollege Gr
 Working Highest Working Guardian's Highest
from home Educational from home name (not Educational
Employmen due to Contact Mother's Attainment Employmen due to Contact parents) Attainment
t status ECQ? Number name (Pinakamat t status ECQ? Number (Pangalan (Pinakamat
(Katayuan (Nagtratrab (Cellphone/ (Pangalan aas na (Katayuan (Nagtratrab (Cellphone/ ng tagapag- aas na
sa trabaho) aho sa Telephone) ng Ina) antas na sa Trabaho) aho sa Telephone) alaga na antas na
bahay dahil natapos sa bahay dahil hindi ama o natapos sa
sa ECQ) pag-aaral) sa ECQ) ina) pag-aaral)
Full time No Longhas, ACollege GrPart time Yes 949628573Conchita LHigh Schoo
Full time No 099542894Barracas,HHigh SchooNot workingNo 099542894Barracas,HHigh Schoo
Part time No De Leon J Self EmploYes 0939 564
Part time No Natividad College GrNot workingNo 093688244Natividad College Gr
UnemployedNo 093531129Sarmiento High SchooNot workingNo 995658026Sarmiento High Schoo
Calinagan jCollege GrPart time No 092788262Guibani luzCollege Gr
Buñales, ACollege GrFull time No 094774178Santos, JoHigh Schoo
Full time No 093084229ATENCIO,JCollege GrNot workingNo 092066371
No 0926-336- Gendibe, mCollege GrFull time No 093845359None
 How does
your child
goes to
Working
school?
from home
Choose all
Employmen due to Contact
that applies
t status ECQ? Number
(Paano Kinder Grade 1 Grade 2 Grade 3 Grade 4 Grade 5
(Katayuan (Nagtratrab (Cellphone/
pumapasok
sa Trabaho) aho sa Telephone)
ang bata sa
bahay dahil
paaralan?
sa ECQ)
Piliin ang
Not workingNo 094805566Public Com
lahat ng
1
Not workingNo 099542894Walking
naaangkop) (N 1
Walking (N 1 1
Not workingNo Walking (N 0 1 0 0 0 0
Self EmploNo 092984428Public Com 1
Not workingNo 090573448Public Com
Part time No 091558357Walking (N 1
Family-own 1 1
School Ser 1
 can provide
What
instructiona
devices are
l support to
available at
the child's
home that
distance
the learner
learning?
can use for
Choose all
learning?
that
Check all
applies.
that
(Sino-sino
Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 Others applies.
sa
(Anong
miyembro
mga
ng inyong
kagamitan
tahanan
sa tahanan
Parents/Gua
ang Smartphon
ang
maaaring
Parents/Gu
tumulong Cable TV,
magagamit
ng bata
sa distance Cable TV,
Parents/Gua para sa
learning na
pag-aaral)
0 0 0 0 0 0 0 Parents/Gua
pag-aaral Tablet, De
ng bata?
Parents/Gu
Piliin ang Non-Cable
lahat ng Tablet
Grandparent
naaangkop)
Parents/GuNon-Cable
Parents/GuCable TV,
Parents/GuSmartphone
 child's to
learning herein shall
learning create/upda
modality/ies be treated
progress Do you te your
do you as
How do you through certify that child's
prefer for confidential
connect to distance all the learner
Do you your child? in
the education? information profile in
have a way Choose all compliance
internet? Choose all given are the Learner
to connect that with the
Choose all that true and Information
to the applies. Data
that applies. / correct? System
internet? (Ano-anong Privacy Act
Other. (Iba applies. other (iba Anong mga Others (iba (Ikaw ba'y (LIS)? (Ikaw
Mayroon ka pamamaraa of 2012.
pa) (Paano ka pa) hadlang pa) nangangak ba ay
bang n ng (Lahat ng
nakaka- ang o na ang pumapayag
paraan para “distance impormasy
connect sa maaaring lahat ng na gamitin
maka- learning” on dito ay
internet? makaapekto data na ng
connect sa ang nais dapat na
Yes (Mayroown
internet
Pillinbroadba
ang online learn
mo para sa
difficulty
sa proseso Yesiyong
(Oo) Yes (Oo)
Kagawaran I ituring
agree (S
na
lahat ng ng ibinigay at ng
Yes (Mayroown mobileonline
naangkop)
iyonglear pagkatuto Yes
tunay(Oo)
at Yes (Oo)
Edukasyon Ikumpidensi
agree (S
anak? Piliin yal at
Yes (Mayroown broadba online lear ng iyong
distraction tama?)
Yes (Oo) ang
Yes (Oo) Inaaayon
agree (S
ang lahat sa
anak gamit impormasy
ng Data
Yes (Mayroown broadba online lear
naaangkop.
difficulty
ang Yes (Oo) Yes (Oo)
on na ito IPrivacy
agree Act (S
distance para i-
Yes (Mayroown broadba online ) lear unstable of 2012.)
education?mo Yes (Oo) Yes (Oo)
update ang I agree (S
Yes (Mayroown mobileonline lear Piliin ang
insufficien Yes (Oo) profile
Yes (Oo)ng I agree (S
lahat ng mag-aaral
Yes (Mayroown mobiletelevision lack of ava
naaangkop Yes (Oo) Yes (Oo)
sa Learner I agree (S
Information
Yes (Mayroown broadba
online lear distraction Yes (Oo) Yes (Oo)
I agree (S
System
(LIS)?)
Yes (Mayroown broadba
online lear distraction Yes (Oo) Yes (Oo) I agree (S
 If yes,
please
specify Subdivision
(Kung / baryo/
MAYROON, purok/ sitio
isulat kung
ano ito)
Dreamville
Narra Home No (Hindi)
No (Hindi)
ACM Woods No (Hindi)
No (Hindi)
Tablet Baypoint st No (Hindi)
Primavida No (Hindi)
DREAMVILL No (Hindi)
Israel stree No (Hindi)
 Does the
learner
already
have a Is the Last school
Last grade
registered learner a year Last School
Grade level level School
School Year LRN? (Ang returning completed Attended School ID
to enroll completed Address
Timestamp (Taong mag-aaral student? (Huling (Huling (ID ng
(Baitang na (Huling (Adres ng
Panuruan) ba ay may (Ang mag- natapos na paaralang Paaralan)
nais ipatala) baitang na Paaralan)
nakarehistr aaral ba ay taon sa pinasukan)
natapos)
o nang LRN Balik-aral?) paaralan)
sa
### 2020 - 202Yes (Oo) No (Hindi) Grade 2 Grade 1 2019 - 202Ruther E. E
kasalukuya
Imus Camp
### 2020 - 202Yesn?) (Oo) No (Hindi) Grade 2 Grade 1 2019 - 202Groeien Lea 424082 Blk 14 Lot
### 2020 - 202Yes (Oo) No (Hindi) Grade 2 Grade 1 2019 - 202Other (Wala 424400 ALAPAN I
### 2020 - 202Yes (Oo) No (Hindi) Grade 2 Grade 1 2019 - 202Groeien Lea
### 2020 - 202No (Hindi) No (Hindi) Grade 2 Grade 1 2019 - 202Vox Dei Pl
### 2020 - 202Yes (Oo) No (Hindi) Grade 2 Grade 1 2019 - 202Cachapero
### 2020 - 202Yes (Oo) No (Hindi) Grade 2 Grade 1 2019 - 202Vox Dei Pl 424400 Alapan I-A
### 2020 - 202No (Hindi) No (Hindi) Grade 2 Grade 1 2019 - 202Our Lady of ACM ph7 al
### 2020 - 202Yes (Oo) No (Hindi) Grade 2 Grade 1 2019 - 202Groeien Lea 424082
### 2020 - 202Yes (Oo) No (Hindi) Grade 2 Grade 1 2019 - 202Ashtonville 424468
### 2020 - 202Yes (Oo) No (Hindi) Grade 2 Grade 1 2019 - 202Groeien Lea 424082
### 2020 - 202Yes (Oo) No (Hindi) Grade 2 Grade 1 2019 - 202Other (Wala
Gahak-Maru 108020
### 2020 - 202Yes (Oo) No (Hindi) Grade 2 Grade 1 2019 - 202Groeien Lea 424082
### 2020 - 202Yes (Oo) No (Hindi) Grade 2 Grade 1 2019 - 202Groeien Lea
### 2020 - 202Yes (Oo) No (Hindi) Grade 2 Grade 1 2019 - 202Brehms Sch
### 2020 - 202Yes (Oo) No (Hindi) Grade 2 Grade 1 2019 - 202Other (Wala
Jesus Goo 402145
### 2020 - 202Yes (Oo) Yes (Oo) Grade 2 Grade 1 2019 - 202Groeien Lea 424082
### 2020 - 202Yes (Oo) No (Hindi) Grade 2 Grade 1 2019 - 202Groeien Lea 424082
### 2020 - 202Yes (Oo) No (Hindi) Grade 2 Grade 1 2019 - 202Vox Dei Pl
### 2020 - 202Yes (Oo) No (Hindi) Grade 2 Grade 1 2019 - 202St. Martin 402183
### 2020 - 202No (Hindi) No (Hindi) Grade 2 Grade 1 2018 - 201Groeien Lea
### 2020 - 202Yes (Oo) No (Hindi) Grade 2 Grade 1 2019 - 202Groeien Lea
### 2020 - 202Yes (Oo) No (Hindi) Grade 2 Grade 1 2019 - 202Groeien Lea 424082
 PSA
School to CERTIFACT
enroll in E NUMBER
School School LEARNER
(Paaralan School ID (Numero na LAST
Type (Uri Address Semester Strand (if REFERENC
kung saan (ID ng Track nakalagay NAME
ng (Adres ng (Semestre) any) E NUMBER
nais i-enroll Paaralan) sa Sertipiko (Apelyido)
Paaralan) Paaralan) (LRN)
ang mag- ng
aaral) Kapangana
kan)
Private (P Tinabunan Pag asa 1,1st Tolentino
Private (P Tinabunan 107,989 Pag-asa I I1st Allado
Private (P Tinabunan 107,989 PAGASA I 20133429 4.02E+11 MALINIS
Private (P Tinabunan 4.24E+11 Cartujano
Private (P Tinabunan 1st 20137389 BENDULO
Private (P Tinabunan 107,989 Pag-asa 1 Arcena
Private (P Tinabunan 107,989 Pag-asa 1 20132312 4.24E+11 Chuaseco
Private (P Tinabunan PAG - ASA Uy
ACM Homes Private (P Tinabunan 107989 Pag-asa 1 20133345
B4 L11, 13Private (P Tinabunan 107989 Pag-asa 1, 20142199
B14 L20 PH Private (P Tinabunan 107989 Pag-asa I, 20131795
Kawit, CaviPublic (Pa Tinabunan 107989 Pag-asa 1, 20124327
ACM Homes Private (P Tinabunan 107989 Pag-asa 1, 2013577
ACM Woods Private (P Tinabunan
CarsadangPrivate (P Tinabunan 107989 Pag-asa 1, 2.01E+08
Palico 2 ImPrivate (P Tinabunan 107989 Pag-asa I,
Blk.14 Lot Private (P Tinabunan
BLK 14 LOPrivate (P Tinabunan 107989 PAG-ASA I 2.01E+08
ACM WOOD Private (P Tinabunan 107989 PAG-ASA I
GARDENVIPrivate (P Tinabunan 107989 PAG-ASA I
Acm woodst Private (P Tinabunan Tinabunan
B14 L20 A Private (P Tinabunan 107989 PAG-ASA I 20129066
B14 L20 A Private (P Tinabunan 107989 PAG-ASA I 2.01E+08
 Belonging
to
Indigenous
People (IP)
Community
If yes,
/Indigenous
Extension Date of please
MIDDLE Cultural Mother
FIRST name (if Birth (Petsa specify
NAME Sex Community tongue Religion
NAME applicable/k ng Age (Edad) (Kung oo,
(Gitnang (Kasarian) (Nabibilang (Kinagisnan (Relihiyon)
(Pangalan) ung Kapangana saang
Pangalan) sa g wika)
mayroon) kan) grupo
katutubong
nabibilang)
grupo/
Zyrene JaeDanao 1/9/2013 7 Female (B No (Hindi)
Komunidad Tagalog Roman Cath
ng
Vanlord CalCorrea 3/21/2013 7 Male (LalakNo (Hindi)
Katutubong Tagalog Iglesia Ni C
EANNE SI AYRAN 7/22/2013 Kultural)
7 Female (B No (Hindi) TAGALOGKATOLIKO
Primrose AlTinosa 3/29/2013 7 Female (B No (Hindi) Tagalog Katoliko
JASMINE TULAY 3/19/2013 7 Female (B No (Hindi) Filipino
Jamie EricaSarmiento 9/23/2012 7 Female (B No (Hindi) Tagalog Roman Cath
Sydney Pineda 5/17/2013 7 Female (B No (Hindi) Tagalog Catholic
Jharren ja Halili 6/4/2013 7 Male (LalakNo (Hindi) Tagalog Catholic
4.24E+11 Samson Alia Angel Uy 7/10/2013 7 Female (B No (Hindi)
Mario Andrei Serohijos ### 6 Male (LalakNo (Hindi)
4.24E+11 Lukang Kyle AaronAguilar 4/19/2013 7 Male (LalakNo (Hindi)
1.08E+11 Reponte Elijah Nacar 9/16/2012 7 Male (LalakNo (Hindi)
4.24E+11 Allada Joren Karl Samson 4/6/2013 7 Male (LalakNo (Hindi)
4.24E+11 casillan gianna gel rabanillo ### 7 Female (B No (Hindi)
indico Johnna Ly Rueda ### 7 Female (B No (Hindi)
4.25E+11 IRINEO MARIA PAMAGNO 10/9/2013 6 Female (B No (Hindi)
Panaligan Andrea CoCortez 1/1/2013 7 Female (B No (Hindi)
4.24E+11 DE VERA THEA ANGPABUSTA ### 7 Female (B No (Hindi)
KADIL PRINCESSBILBAO 2/10/2013 7 Female (B No (Hindi)
4.02E+11 AYSON MARGARET VELANTE 11/6/2013 6 Female (B No (Hindi)
Aceron LEMUEL MONTES ### 7 Male (LalakNo (Hindi)
4.24E+11 CORDERORAIVEN RIVERA ### 7 Male (LalakNo (Hindi)
4.24E+11 LUBANG INIGO GABBAGAMAS 10/8/2012 7 Male (LalakNo (Hindi)
 Does this
learner
have
Do you
special
have any
education
assistive
needs? If yes,
technology
(Ang mag- please Highest
devices
aaral ba ay specify Educational
available at House City/Munici
nangangail (Kung Father's Attainment
home? Number pality Province
angan ng MAYROON, Region name (Pinakamat
(May (Numero ng Barangay (Lungsod/ (Probinsiya/
espesyal na isulat kung (Rehiyon) (Pangalan aas na
nagagamit bahay at Munisipalid Lalawigan)
tulong sa ano ang ng Ama) antas na
bang kalye) ad)
pag-aaral? natatanging natapos sa
“assistive
(hal.: sa kalagayan pag-aaral)
technology
Nopisikal,
(Wala) ng bata) Yes (MayroBlk 4 Lot 2Pag asa 2 Imus
devices” sa
Cavite Region IV-Tolentino, College Gr
mental,
No (Wala)
kondisyong Yes (MayroBlk. C Lot Alapan 1-AImus
inyong Cavite 1V-A Allado Khi
College Gr
bahay?)
medical,
No (Wala) No (Wala) B42 L21 P ALAPAN 1IMUS CITYCAVITE KATOLIKOMALINIS College Gr
bukod sa
Noiba(Wala)
pa)) Blk 2 lot CarsadangImus Cavite Region 4A Cartujano, College Gr
No (Wala) No (Wala) Block 2 LotPag-Asa 2 Imus Cavite 4A Bendulo, JiVocational
No (Wala) 193 Pag-asa 1 Imus City Cavite IV-A Arena, Eri College Gr
No (Wala) No (Wala) B7 L13 EastCarsadangImus City Cavite IV-A Chuaseco,College Gr
No (Wala) No (Wala) B 11 L 07 sCarsadangImus city Cavite 4-A Uy GeoffreHigh Schoo
Tagalog Roman Cath
No (Wala) B26 L12 Mt.
ACM HomeAlapan I-A Imus City
Tagalog Roman Cath
No (Wala) No (Wala) B23 L1 Mon
Montefaro Alapan I-B Imus City
Tagalog Baptist ChrNo (Wala) No (Wala) Block B LoACM Woods Alapan I-A Imus City
Tagalog Born AgainNo (Wala) No (Wala) B5 L9 Walin
Cattleya H Pag-asa 2 Imus City
Tagalog Roman Cath No (Wala) No (Wala) B27 L12 Mt.
ACM HomeAlapan 1-AImus City
tagalog roman cathNo (Wala) No (Wala) bl1 lot11 dreamville carsadang imus
Tagalog Roman Cath No (Wala) No (Wala) B9 L9 MontefarroAlapan 1-BImus City
TAGALOGCATHOLICNo (Wala) 9 PAG-ASA ICAVITE
Tagalog Catholic No (Wala) No (Wala) Block 12 L Palazzo BeCarsadangImus Cavit
TAGALOGIGLESIA NNo (Wala) BLK.1 LOTDREAMVILL CARSADAN IMUS CITY
TAGALOGCATHOLICNo (Wala) No (Wala) BLK 1 LOTPRIMAVIDPAG-ASA IMUS CITY
TAGALOGCATHOLICNo (Wala) 53 TULIP SSAUDIA V PAG-ASA I MUS CITY
Tagalog Catholic No (Wala) No (Wala) Blk. 2 lot 2 Pacific wo CarsadangImus city
TAGALOGCATHOLICNo (Wala) No (Wala) B6 L15 DREAMVILCARSADAN IMUS CITY
TAGALOGCATHOLICNo (Wala) B11 L4 LEGIAN 2 CARSADAIMUS CITY
 Working Highest Working Guardian's Highest
from home Educational from home name (not Educational
Employmen due to Contact Mother's Attainment Employmen due to Contact parents) Attainment
t status ECQ? Number name (Pinakamat t status ECQ? Number (Pangalan (Pinakamat
(Katayuan (Nagtratrab (Cellphone/ (Pangalan aas na (Katayuan (Nagtratrab (Cellphone/ ng tagapag- aas na
sa trabaho) aho sa Telephone) ng Ina) antas na sa Trabaho) aho sa Telephone) alaga na antas na
bahay dahil natapos sa bahay dahil hindi ama o natapos sa
sa ECQ) pag-aaral) sa ECQ) ina) pag-aaral)
Unemployed
No 091506319Danao, JanCollege GrUnemployed
No 095652146DANAO, MCollege Gr
Self EmploNo 099759901Allado VanHigh SchooFull time No 092611604
Full time No 099797700AYRAN ARHigh SchooNot workingNo 099797700AYRAN ARHigh Schoo
Part time No 090827852Cartujano, College GrUnemployedNo 090849137
Full time Yes 927008229Tulay, JamiCollege GrPart time Yes 917789383
Full time No 090963760 No Arcena, ErCollege Gr
UnemployedNo 093313368Pineda, LulCollege GrFull time No 092578798Pineda, MyCollege Gr
Full time No 099555705Uy RenalynCollege GrPart time Yes 099745705Uy MeleciaVocational
Cavite IV-A Samson, RCollege GrUnemployed Chan, JennHigh SchooNot working
Cavite IV-A Serohijos, College GrFull time
Cavite IV-A Lukang, EdCollege GrSelf EmploNo 922871099Aguilar, N College GrNot working
Cavite IV-A Responte, HSigh SchooFull time No N/A Nacar, MicHigh SchooNot working
Cavite IV-A Allada, Jo College GrSelf EmploYes N/A Samson, KCollege GrFull time
cavite 4 casillan geCollege GrFull time No casillan geVocational Not working
Cavite IV-A Indico, Jo College GrUnemployedNo 094852604Rueda, Man High SchooFull time
CAVITE IV-A IRINEO, College GrSelf EmploNo 093230456MAGNO, JCollege GrFull time
Oriental M Region IV-Panaligan,College GrPart time No 099598398Cortez, JesCollege GrNot working
CAVITE IV-A DE VERA, College GrFull time No PABUSTAN College GrNot working
CAVITE IV-A KADIL, M College GrUnemployed No BILBAO, College GrUnemployed
CAVITE IV-A AYSON, J College GrFull time No 096542322VELANTE,College GrNot working
Cavite 4 Aceron, emElementaryUnemployedNo 094945325Montes, layElementaryNot working
CAVITE IV-A CORDERO, High SchooUnemployed RIVERA, College GrPart time
CAVITE IV-A LUBANG, College GrFull time Yes BAGAMASB
College GrFull time
 How does
your child
goes to
Working
school?
from home
Choose all
Employmen due to Contact
that applies
t status ECQ? Number
(Paano Kinder Grade 1 Grade 2 Grade 3 Grade 4 Grade 5
(Katayuan (Nagtratrab (Cellphone/
pumapasok
sa Trabaho) aho sa Telephone)
ang bata sa
bahay dahil
paaralan?
sa ECQ)
Piliin ang
Full time No 099824046School
lahat ng
Ser 1
Family-own
naaangkop) 1
Not workingNo 099897700Family-own 0 0 1 0 0 0
School Ser 1
Public Com
Full time No 090963760School Ser 1
Not workingNo 092358411 1
Part time No 091051065School Ser 1
Yes 091696436 No (Hindi) School Ser
Yes 094687159 No (Hindi) School Ser
No 090821142 No (Hindi) School Ser 1
No 091659670 No (Hindi) School Ser
No 097768360Samson, ViCollege GrNot working 092662923No (Hindi) School Ser
No No (Hindi) School Ser 1
No 094852604Indico, Jo College GrUnemployed
No 094852604No (Hindi) School Ser
Yes 091730561 No (Hindi) School Ser
No 091631557Catina, Es ElementaryPart time No 093644638No (Hindi) Family-own
No 090533846 No (Hindi) Family-own 1
No ALBAO, WHigh SchooNot workingNo 091647005No (Hindi) Public Com
No 091596121AYSON, CCollege GrNot workingNo 091596121No (Hindi) School Ser
No 094945325Duco, analHigh SchooNot workingNo 094945325No (Hindi) School Ser
No 092131614 No (Hindi) School Ser
Yes 4569526/0 No (Hindi) Public Com
 can provide
What
instructiona
devices are
l support to
available at
the child's
home that
distance
the learner
learning?
can use for
Choose all
learning?
that
Check all
applies.
that
(Sino-sino
Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 Others applies.
sa
(Anong
miyembro
mga
ng inyong
kagamitan
tahanan
sa tahanan
Othersang (tutDesktop Co
ang
maaaring
Parents/Gu
tumulong Non-Cable
magagamit
ng bata
0 0 0 0 0 0 0 sa distance Smartphone
0 Parents/Gu para sa
learning na
pag-aaral)
Parents/Gu
pag-aaral Smartphone
ng bata?
Parents/Gu
Piliin ang Smartphon
1 lahat ng Smartphon
Parents/Gu
naaangkop)
Parents/Gua
Smartphone
Parents/Gua
Smartphon

1 1
1 1
1
1
1
1 1
1 1
1 8
 child's to
learning herein shall
learning create/upda
modality/ies be treated
progress Do you te your
do you as
How do you through certify that child's
prefer for confidential
connect to distance all the learner
Do you your child? in
the education? information profile in
have a way Choose all compliance
internet? Choose all given are the Learner
to connect that with the
Choose all that true and Information
to the applies. Data
that applies. / correct? System
internet? (Ano-anong Privacy Act
Other. (Iba applies. other (iba Anong mga Others (iba (Ikaw ba'y (LIS)? (Ikaw
Mayroon ka pamamaraa of 2012.
pa) (Paano ka pa) hadlang pa) nangangak ba ay
bang n ng (Lahat ng
nakaka- ang o na ang pumapayag
paraan para “distance impormasy
connect sa maaaring lahat ng na gamitin
maka- learning” on dito ay
internet? makaapekto data na ng
connect sa ang nais dapat na
Yes (Mayroown
internet
Pillinmobile
ang online lear
mo para sa
insufficien
sa proseso Yesiyong
(Oo) Yes (Oo)
Kagawaran I ituring
agree (S
na
lahat ng ng ibinigay at ng
Yes (Mayroown mobileonline
naangkop)
iyonglear insufficien
pagkatuto Yes
tunay(Oo)
at Yes (Oo)
Edukasyon Ikumpidensi
agree (S
anak? Piliin yal at
Yes (Mayroown broadba modular ng iyong mo tama?) ang
ang lahatle unstable Yes (Oo) Yes (Oo) Inaaayon
agree (S sa
anak gamit impormasy
ng Data
Yes (Mayroown broadba online lear
naaangkop.
unstable
ang mo Yes (Oo) Yes (Oo)
on na ito IPrivacy
agree Act (S
distance para i-
Yes (Mayroown broadba online ) lear Yes (Oo) Yes (Oo) of 2012.)
I agree (S
education? update ang
own mobilemodular le Piliin ang
insufficien Yes (Oo) profile
Yes (Oo)ng I agree (S
lahat ng mag-aaral
Yes (Mayroown broadba modular le naaangkop None Yes (Oo) Yes (Oo)
sa Learner I agree (S
Information
Yes (Mayroown broadba
online lear unstable mo Yes (Oo) Yes
I agree (S (Oo)
System
(LIS)?)
Parents/GuNon-Cable Yes (Mayroown mobileonline lear
Parents/GuCable TV, Yes (Mayroown broadba
modular le
Parents/GuDesktop C Yes (Mayroown broadba
modular le
Parents/GuSmartphon No (Wala) modular le
Parents/GuCable TV, Yes (Mayroown mobileonline lear
Parents/GuSmartphone Yes (Mayroown broadba
online lear
Parents/GuSmartphon No (Wala) modular le
Parents/GuSmartphone Yes (Mayroown broadba
modular le
Parents/Gua
Non-Cable No (Wala) own mobilemodular le
1 Parents/GuNone (Wala No (Wala) modular le
Grandparent
Basic Cell own mobilemodular le
Parents/GuSmartphon Yes (Mayroown broadba
modular le
Parents/GuSmartphon Yes (Mayroown mobilemodular le
Parents/Gua
Non-Cable Yes (Mayroown broadba
online lear
Parents/Gua
Tablet Yes (Mayroown broadba
online lear
 If yes,
please
specify Subdivision
(Kung / baryo/
MAYROON, purok/ sitio
isulat kung
ano ito)
Laptop andPrimavida No (Hindi)
Acm Woods No (Hindi)
ACM WOOVOX DEI No (Hindi)
Acm woods No (Hindi)
Primavida No (Hindi)
No (Hindi)
Pacific Wo No (Hindi)
ACM woods No (Hindi)
existing he Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
unstable mo Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
difficulty Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
lack of ava Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
existing he Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
unstable mo Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
insufficien Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
unstable mo Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
insufficien Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
lack of ava Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
insufficien Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
unstable mo Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
unstable mo Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
distraction Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
difficulty Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
 Does the
learner
already
have a Is the Last school
Last grade
registered learner a year Last School
Grade level level School
School Year LRN? (Ang returning completed Attended School ID
to enroll completed Address
Timestamp (Taong mag-aaral student? (Huling (Huling (ID ng
(Baitang na (Huling (Adres ng
Panuruan) ba ay may (Ang mag- natapos na paaralang Paaralan)
nais ipatala) baitang na Paaralan)
nakarehistr aaral ba ay taon sa pinasukan)
natapos)
o nang LRN Balik-aral?) paaralan)
sa
### 2020 - 202Yes (Oo) No (Hindi) Grade 3 Grade 2 2019 - 202Alano Aca
kasalukuya
ACM phase
### 2020 - 202Yesn?) (Oo) No (Hindi) Grade 3 Grade 2 2019 - 202Groeien Lea 424082 B14L20 AC
### 2020 - 202Yes (Oo) No (Hindi) Grade 3 Grade 2 2019 - 202Tinabunan 107989 Advincula
### 2020 - 202Yes (Oo) No (Hindi) Grade 3 Grade 2 2019 - 202Groeien Lea B14 L20 Ph
### 2020 - 202Yes (Oo) No (Hindi) Grade 3 Grade 2 2019 - 202Groeien Lea Alapan I-A
### 2020 - 202Yes (Oo) No (Hindi) Grade 3 Grade 2 2019 - 202Groeien Lea ACM Alapan
### 2020 - 202Yes (Oo) No (Hindi) Grade 3 Grade 2 2019 - 202Other (Wala 108020 Gahak Kawi
### 2020 - 202Yes (Oo) No (Hindi) Grade 3 Grade 2 2019 - 202Damascus E 424469 B1 L3&4 Ca
### 2020 - 202Yes (Oo) No (Hindi) Grade 3 Grade 2 2019 - 202Vox Dei Pl 424400 Alapan I-A
### 2020 - 202Yes (Oo) No (Hindi) Grade 3 Grade 2 2019 - 202Joseph Imm 10028
### 2020 - 202Yes (Oo) No (Hindi) Grade 3 Grade 2 2019 - 202Vox Dei Pl
### 2020 - 202Yes (Oo) No (Hindi) Grade 3 Grade 2 2019 - 202Our Lady of 424810
### 2020 - 202Yes (Oo) No (Hindi) Grade 3 Grade 2 2019 - 202La Trinida
### 2020 - 202Yes (Oo) No (Hindi) Grade 3 Grade 2 2019 - 202St. Martin
### 2020 - 202Yes (Oo) No (Hindi) Grade 3 Grade 2 2019 - 202La Trinida
### 2020 - 202Yes (Oo) No (Hindi) Grade 3 Grade 2 2019 - 202Groeien Lea
### 2020 - 202Yes (Oo) No (Hindi) Grade 3 Grade 2 2019 - 202Vox Dei Pl
### 2020 - 202Yes (Oo) No (Hindi) Grade 3 Grade 2 2019 - 202Vox Dei Pl
### 2020 - 202Yes (Oo) No (Hindi) Grade 3 Grade 2 2019 - 202Groeien Lea 424082
 PSA
School to CERTIFACT
enroll in E NUMBER
School School LEARNER
(Paaralan School ID (Numero na LAST
Type (Uri Address Semester Strand (if REFERENC
kung saan (ID ng Track nakalagay NAME
ng (Adres ng (Semestre) any) E NUMBER
nais i-enroll Paaralan) sa Sertipiko (Apelyido)
Paaralan) Paaralan) (LRN)
ang mag- ng
aaral) Kapangana
kan)
Private (P Tinabunan 107,989 Pagasa1 2.01E+08 Reyes
Private (P Tinabunan 107,989 Advincula 3.01E+08 Fabular
Private (P Tinabunan 107,989 Advincula 1st 1.08E+11 Magnaye
Private (P Tinabunan Pagasa Imu Tabua
Private (P Tinabunan 107,989 Pag-asa I I 20114607 Morales
Private (P Tinabunan 107,989 Pag-asa I I Tabua
Public (Pa Tinabunan 107,989 Pag-asa 1 20111337 1.08E+11 Jarin
Private (P Tinabunan 107,989 Pag-asa 1 4.24E+11 Araquel
Private (P Tinabunan 107,989 Pag asa I, Aquino
Blk 1 Lot Private (P Tinabunan Tinabunan1st 7348
ACM AlapanPrivate (P Tinabunan 107989 Pag-asa I,
ACM PH.7 Private (P Tinabunan 107989 PAG-ASA I 20123366
TREELANEPrivate (P Tinabunan 107989 PAG-ASA I 2.01E+08
BLK 11 LOPrivate (P Tinabunan Pag asa I, 20113031
TREELANEPrivate (P Tinabunan 107989 PAG-ASA I 2.01E+08
StrawberryPrivate (P Tinabunan Pag asa im1st
ACM ALAPAPrivate (P Tinabunan PAG-ASA I
ACM WOOD Private (P Tinabunan 107989 PAG-ASA I
BLK14 L20Private (P Tinabunan 107989 PAG-ASA I
 Belonging
to
Indigenous
People (IP)
Community
If yes,
/Indigenous
Extension Date of please
MIDDLE Cultural Mother
FIRST name (if Birth (Petsa specify
NAME Sex Community tongue Religion
NAME applicable/k ng Age (Edad) (Kung oo,
(Gitnang (Kasarian) (Nabibilang (Kinagisnan (Relihiyon)
(Pangalan) ung Kapangana saang
Pangalan) sa g wika)
mayroon) kan) grupo
katutubong
nabibilang)
grupo/
Zaicy Yuki Peregina 8/18/2012 7 Female (B No (Hindi)
Komunidad Tagalog Roman Cath
ng
Neil XandeCantos 3/13/2012 8 Male (LalakNo (Hindi)
Katutubong Tagalog Roman Cath
Cyra ShanEneran 8/15/2011 Kultural)
9 Female (B No (Hindi) Tagalog IV-A
Myla Ordonez 6/5/2020 8 Male (LalakNo (Hindi) Filipino Catholic
Chariz Ale Cotillon ### 8 Female (B No (Hindi) Tagalog Catholic
Richmond Ordonez 6/5/2012 8 Male (LalakNo (Hindi) Tagalog Catholic
Maria ChesValencia ### 8 Female (B No (Hindi) Tagalog Catholic
Alexandra Delos Sant 7/30/2011 8 Female (B No (Hindi) Tagalog Catholic
Juan NavieAguado 3/2/2013 7 Male (LalakNo (Hindi) Filipino Catholic
4.09E+11 Patron John DanieDoce 7/16/2012 7 Male (LalakNo (Hindi)
4.25E+11 BallesterosXander Escobar 4/14/2012 8 Male (LalakNo (Hindi)
1.08E+11 QUILLAO ZEPHERINMAGNO 8/6/2012 7 Female (B No (Hindi)
4.25E+11 SILVA ANGELICAPAPA 9/14/2011 8 Female (B No (Hindi)
1.08E+11 PASILIAO ROSS BRACAIGAN 8/19/2011 8 Male (LalakNo (Hindi)
4.25E+11 SILVA ANGELICAPAPA 9/14/2011 8 Female (B No (Hindi)
4.24E+11 MAYOR JANE LUISVICENTE 6/27/2012 8 Female (B No (Hindi)
ANCHETASAMALA AMUNOZ 2/17/2013 7 Female (B No (Hindi)
PORTUGAMALLORY ALZONA ### 7 Female (B No (Hindi)
4.24E+11 MONTEMOGEORGE DMANDAWE ### 8 Male (LalakNo (Hindi)
 Does this
learner
have
Do you
special
have any
education
assistive
needs? If yes,
technology
(Ang mag- please Highest
devices
aaral ba ay specify Educational
available at House City/Munici
nangangail (Kung Father's Attainment
home? Number pality Province
angan ng MAYROON, Region name (Pinakamat
(May (Numero ng Barangay (Lungsod/ (Probinsiya/
espesyal na isulat kung (Rehiyon) (Pangalan aas na
nagagamit bahay at Munisipalid Lalawigan)
tulong sa ano ang ng Ama) antas na
bang kalye) ad)
pag-aaral? natatanging natapos sa
“assistive
(hal.: sa kalagayan pag-aaral)
technology
Nopisikal,
(Wala) ng bata) No (Wala)
devices” sa
Blk17 Lot1Alapan 1A Imus city Cavite Region IVAReyes, Ron
College Gr
mental,
No (Wala)
kondisyong Yes (MayroB14L9 Cher
inyong Alapan 1A Imus Cavite Region IV-Fabular,Al Vocational
bahay?)
medical,
No (Wala) No (Wala) Toclong Kawit Cavite IV-A Magnaye, E High Schoo
bukod sa
Noiba(Wala)
pa)) No (Wala) 13 Alapan 1-AImus Cavite 4-A Tabua RayVocational
No (Wala) 15 Pag-asaPag-asa I Imus City Cavite IV-A Morales, RCollege Gr
No (Wala) 13 Alapan I-A Imus City Cavite Catholic Tabua, Ra Vocational
No (Wala) 150 Marulas Kawit Cavite IV-A Jarin, EngeVocational
No (Wala) No (Wala) B6 L16 Alapan I-A Imus City Cavite IV-A A Raquel, College Gr
No (Wala) No (Wala) Blk. 24 LotAlapan I-A Imus Cavite IV-A Aquino, JoCollege Gr
Tagalog Christian No (Wala) Yes (MayroMobile phoBlk 26 Lot Acm Woods
CarsadongImus City
Tagalog Roman CathNo (Wala) Block 41 L ACM Alapan I-A Imus City
TAGALOGROMAN CA No (Wala) 9 PAG-ASA I MUS CITY
TAGALOGBAPTIST- No (Wala) No (Wala) 135 CARSADAN IMUS CITY
TAGALOGROMAN CA No (Wala) No (Wala) BLK 5 LOTGEOROSVI PAGASA 2IMUS
TAGALOGBAPTIST- No (Wala) No (Wala) 135 CARSADAN IMUS CITY
Tagalong aRoman Cath
No (Wala) Yes (MayroCellphonesBlck 1 Lot Dreamville CarsadangImus City
TAGALOG/CATHOLICNo (Wala) UNIBROS PACIFIC CARSADAN IMUS CITY
ENGLISH/ TAGALOGNo (Wala) BLK.29 L1 ACM WOOALAPAN I-IMUS CITY
TAGALOGCATHOLICNo (Wala) BLK32 L6 ACM WOOCARSADAN IMUS CITY
 Working Highest Working Guardian's Highest
from home Educational from home name (not Educational
Employmen due to Contact Mother's Attainment Employmen due to Contact parents) Attainment
t status ECQ? Number name (Pinakamat t status ECQ? Number (Pangalan (Pinakamat
(Katayuan (Nagtratrab (Cellphone/ (Pangalan aas na (Katayuan (Nagtratrab (Cellphone/ ng tagapag- aas na
sa trabaho) aho sa Telephone) ng Ina) antas na sa Trabaho) aho sa Telephone) alaga na antas na
bahay dahil natapos sa bahay dahil hindi ama o natapos sa
sa ECQ) pag-aaral) sa ECQ) ina) pag-aaral)
Not workingNo 099535415Peregina, College GrUnemployed
No 099535415Bernus, JoCollege Gr
Self EmploNo 096102453Cantos JocHigh SchooNot workingNo 092945593
Part time No 094387027Eneran, EmHigh SchooUnemployed No 094387027
Full time No Tabua Myl Vocational Not workingNo 097778531
Full time Yes 926026885Cotillon, MCollege GrNot workingNo 932845122
Full time Yes Tabua, MylVocational Not workingNo
Full time Yes 091874587Valencia, High SchooNot workingNo 092035505Valencia, High Schoo
Full time No 091786735Delos SantCollege GrNot workingNo 099847840
Full time Yes 090610587Aquino, Kr College GrFull time Yes 090552127Telmo, Tere
Cavite Region IV Patron, JohHigh SchooNot workingNo 090896695Doce, AnaliHigh SchooNot working
Cavite IV-A BallesterosCollege GrUnemployed
No 094299999Escobar, PaCollege GrSelf Emplo
CAVITE IV-A QUILLAO, College GrPart time 096616081MAGNO, MCollege GrFull time
CAVITE IV-A SILVA, M College GrUnemployed Yes 093993567PAPA,JOCCollege GrPart time
CAVITE REGION IVPASILIAO ElementaryNot workingNo 091665973CAIGAN,RHigh SchooNot working
CAVITE IV-A SILVA, M College GrUnemployed Yes 093993567PAPA,JOCCollege GrPart time
Cavite Roman Cath
Mayor LorlCollege GrFull time No 099917890Mayor , Vi College GrPart time
CAVITE IV-A ANCHETA,College GrUnemployed
No MUNOZ, SCollege GrNot working
CAVITE IV-A PORTUGALCollege GrUnemployed
No 099558160ALZONA, College GrPart time
CAVITE IV-A CORVERA,College GrUnemployed
No 096698763MONTEMORCollege GrSelf Emplo
 How does
your child
goes to
Working
school?
from home
Choose all
Employmen due to Contact
that applies
t status ECQ? Number
(Paano Kinder Grade 1 Grade 2 Grade 3 Grade 4 Grade 5
(Katayuan (Nagtratrab (Cellphone/
pumapasok
sa Trabaho) aho sa Telephone)
ang bata sa
bahay dahil
paaralan?
sa ECQ)
Piliin ang
Self EmploNo 090674341Public Com
lahat ng
2
Family-own
naaangkop) 1
Public Com
School Ser 1
School Ser
School Ser
Not workingNo 092035505Public Com 1 1
Public Com 1
Not workingNo Walking (N 1
No 090896695 No (Hindi) Public Com
Yes 099515770 No (Hindi) Public Com
096670594 No (Hindi) Public Com
Yes 091715241N/A No (Hindi) School Ser
No 091665973PASILIAO High SchooNot workingNo 091665973No (Hindi) School Ser
Yes 091715241N/A No (Hindi) School Ser
No 091744711Mayor VilmCollege GrPart time No 091744711No (Hindi) Family-own
No 090816539 No (Hindi) School Ser
No PORTUGAL
College GrPart time No No (Hindi) School Ser
No (Hindi) School Ser
 can provide
What
instructiona
devices are
l support to
available at
the child's
home that
distance
the learner
learning?
can use for
Choose all
learning?
that
Check all
applies.
that
(Sino-sino
Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 Others applies.
sa
(Anong
miyembro
mga
ng inyong
kagamitan
tahanan
sa tahanan
1 Parents/Gu
ang Non-Cable
ang
maaaring
1 Parents/Gu
tumulong Smartphon
magagamit
ng bata
sa distance Non-Cable
Parents/Gu para sa
learning na
pag-aaral)
Parents/Gu
pag-aaral Smartphone
ng bata?
Parents/Gu
Piliin ang Non-Cable
lahat ng Smartphone
Parents/Gu
naaangkop)
1 Parents/Gua
Smartphone
Parents/GuNon-Cable
Parents/GuNon-Cable
1
1
1
1
1
1
1 1
1
1 1 1
1 1
 child's to
learning herein shall
learning create/upda
modality/ies be treated
progress Do you te your
do you as
How do you through certify that child's
prefer for confidential
connect to distance all the learner
Do you your child? in
the education? information profile in
have a way Choose all compliance
internet? Choose all given are the Learner
to connect that with the
Choose all that true and Information
to the applies. Data
that applies. / correct? System
internet? (Ano-anong Privacy Act
Other. (Iba applies. other (iba Anong mga Others (iba (Ikaw ba'y (LIS)? (Ikaw
Mayroon ka pamamaraa of 2012.
pa) (Paano ka pa) hadlang pa) nangangak ba ay
bang n ng (Lahat ng
nakaka- ang o na ang pumapayag
paraan para “distance impormasy
connect sa maaaring lahat ng na gamitin
maka- learning” on dito ay
internet? makaapekto data na ng
connect sa ang nais dapat na
Nointernet
(Wala) own
Pillinmobile
ang modular le
mo para sa
lack of ava
sa proseso Yesiyong
(Oo) Yes (Oo)
Kagawaran I ituring
agree (S
na
lahat ng ng ibinigay at ng
Yes (Mayroown broadba
naangkop) online
iyonglear conflict
pagkatutowi Yes
tunay(Oo)
at Yes (Oo)
Edukasyon Ikumpidensi
agree (S
anak? Piliin yal at
No (Wala) own mobilemodular ng iyong tama?) ang
ang lahatle lack of ava Yes (Oo) Yes (Oo) Inaaayon
agree (S sa
anak gamit impormasy
ng Data
Yes (Mayroown broadba online lear
naaangkop.
ang Yes (Oo) Yes (Oo)
on na ito IPrivacy
agree Act (S
distance para i-
Yes (Mayroown mobileonline ) lear unstable of 2012.)
education?mo Yes (Oo) Yes (Oo)
update ang I agree (S
Yes (Mayroown broadba online lear Piliin ang Yes (Oo) profile
Yes (Oo)ng I agree (S
lahat ng mag-aaral
Yes (Mayroown mobilemodular le unstable
naaangkopmo Yes (Oo) Yes (Oo)
sa Learner I agree (S
Information
Yes (Mayroown mobilemodular le unstable mo Yes (Oo) Yes
I agree (S (Oo)
System
(LIS)?)
Yes (Mayroown broadba
online lear difficulty Yes (Oo) Yes (Oo) I agree (S
Parents/GuSmartphon Yes (Mayroown mobileonline lear
Parents/GuSmartphon Yes (Mayroown broadba
online lear
Parents/GuSmartphon Yes (Mayroown mobilemodular le
Parents/GuNone (Wala Yes (Mayroown mobilemodular le
Parents/GuSmartphon Yes (Mayroown broadba
online lear
Parents/GuNone (Wala Yes (Mayroown mobilemodular le
Parents/GuCable TV, Yes (Mayroown broadba
online lear
Parents/GuCable TV, Yes (Mayroown broadba
modular le
Parents/GuNon-Cable Yes (Mayroown broadba
modular le
Smartphone Yes (Mayro online lear
 If yes,
please
specify Subdivision
(Kung / baryo/
MAYROON, purok/ sitio
isulat kung
ano ito)
ACM Phase
Smart PhoACM Home No (Hindi)
No (Hindi)
No (Hindi)
No (Hindi)
No (Hindi)
Gahak Maru No (Hindi)
Sunnydale No (Hindi)
ACM Phase No (Hindi)
difficulty Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
distraction Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
lack of ava Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
distraction Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
lack of ava Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
conflict wi Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
difficulty Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
unstable mo Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
 Does the
learner
already
have a Is the Last school
Last grade
registered learner a year Last School
Grade level level School
School Year LRN? (Ang returning completed Attended School ID
to enroll completed Address
Timestamp (Taong mag-aaral student? (Huling (Huling (ID ng
(Baitang na (Huling (Adres ng
Panuruan) ba ay may (Ang mag- natapos na paaralang Paaralan)
nais ipatala) baitang na Paaralan)
nakarehistr aaral ba ay taon sa pinasukan)
natapos)
o nang LRN Balik-aral?) paaralan)
sa
### 2020 - 202Yes (Oo) No (Hindi) Grade 4 Grade 3 2019 - 202Cachapero 402112 B7 L13 Mah
kasalukuya
### 2020 - 202Yesn?) (Oo) No (Hindi) Grade 4 Grade 3 2019 - 202Cachapero 402112 B7 L13 Mah
### 2020 - 202No (Hindi) Yes (Oo) Grade 4 Grade 3 2019 - 202Groeien Lea 424082 Acm subd.
### 2020 - 202Yes (Oo) Yes (Oo) Grade 4 Grade 3 2019 - 202Other (Wala 418523 Marilao Bu
### 2020 - 202Yes (Oo) No (Hindi) Grade 4 Grade 3 2019 - 202Joseph Imm ACM Carsa
### 2020 - 202Yes (Oo) Yes (Oo) Grade 4 Grade 3 2019 - 202Other (Wala 107989 A. Santos
### 2020 - 202Yes (Oo) Yes (Oo) Grade 4 Grade 3 2019 - 202Other (Wala 107989 Grand Rive
### 2020 - 202Yes (Oo) No (Hindi) Grade 4 Grade 3 2019 - 202Other (Wala 401840 39 Niog 1
### 2020 - 202No (Hindi) No (Hindi) Grade 4 Grade 3 2019 - 202St. Martin
### 2020 - 202Yes (Oo) No (Hindi) Grade 4 Grade 3 2019 - 202Vox Dei Pl 424400 Alapan I-A
### 2019 - 202Yes (Oo) Yes (Oo) Grade 4 Grade 3 2019 - 202Tinabunan 1.08E+11 tinabunan
### 2019 - 202Yes (Oo) No (Hindi) Grade 4 Grade 3 2019 - 202St. Martin 402183 B11 L9 Ilan
### 2020 - 202Yes (Oo) No (Hindi) Grade 4 Grade 3 2019 - 202St. Martin Gardenville
### 2020 - 202Yes (Oo) No (Hindi) Grade 4 Grade 3 2019 - 202St. Hilary S 402179 Medicion I-
### 2020 - 202Yes (Oo) No (Hindi) Grade 4 Grade 3 2019 - 202Cachapero 402112
### 2020 - 202No (Hindi) Yes (Oo) Grade 4 Grade 3 2019 - 202Our Lady of
### 2020 - 202Yes (Oo) No (Hindi) Grade 4 Grade 3 2019 - 202Other (WalaArellano Un
### 2020 - 202Yes (Oo) No (Hindi) Grade 4 Grade 3 2019 - 202Brehms Sch
### 2020 - 202Yes (Oo) No (Hindi) Grade 4 Grade 3 2019 - 202Southwoods
### 2020 - 202Yes (Oo) No (Hindi) Grade 4 Grade 3 2019 - 202Other (WalaLA TRINI
### 2020 - 202Yes (Oo) No (Hindi) Grade 4 Grade 3 2019 - 202La Trinida
### 2020 - 202No (Hindi) No (Hindi) Grade 4 Grade 3 2019 - 202Vox Dei Pl
### 2020 - 202Yes (Oo) No (Hindi) Grade 4 Grade 3 2019 - 202Cachapero
 PSA
School to CERTIFACT
enroll in E NUMBER
School School LEARNER
(Paaralan School ID (Numero na LAST
Type (Uri Address Semester Strand (if REFERENC
kung saan (ID ng Track nakalagay NAME
ng (Adres ng (Semestre) any) E NUMBER
nais i-enroll Paaralan) sa Sertipiko (Apelyido)
Paaralan) Paaralan) (LRN)
ang mag- ng
aaral) Kapangana
kan)
Private (P Tinabunan 1st 1.08E+11 Armenta
Private (P Tinabunan Pagasa 1 I 4.24E+11 RAMOS
Private (P Tinabunan 107,989 Pag Asa In1st 449 Dela Cruz
Private (P Tinabunan 107,889 Pag-asa 1 2011729 4.19E+11 Pino
Private (P Tinabunan 107,989 Pag-asa 1 20101099 Manalo
Private (P Tinabunan 107,989 Pagasa 1 I1st 20114391 4.07E+11 Bolisay
Private (P Tinabunan 107,989 Pagasa 1 I 2011725 4.07E+11 Alaban
Private (P Tinabunan Pagasa Imu 20101562 1.60E+05 Aranzaso
Private (P Tinabunan Advincula 1st BOLANOS
Private (P Tinabunan 107,989 Pag-asa I I 2.01E+09 4.24E+11 Chuaseco
Private (P Tinabunan tinabunan 2011308 1.08E+11 Manuel
Private (P Tinabunan 107,989 Advincula 5237 4.02E+11 Nicolas
Private (P Tinabunan 107,989 Advincula R 4.02E+10 BASTO
Private (P Tinabunan 107,989 Pag-asa I I 20111789 4.02E+11 Camahalan
Narra AHom Private (P Tinabunan 107989 Pag-asa 1,
Alapan ImuPrivate (P Tinabunan
2600 LegarPrivate (P Tinabunan Advincula R
CarsadangPrivate (P Tinabunan 107989 Pag-sa 1 I 2.01E+09
ALAPAN I-Private (P Tinabunan 107989 PAG-ASA I
BAYAN LUPrivate (P Tinabunan 107989 PAG-ASA 1 20113667
TREELANEPrivate (P Tinabunan 107989 PAG-ASA I
Private (P Tinabunan 2012682
NARRA HOPrivate (P Tinabunan 107989 PAG-ASA I
 Belonging
to
Indigenous
People (IP)
Community
If yes,
/Indigenous
Extension Date of please
MIDDLE Cultural Mother
FIRST name (if Birth (Petsa specify
NAME Sex Community tongue Religion
NAME applicable/k ng Age (Edad) (Kung oo,
(Gitnang (Kasarian) (Nabibilang (Kinagisnan (Relihiyon)
(Pangalan) ung Kapangana saang
Pangalan) sa g wika)
mayroon) kan) grupo
katutubong
nabibilang)
grupo/
Nigel Moneda 10/2/2010 9 Male (LalakNo (Hindi)
Komunidad tagalog roman cath
ng
EZRA KIE DETRUZ ### 9 Male (LalakNo (Hindi)
Katutubong Tagalog Romano Kat
Chloe David 2/15/2011 Kultural)
9 Female (B No (Hindi) Pilipino Catholic
Vhenz Jos Borromeo 6/30/2011 9 Male (LalakNo (Hindi) Tagalog Catholic
Karylle EyzMogan 7/31/2010 9 Female (B No (Hindi) Tagalog Catholic
Rhys Gavi Llamado 4/20/2011 9 Male (LalakNo (Hindi) Tagalog Roman Cath
Zhyra ColeMagallanes 7/16/2011 9 Female (B No (Hindi) Tagalog Roman Cath
Jaden kyleDadia Wala ### 9 Male (LalakNo (Hindi) Tagalog Katoliko
KEISHA S BERMAS 4/25/2011 9 Female (B No (Hindi) TAGALOGCHRISTIA
Eunice Pineda 10/4/2010 9 Female (B No (Hindi) Tagalog Catholic
Kent Andr Solayao 3/6/2011 9 Male (LalakNo (Hindi) tagalog Catholic
Guillier Dikit 3/2/2011 9 Male (LalakNo (Hindi) N/A Tagalog Catholic
PRINCESSALBA 8/13/2011 8 Female (B No (Hindi) Tagalog
Arwen Elij Blanco 5/14/2011 9 Female (B No (Hindi) Tagalog Protestant
4.02E+11 Ramirez Sophia ClaPanal 9/6/2011 8 Female (B No (Hindi)
Nuñez Maybelyn De leon 1/8/2011 9 Female (B Yes (Oo) Legion of
4.06E+11 JOSON JULIAN KI TAYOTO ### 9 Male (LalakNo (Hindi)
Indico John Rueda 9/13/2010 9 Male (LalakNo (Hindi)
GO JOHN JAYSANCHEZ 4/26/2011 9 Male (LalakNo (Hindi)
4.25E+11 BALA KAITLYN PAPA 9/30/2011 8 Female (B No (Hindi)
4.25E+11 TAGAYONDAVID ISA 6/7/2011 9 Male (LalakNo (Hindi)
RIETA KYLEE SOBENDULO 9/23/2011 8 Male (LalakNo (Hindi)
COLLINS NATHANIAUTLEG 8/24/2011 8 Female (B No (Hindi)
 Does this
learner
have
Do you
special
have any
education
assistive
needs? If yes,
technology
(Ang mag- please Highest
devices
aaral ba ay specify Educational
available at House City/Munici
nangangail (Kung Father's Attainment
home? Number pality Province
angan ng MAYROON, Region name (Pinakamat
(May (Numero ng Barangay (Lungsod/ (Probinsiya/
espesyal na isulat kung (Rehiyon) (Pangalan aas na
nagagamit bahay at Munisipalid Lalawigan)
tulong sa ano ang ng Ama) antas na
bang kalye) ad)
pag-aaral? natatanging natapos sa
“assistive
(hal.: sa kalagayan pag-aaral)
technology
Nopisikal,
(Wala) ng bata) No (Wala)
devices” sa
blk 12 lot 5Toclong Kawit Cavite 4
mental,
No (Wala)
kondisyong Noinyong
(Wala) B4 L13 A ALAPAN 1A IMUS CAVITE REGION 4RAMOS DA College Gr
bahay?)
medical,
No (Wala) Yes (Mayroblk3 lot7 p alapan 1-AImus Cavite 4-A Dela Cruz, High Schoo
bukod sa
Noiba(Wala)
pa)) No (Wala) Blk 5 Lot 2Pag-asa 2 Imus City Cavite IV-A Pino, JoselCollege Gr
No (Wala) No (Wala) Blk 2 Lot 1Alapan I-A Imus City Cavite VI-A Manalo, R College Gr
No (Wala) No (Wala) Block 11, Kalayaan Kawit CaviCamarines5 Bolisay RyCollege Gr
No (Wala) No (Wala) Block 20 L Gen. Trias Cavite CityIlo ilo 4 Alaban Re Vocational
No (Wala) Yes (Mayro279 Alapan Imus City Cavite 4A Aranzaso GCollege Gr
No (Wala) Yes (MayroUNIT-C IR PAG-ASA 2IMUS CAVITE REGION 4BOLANOS,College Gr
No (Wala) No (Wala) B3 L13 East
CarsadangImus City Cavite IV-A Chuaseco,College Gr
No (Wala) No (Wala) block 24 lotoclong kawkawit cavite calabarzonManuel JemHigh Schoo
No (Wala) N/A No (Wala) 277-83 Pag-asa 1 Imus, CaviImus,CavitRegion IV-Nicolas, GiHigh Schoo
No (Wala) No (Wala) Blk 8 Lot 1Pag asa 2 Imus Cavite 4a Basto, BayCollege Gr
No (Wala) No (Wala) 414 CamiaMedicion I Imus Cavite IV-A Camahalan,Vocational
Filipino Catholic No (Wala) No (Wala) 108 Pag-asa 1 Imus City
Tagalog Katoliko No (Wala) Yes (MayroLoptop at BLK 1lot 3 ACM Woods CarsadangImus Cavit
Tagalog Catholic No (Wala) No (Wala) BLK 2 LOTMIKESELLPAG-ASA IMUS CITY
Tagalog Roman Cath No (Wala) No (Wala) B9 L9 MontMontefarroAlapan 1-BImus City
ENGLISH, CATHOLICNo (Wala) No (Wala) BLK6 LOT PRIMAVIDPAG-ASA I MUS CITY
TAGALOGBAPTIST No (Wala) No (Wala) 152 ALAPAN I-IMUS CITY
TAGALOGBORN AGANo (Wala) No (Wala) 341 ALAPAN I-IMUS CITY
Filipino Christian No (Wala) No (Wala) Blk 11 Lot Narra HomPag Asa 1 Imus
TAGALOGROMAN CA
No (Wala) No (Wala) 44 SAUDIA V PAG-ASA I MUS CITY
 Working Highest Working Guardian's Highest
from home Educational from home name (not Educational
Employmen due to Contact Mother's Attainment Employmen due to Contact parents) Attainment
t status ECQ? Number name (Pinakamat t status ECQ? Number (Pangalan (Pinakamat
(Katayuan (Nagtratrab (Cellphone/ (Pangalan aas na (Katayuan (Nagtratrab (Cellphone/ ng tagapag- aas na
sa trabaho) aho sa Telephone) ng Ina) antas na sa Trabaho) aho sa Telephone) alaga na antas na
bahay dahil natapos sa bahay dahil hindi ama o natapos sa
sa ECQ) pag-aaral) sa ECQ) ina) pag-aaral)
Babylyn M.Vocational Self Emplo 092875693
UnemployedNo 091744663DETRUZ HCollege GrNot workingNo 091744663
Full time No 092630043David, RissCollege GrFull time No 092630043David, MariVocational
Self EmploNo 908322120Borromro, High SchooNot workingNo 094579949
Full time 942545465Manalo, CaCollege GrSelf EmploYes 932971781
Full time No 091588560Bolisay Gl College GrFull time No 091588560Llamado GlVocational
Full time No 090847801MagallanesVocational Part time No 090847801MagallanesVocational
Full time Yes 090888395Dadia Iren High SchooNot working 091679482Aranzaso JCollege Gr
Full time No 091757654BOLANOS,College GrFull time No 091757654
UnemployedNo 093313368Pineda, LulCollege GrFull time No 092578798Pineda, MyCollege Gr
Full time No 092773861Solayao MHigh SchooNot workingYes 092773861Juan carlo High Schoo
Full time No 092874701Nicolas, LaiHigh SchooUnemployed
No 092874701Nicolas, LaiHigh Schoo
Self Emplo 092700553Basto, ErraCollege GrSelf Emplo 092700553
UnemployedNo 092663423Camahalan, College GrFull time No 092663423
Cavite 4A Ramirez, dHigh SchooPart time No 092555359Ramirez, MCollege GrFull time
Cavite Katoliko Nuñez RomCollege GrSelf EmploNo 091618219Ñuñez AnaHigh SchooPart time
CAVITE IV-A JOSON, MCollege GrFull time Yes 092944136JOSON, K College GrFull time
Cavite IV-A Indico, Jo College GrUnemployed
No 094852604Rueda, ManHigh SchooFull time
CAVITE IV-A GO, JEROCollege GrFull time No 092786996SANCHEZ,College GrFull time
CAVITE IV-A BALA, NA Vocational Self Emplo 471-44-79 PAPA, JA Master's/DFull time
CAVITE IV-A TAGAYON,College GrFull time
Cavite 4A RIETA, A College GrFull time No 093386211Bendulo, ma
College GrSelf Emplo
CAVITE IV-A COLLINS, College GrSelf EmploNo 090641292UTLEG, NEVocational Unemployed
 How does
your child
goes to
Working
school?
from home
Choose all
Employmen due to Contact
that applies
t status ECQ? Number
(Paano Kinder Grade 1 Grade 2 Grade 3 Grade 4 Grade 5
(Katayuan (Nagtratrab (Cellphone/
pumapasok
sa Trabaho) aho sa Telephone)
ang bata sa
bahay dahil
paaralan?
sa ECQ)
Piliin ang
Public Com
lahat ng
School
naaangkop)Ser 1
Full time Yes 097535699School Ser
Family-own 1
Family-own
Not workingNo 091588560Walking (N 1
Part time No 090847901Walking (N 1
Full time Yes 091759790Public Com 1
Public Com 1 1
Not workingNo 923584119Family-own 1
Not workingYes 1 1
Unemployed No 092874701School Ser 0 0 0 0 1 0
Walking (N
Family-own 1
No 091771367Trajico, AvCollege GrNot workingNo No (Hindi) Walking (N
No 097511073Nuñez AnaHigh SchooPart time No 097511073No (Hindi) Family-own
Yes 092147658TAYOTO, Vocational Not workingNo 090761307No (Hindi) Public Com 0
No 094852604Indico, Jo College GrUnemployed
No 094852604No (Hindi) School Ser
Yes 091784771SANCHEZ,College GrFull time Yes 091784771No (Hindi) School Ser
Yes 092842064 No (Hindi) School Ser
Yes 091538304 No (Hindi) School Ser
Yes 093386211 No (Hindi) Walking (N
No DANTES, M
College GrUnemployed
No 091618691No (Hindi) Family-own
 can provide
What
instructiona
devices are
l support to
available at
the child's
home that
distance
the learner
learning?
can use for
Choose all
learning?
that
Check all
applies.
that
(Sino-sino
Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 Others applies.
sa
(Anong
miyembro
mga
ng inyong
kagamitan
tahanan
sa tahanan
Parents/Gu
ang Basicang
Cell
maaaring
1 Parents/Gu
tumulong Cable TV,
magagamit
ng bata
sa distance
Parents/GuSmartphone
para sa
learning na
pag-aaral)
pag-aaral Smartphone
ng bata?
Parents/Gu
Piliin ang Cable TV,
lahat ng Basic Cell
Parents/Gu
naaangkop)
Parents/GuBasic Cell
Parents/GuSmartphon
1 none (walaSmartphone
Parents/GuSmartphone
1 Parents/Gu
0 0 0 0 0 1 0 Parents/GuBasic Cell
1 Parents/GuSmartphon
Parents/GuCable TV,
1
1 1
0 0 0 1 0 0 0 0 0 0
1 1
1
1
1
1
1
 child's to
learning herein shall
learning create/upda
modality/ies be treated
progress Do you te your
do you as
How do you through certify that child's
prefer for confidential
connect to distance all the learner
Do you your child? in
the education? information profile in
have a way Choose all compliance
internet? Choose all given are the Learner
to connect that with the
Choose all that true and Information
to the applies. Data
that applies. / correct? System
internet? (Ano-anong Privacy Act
Other. (Iba applies. other (iba Anong mga Others (iba (Ikaw ba'y (LIS)? (Ikaw
Mayroon ka pamamaraa of 2012.
pa) (Paano ka pa) hadlang pa) nangangak ba ay
bang n ng (Lahat ng
nakaka- ang o na ang pumapayag
paraan para “distance impormasy
connect sa maaaring lahat ng na gamitin
maka- learning” on dito ay
internet? makaapekto data na ng
connect sa ang nais dapat na
Yes (Mayroother
internet
Pillin placeonline
ang learn
mo para sa
lack of ava
sa proseso Yesiyong
(Oo) Yes (Oo)
Kagawaran I ituring
agree (S
na
lahat ng ng ibinigay at ng
Yes (Mayroown broadba
naangkop) online
iyonglear insufficien
pagkatuto Yes
tunay(Oo)
at Yes (Oo)
Edukasyon Ikumpidensi
agree (S
anak? Piliin yal at
Yes (Mayroown broadba online lear ng iyong tama?)
Yes (Oo) ang
Yes (Oo) Inaaayon
agree (S
ang lahat sa
anak gamit impormasy
ng Data
Yes (Mayroown broadba online lear
naaangkop.
unstable
ang mo Yes (Oo) Yes (Oo)
on na ito IPrivacy
agree Act (S
distance para i-
Yes (Mayroown mobileonline ) lear Yes (Oo) Yes (Oo) of 2012.)
I agree (S
education? update ang
Yes (Mayroown mobilemodular le Piliin angmo
unstable Yes (Oo) profile
Yes (Oo)ng I agree (S
lahat ng mag-aaral
Yes (Mayroown mobilemodular le lack of ava
naaangkop Yes (Oo) Yes (Oo)
sa Learner I agree (S
Information
Yes (Mayroown broadba
online lear unstable mo Yes (Oo) Yes (Oo)
I agree (S
System
(LIS)?)
Yes (Mayroown broadba
online lear Yes (Oo) Yes (Oo) I agree (S
Yes (Mayroown broadba
modular le None Yes (Oo) Yes (Oo) I agree (S
No (Wala) modular le insufficien Yes (Oo) Yes (Oo) I agree (S
N/A Yes (Mayroown mobileonline lear N/A lack of avaN/A Yes (Oo) Yes (Oo) I agree (S
Yes (Mayroown broadbaonline lear unstable mo Yes (Oo) Yes (Oo) I agree (S
Yes (Mayroother placemodular le unstable mo Yes (Oo) Yes (Oo) I agree (S
Parents/GuSmartphone Yes (Mayroown mobileonline lear
1 Parents/GuSmartphone Yes (Mayroown broadba
online lear
0 0 Parents/GuNon-Cable Yes (Mayroown mobileonline lear
Parents/GuSmartphon No (Wala) modular le
Parents/GuCable TV, Yes (Mayroown broadba
online lear
Parents/GuBasic Cell Yes (Mayroown mobilemodular le
Grandparent
Smartphon own mobilemodular le
Parents/GuCable TV, Yes (Mayroown broadba
online lear
1 1 Elder Sibli Desktop C Yes (Mayroown broadba
online lear
 If yes,
please
specify Subdivision
(Kung / baryo/
MAYROON, purok/ sitio
isulat kung
ano ito)
Rockwell C No (Hindi)
ACM PHAS No (Hindi)
Laptop ACM subdiv No (Hindi)
Onyx St. Ge
Mary Moar No (Hindi)
ACM Woods No (Hindi)
Baypoint Su
Olivarez Co No (Hindi)
Navarro Claremont S No (Hindi)
Mobile pho1A ST.MATTE No (Hindi)
LAPTOP SAUDIA VI No (Hindi)
Pacific Wo No (Hindi)
laptop boston heig No (Hindi)
N/A Pag-asa 1 No (Hindi)
Saudia Vill No (Hindi)
E. Villanue No (Hindi)
unstable mo Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
difficulty Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
insufficien Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
unstable mo Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
lack of ava Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
insufficien Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
distraction Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
 Does the
learner
already
have a Is the Last school
Last grade
registered learner a year Last School
Grade level level School
School Year LRN? (Ang returning completed Attended School ID
to enroll completed Address
Timestamp (Taong mag-aaral student? (Huling (Huling (ID ng
(Baitang na (Huling (Adres ng
Panuruan) ba ay may (Ang mag- natapos na paaralang Paaralan)
nais ipatala) baitang na Paaralan)
nakarehistr aaral ba ay taon sa pinasukan)
natapos)
o nang LRN Balik-aral?) paaralan)
sa
### 2020 - 202Yes (Oo) No (Hindi) Grade 5 Grade 4 2019 - 202Groeien Le 424082 Blk14 L20
kasalukuya
### 2020 - 202No (Hindi)
n?) No (Hindi) Grade 5 Grade 4 2019 - 202Joseph Imm Blk2 Lot1
### 2020 - 202Yes (Oo) Yes (Oo) Grade 5 Grade 4 2019 - 202Southwoods
### 2020 - 202Yes (Oo) No (Hindi) Grade 5 Grade 4 2019 - 202Groeien Lea 424082 Block 14 L
### 2020 - 202Yes (Oo) No (Hindi) Grade 5 Grade 4 2019 - 202Cachapero 424810 Narra Home
### 2020 - 202No (Hindi) No (Hindi) Grade 5 Grade 4 2019 - 202St. Martin
### 2020 - 202Yes (Oo) No (Hindi) Grade 5 Grade 4 2019 - 202Cachapero
### 2020 - 202Yes (Oo) No (Hindi) Grade 5 Grade 4 2019 - 202Cachapero 424222 B7 L13 Mah
### 2020 - 202Yes (Oo) No (Hindi) Grade 5 Grade 4 2019 - 202Saint Simo
### 2020 - 202Yes (Oo) No (Hindi) Grade 5 Grade 4 2019 - 202Saint Simo 039 NIA Rd
### 2020 - 202Yes (Oo) No (Hindi) Grade 5 Grade 4 2019 - 202Other (WalaCavite Stat 402201
### 2020 - 202Yes (Oo) No (Hindi) Grade 5 Grade 4 2019 - 202Vox Dei Pl 424400
### 2020 - 202Yes (Oo) No (Hindi) Grade 5 Grade 4 2019 - 202Groeien Lea
### 2020 - 202Yes (Oo) No (Hindi) Grade 5 Grade 4 2019 - 202Groeien Lea
### 2020 - 202Yes (Oo) No (Hindi) Grade 5 Grade 4 2019 - 202Groeien Lea 424082
 PSA
School to CERTIFACT
enroll in E NUMBER
School School LEARNER
(Paaralan School ID (Numero na LAST
Type (Uri Address Semester Strand (if REFERENC
kung saan (ID ng Track nakalagay NAME
ng (Adres ng (Semestre) any) E NUMBER
nais i-enroll Paaralan) sa Sertipiko (Apelyido)
Paaralan) Paaralan) (LRN)
ang mag- ng
aaral) Kapangana
kan)
Private (P Tinabunan 107,989 Pag-asa I I 2.01E+08 4.24E+11 Arquines
Private (P Tinabunan Advincula 20101099 Manalo
Private (P Tinabunan Pag asa 2 4.24E+11 PERDIGO
Private (P Tinabunan 107,989 Advincula 1st n/a n/a 4.24E+11 Cabagon
Private (P Tinabunan 107,989 Pag, - Asa 1st 4.25E+11 De Leon
Private (P Tinabunan Advincula 1st BOLANOS
Private (P Tinabunan 107,989 Pag-asa 1 1.08E+11 Nevalasca
Private (P Tinabunan 107,989 Pag-asa 1 2.01E+08 4.24E+11 Mohamme
Private (P Tinabunan 107,989 Pag-asa 1, 20101132 1.25E+11 Sales
Private (P Tinabunan 107,989 Pag-asa 1 20095957 4.24E+11 Tapas
Indang, CaPrivate (P Tinabunan 107989 Pag-asa 1, 2010217
ACM AlapaPrivate (P Tinabunan 107989 Pag-asa 1, 20105247
ACM WOOD Private (P Tinabunan 107989 PAG-ASA I 20101159
IMUS CAVPrivate (P Tinabunan 107989 PAG-ASA I
BLK14 LOTPrivate (P Tinabunan 107989 PAG-ASA I 2.01E+09
 Belonging
to
Indigenous
People (IP)
Community
If yes,
/Indigenous
Extension Date of please
MIDDLE Cultural Mother
FIRST name (if Birth (Petsa specify
NAME Sex Community tongue Religion
NAME applicable/k ng Age (Edad) (Kung oo,
(Gitnang (Kasarian) (Nabibilang (Kinagisnan (Relihiyon)
(Pangalan) ung Kapangana saang
Pangalan) sa g wika)
mayroon) kan) grupo
katutubong
nabibilang)
grupo/
Reese ClaiCamilon 5/9/2009 11 Female (B No (Hindi)
Komunidad Tagalog Born Again
ng
Karylle EyzMogan 7/31/2010 9 Female (B No (Hindi)
Katutubong Filipino Calabarzon
NEILJOHNMIRAS 5/30/2010 Kultural)
10 Male (LalakNo (Hindi) English TaRegion 4-A
CauthrieneLayaban 3/29/2010 10 Female (B No (Hindi) Filipino an Catholic
Miel Marie De Guzma ### 10 Female (B Yes (Oo) Filipino Tagalog Catholic
NICODIMUBERMAS 4/5/2011 10 Male (LalakNo (Hindi) TAGALOG
Marianne Curioso 7/4/2010 10 Female (B No (Hindi) Tagalog Catholic
Ayesha AsSalonga ### 9 Female (B No (Hindi) English Islam
Kurt DominMutas 1/29/2010 10 Male (LalakNo (Hindi) Tagalog Roman Cath
Juan RaphNodalo 10/1/2009 10 Male (LalakNo (Hindi) Tagalog Christian
4.02E+11 Marcelo Akira Pambuena 1/12/2010 10 Female (B No (Hindi)
4.24E+11 Redondo Jhenna ### 9 Female (B No (Hindi)
SANTOS ELLA MHAHILARIO 5/11/2010 10 Female (B No (Hindi)
CABAGONCAUTHRIELAYABAN 3/29/2010 10 Female (B No (Hindi)
4.24E+11 MANAS ARNIE KRHILARIO 7/18/2009 10 Female (B No (Hindi)
 Does this
learner
have
Do you
special
have any
education
assistive
needs? If yes,
technology
(Ang mag- please Highest
devices
aaral ba ay specify Educational
available at House City/Munici
nangangail (Kung Father's Attainment
home? Number pality Province
angan ng MAYROON, Region name (Pinakamat
(May (Numero ng Barangay (Lungsod/ (Probinsiya/
espesyal na isulat kung (Rehiyon) (Pangalan aas na
nagagamit bahay at Munisipalid Lalawigan)
tulong sa ano ang ng Ama) antas na
bang kalye) ad)
pag-aaral? natatanging natapos sa
“assistive
(hal.: sa kalagayan pag-aaral)
technology
Nopisikal,
(Wala) ng bata) Yes (Mayro
devices” sa
Blk12 L67 P
C arsadangImus Cavite Region 4A Arquines, Vocational
mental,
No (Wala)
kondisyong Noinyong
(Wala) Blk2 Lot1 Alapan1A Imus Cavite Roman Cath Manalo, RoCollege Gr
bahay?)
medical,
No (Wala) No (Wala) BLK2 LOT CARSADAN IMUS CITYCAVITE Region 4A PERDIGON High Schoo
bukod sa
Noiba(Wala)
pa)) No (Wala) Block12 LoToclong Kawit Cavite IV-A Cabagon, ECollege Gr
No (Wala) Yes (MayroBlk4 Lot 9 CarsadangImus City Cavite IV-A De Leon, Wi
College Gr
No (Wala) Yes (MayroUNIT-C IR PAG-ASA 2IMUS CAVITE REGION 4BOLANOSCollege Gr
No (Wala) Pag-asa 1 Imus City Cavite IV-A Nevalasca,College Gr
No (Wala) B4 L15 IpilPag-asa 1 Imus City Cavite IV-A Mohammed, College Gr
No (Wala) No (Wala) L0012 B30Alapan 1-AImus City Cavite IV-A Mutas, Jr. High Schoo
No (Wala) No (Wala) B4 L6 CarsadangImus City Cavite IV-A Tapas, MarCollege Gr
Tagalog Christian No (Wala) No (Wala) B5 L3. PH.Saudia VillPag-asa 2 Imus City
Tagalog Catholic No (Wala) B43 L12 PHACM WoodCarsadangImus City
TAGALOGCATHOLICNo (Wala) No (Wala) B4 LOT 8 DREAMVILCARSADAN IMUS CITY
TAGALOGCATHOLICNo (Wala) No (Wala) B12 L6 ESTRELLATOCLONGKAWIT
ENGLISH/ CATHOLICNo (Wala) No (Wala) BLOCK 4 LPACIFIC CARSADAN IMUS CITY
 Working Highest Working Guardian's Highest
from home Educational from home name (not Educational
Employmen due to Contact Mother's Attainment Employmen due to Contact parents) Attainment
t status ECQ? Number name (Pinakamat t status ECQ? Number (Pangalan (Pinakamat
(Katayuan (Nagtratrab (Cellphone/ (Pangalan aas na (Katayuan (Nagtratrab (Cellphone/ ng tagapag- aas na
sa trabaho) aho sa Telephone) ng Ina) antas na sa Trabaho) aho sa Telephone) alaga na antas na
bahay dahil natapos sa bahay dahil hindi ama o natapos sa
sa ECQ) pag-aaral) sa ECQ) ina) pag-aaral)
Self EmploNo 091565387Arquines, Vocational Not workingNo 091629913
Full time No 094254546Manalo, CaCollege GrSelf EmploYes 093297178
Not workingNo 090727545PERDIGON High SchooFull time No 090727545PERDIGON High Schoo
Full time Yes 099538965Cabagon, DCollege GrNot workingNo 099507559
Unemployed Yes 093956458De Guzman,College GrSelf EmploYes 093956458De Leon, JCollege Gr
Full time No 091757654BOLANOSCollege GrFull time No 091757654
Unemployed 094750031Curioso, MCollege GrNot working 092191206
Self EmploNo 099952611MohammedCollege GrSelf EmploYes 099952611MohammedCollege Gr
Full time No Mutas, NemHigh SchooSelf EmploNo 092664480Mutas, AurHigh Schoo
UnemployedNo Nodalo, CyCollege GrNot workingNo 092359483Nadalo, CyCollege Gr
Cavite IV-A Marcelo, JeCollege GrSelf EmploNo N/A Pambuena,College GrUnemployed
Cavite IV-A De Leon, HCollege GrSelf EmploNo 092662645Redondo, High SchooSelf Emplo
CAVITE IV-A SANTOS, College GrFull time No HILARIO, College GrNot working
CAVITE IV-A CABAGON,College GrFull time 099538965CABAGON,College GrNot working
CAVITE IV-A MANAS, TO College GrSelf EmploYes 097781376MANAS, ACollege GrUnemployed
 How does
your child
goes to
Working
school?
from home
Choose all
Employmen due to Contact
that applies
t status ECQ? Number
(Paano Kinder Grade 1 Grade 2 Grade 3 Grade 4 Grade 5
(Katayuan (Nagtratrab (Cellphone/
pumapasok
sa Trabaho) aho sa Telephone)
ang bata sa
bahay dahil
paaralan?
sa ECQ)
Piliin ang
School
lahat ng
Ser 1
Walking
naaangkop) (N 1
Full time No 090727545Public Com
School Ser 1
Self EmploYes 093956458School Ser 1 1
No Public Com 1 1
Walking (N 1
Self EmploYes 099952611Walking (N 1
Not workingNo 092664480
Not workingNo 092359486Public Com
No 929150809 No (Hindi) School Ser
No 092662644Redondo, JHigh SchooSelf EmploNo 092662644No (Hindi) Family-own
No 091847037 No (Hindi) Family-own
4242603 No (Hindi) School Ser
No 092830090 No (Hindi) Family-own
 can provide
What
instructiona
devices are
l support to
available at
the child's
home that
distance
the learner
learning?
can use for
Choose all
learning?
that
Check all
applies.
that
(Sino-sino
Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 Others applies.
sa
(Anong
miyembro
mga
ng inyong
kagamitan
tahanan
sa tahanan
1 Parents/Gu
ang Non-Cable
ang
maaaring
Parents/Gu
tumulong Smartphon
magagamit
ng bata
sa distance Smartphon
Parents/Gu para sa
learning na
pag-aaral)
Parents/Gu
pag-aaral Basic Cell
ng bata?
Parents/Gua
Piliin ang Cable TV,
1 nonelahat(walaSmartphone
ng
naaangkop)
1 1 Parents/GuSmartphon
1 Parents/GuNon-Cable
1 Parents/GuSmartphon
1 1 1 Parents/GuSmartphon

1 1
1
1
 child's to
learning herein shall
learning create/upda
modality/ies be treated
progress Do you te your
do you as
How do you through certify that child's
prefer for confidential
connect to distance all the learner
Do you your child? in
the education? information profile in
have a way Choose all compliance
internet? Choose all given are the Learner
to connect that with the
Choose all that true and Information
to the applies. Data
that applies. / correct? System
internet? (Ano-anong Privacy Act
Other. (Iba applies. other (iba Anong mga Others (iba (Ikaw ba'y (LIS)? (Ikaw
Mayroon ka pamamaraa of 2012.
pa) (Paano ka pa) hadlang pa) nangangak ba ay
bang n ng (Lahat ng
nakaka- ang o na ang pumapayag
paraan para “distance impormasy
connect sa maaaring lahat ng na gamitin
maka- learning” on dito ay
internet? makaapekto data na ng
connect sa ang nais dapat na
Yes (Mayroown
internet
Pillinbroadba
ang online lear
mo para sa
lack of ava
sa proseso Yesiyong
(Oo) Yes (Oo)
Kagawaran I ituring
agree (S
na
lahat ng ng ibinigay at ng
Yes (Mayroown mobilemodular
naangkop)
iyong le lack of ava
pagkatuto Yes
tunay(Oo)
at Yes (Oo)
Edukasyon Ikumpidensi
agree (S
anak? Piliin yal at
No (Wala) own mobileonline lear ng iyong
lack of ava tama?)
Yes (Oo) ang
Yes (Oo) Inaaayon
agree (S
ang lahat sa
anak gamit impormasy
ng Data
Yes (Mayroown broadba online lear
naaangkop.
high angelectr Yes (Oo) Yes (Oo)
on na ito IPrivacy
agree Act (S
distance para i-
Yes (Mayroown broadba online ) lear unstable of 2012.)
education?mo Yes (Oo) Yes (Oo)
update ang I agree (S
Yes (Mayroown broadba online lear Piliin ang Yes (Oo) profile
Yes (Oo)ng I agree (S
lahat ng mag-aaral
Yes (Mayroown broadba modular le difficulty
naaangkop Yes (Oo) Yes (Oo)
sa Learner I agree (S
Information
Yes (Mayroown mobilemodular le unstable mo Yes (Oo) Yes (Oo)
I agree (S
System
(LIS)?)
Yes (Mayroown mobilemodular le unstable mo Yes (Oo) Yes (Oo) I agree (S
Yes (Mayroown mobilemodular le unstable mo Yes (Oo) Yes (Oo) I agree (S
Parents/GuDesktop C Yes (Mayroown broadba
online lear
Parents/GuDesktop C Yes (Mayroown broadba
online lear
Parents/GuBasic Cellp Yes (Mayroown broadba
modular le
Parents/GuDesktop C Yes (Mayroown broadba
online lear
Parents/GuCable TV, Yes (Mayroown broadba
modular le
 If yes,
please
specify Subdivision
(Kung / baryo/
MAYROON, purok/ sitio
isulat kung
ano ito)
smartphonACM Woods
ACM Woods No (Hindi)
DREAMVIL No (Hindi)
St. Estrell No (Hindi)
DSL Dreamville No (Hindi)
LAPTOP SAUDIA V No (Hindi)
Narra Hom No (Hindi)
Narra Hom No (Hindi)
ACM Woods No (Hindi)
Starkville No (Hindi)
unstable mo Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
lack of ava Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
insufficien Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
difficulty Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
unstable mo Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
 Does the
learner
already
have a Is the Last school
Last grade
registered learner a year Last School
Grade level level School
School Year LRN? (Ang returning completed Attended School ID
to enroll completed Address
Timestamp (Taong mag-aaral student? (Huling (Huling (ID ng
(Baitang na (Huling (Adres ng
Panuruan) ba ay may (Ang mag- natapos na paaralang Paaralan)
nais ipatala) baitang na Paaralan)
nakarehistr aaral ba ay taon sa pinasukan)
natapos)
o nang LRN Balik-aral?) paaralan)
sa
### 2020 - 202Yes (Oo) No (Hindi) Grade 6 Grade 5 2019 - 202Southwoods 424261 Alapan I-A
kasalukuya
### 2020 - 202Yesn?) (Oo) No (Hindi) Grade 6 Grade 5 2019 - 202Cachapero B7 L13 Mah
### 2020 - 202Yes (Oo) No (Hindi) Grade 6 Grade 5 2019 - 202Our Lady of Tirona St.
### 2020 - 202Yes (Oo) No (Hindi) Grade 6 Grade 5 2019 - 202Cachapero 402112
### 2020 - 202Yes (Oo) No (Hindi) Grade 6 Grade 5 2019 - 202Pasong Bua
### 2020 - 202Yes (Oo) No (Hindi) Grade 6 Grade 5 2019 - 202San Isidro I
### 2020 - 202Yes (Oo) No (Hindi) Grade 6 Grade 5 2019 - 202Groeien Lea
 PSA
School to CERTIFACT
enroll in E NUMBER
School School LEARNER
(Paaralan School ID (Numero na LAST
Type (Uri Address Semester Strand (if REFERENC
kung saan (ID ng Track nakalagay NAME
ng (Adres ng (Semestre) any) E NUMBER
nais i-enroll Paaralan) sa Sertipiko (Apelyido)
Paaralan) Paaralan) (LRN)
ang mag- ng
aaral) Kapangana
kan)
Private (P Tinabunan 107,989 Pag-asa I I 2.01E+08 4.24E+11 Asprec
Private (P Tinabunan 107,989 Pag-asa 1 10750709 4.02E+11 Mohamme
Private (P Tinabunan 107,989 Pag-asa 1, 20092165 4.02E+11 Gilhang
Narra Home Private (P Tinabunan 107989 Pag-asa 1,
Pasong Kaw Public (Pa Tinabunan 107989 Pag-asa 1,
CarsadangPrivate (P Tinabunan 107989 Pag-asa 1, 2.01E+10
B14 L20 Private (P Tinabunan 107989 PAG-ASA I 2.01E+09
 Belonging
to
Indigenous
People (IP)
Community
If yes,
/Indigenous
Extension Date of please
MIDDLE Cultural Mother
FIRST name (if Birth (Petsa specify
NAME Sex Community tongue Religion
NAME applicable/k ng Age (Edad) (Kung oo,
(Gitnang (Kasarian) (Nabibilang (Kinagisnan (Relihiyon)
(Pangalan) ung Kapangana saang
Pangalan) sa g wika)
mayroon) kan) grupo
katutubong
nabibilang)
grupo/
SOPHIA L DELA GUE 6/2/2009 11 Female (B No (Hindi)
Komunidad TAGALOGRoman Cath
ng
Swvethlan Ramos ### 11 Female (B No (Hindi)
Katutubong Tagalog Catholic
Fatima AslSalonga 5/27/2009 Kultural)
11 Female (B No (Hindi) English Islam
Sophia LorDela Guerr 6/2/2009 11 Female (B No (Hindi) Tagalog Roman Cath
4.02E+11 Hingada Chris Mich Luna 5/14/2008 12 Male (LalakNo (Hindi) N/A
2.24E+11 De Luna Rensy Madrigalej 6/5/2009 11 Male (LalakNo (Hindi)
4.25E+11 Busmion Saint Agan 6/11/2008 12 Male (LalakNo (Hindi)
AGUIRRE LAWRENCE
BELDAD 1/31/2009 10 Male (LalakNo (Hindi)
 Does this
learner
have
Do you
special
have any
education
assistive
needs? If yes,
technology
(Ang mag- please Highest
devices
aaral ba ay specify Educational
available at House City/Munici
nangangail (Kung Father's Attainment
home? Number pality Province
angan ng MAYROON, Region name (Pinakamat
(May (Numero ng Barangay (Lungsod/ (Probinsiya/
espesyal na isulat kung (Rehiyon) (Pangalan aas na
nagagamit bahay at Munisipalid Lalawigan)
tulong sa ano ang ng Ama) antas na
bang kalye) ad)
pag-aaral? natatanging natapos sa
“assistive
(hal.: sa kalagayan pag-aaral)
technology
Nopisikal,
(Wala) ng bata) No (Wala)
devices” sa
Block 2 LotAlapan 1A Imus City Cavite Region IV-GILHANG,College Gr
mental,
No (Wala)
kondisyong
inyong Blk 9 Lot 8Toclong Kawit Cavite IV-A Asprec, JohMaster's/D
bahay?)
medical,
No (Wala) B4 L15 Ipil Pag-asa 1 Imus City Cavite IV-A Mohammed, College Gr
bukod sa
Noiba(Wala)
pa)) No (Wala) B2 L6 Alapan I-A Imus City Cavite IV-A Gilhang, RCollege Gr
Tagalog Members Ch
No (Wala) No (Wala) 82 Pag-asa 1 Imus City
Tagalog Catholic No (Wala) 99 Toclong Kawit
Tagalog Catholic No (Wala) No (Wala) Blk9 Lot 13MontefarroAlapam I-BImus City
TAGALOGIGLESIA NNo (Wala) No (Wala) B5 LOT40 ACM SUBDALAPAN I-IMUS CITY
 Working Highest Working Guardian's Highest
from home Educational from home name (not Educational
Employmen due to Contact Mother's Attainment Employmen due to Contact parents) Attainment
t status ECQ? Number name (Pinakamat t status ECQ? Number (Pangalan (Pinakamat
(Katayuan (Nagtratrab (Cellphone/ (Pangalan aas na (Katayuan (Nagtratrab (Cellphone/ ng tagapag- aas na
sa trabaho) aho sa Telephone) ng Ina) antas na sa Trabaho) aho sa Telephone) alaga na antas na
bahay dahil natapos sa bahay dahil hindi ama o natapos sa
sa ECQ) pag-aaral) sa ECQ) ina) pag-aaral)
Self EmploNo 094246547GILHANG,High SchooNot workingNo 091626838
Full time Yes 090609329Ramos, Joa College GrNot working 916677094
Self EmploNo 099952611MohammedCollege GrSelf EmploYes 999526115MohammedCollege Gr
Self EmploNo 094792197Dela GuerrCollege GrNot workingNo 091626838
Cavite IV-A Hingada, ECollege GrFull time Yes 997167805Luna, MarieHigh SchooPart time
Cavite IV-A MadrigalejoHigh SchooNot working
Cavite IV-A Busmion, RVocational Self EmploNo 093905463Agan, Divi College GrNot working
CAVITE IV-A AGUIRRE,College GrFull time No 092033203BELDAD, College GrFull time
 How does
your child
goes to
Working
school?
from home
Choose all
Employmen due to Contact
that applies
t status ECQ? Number
(Paano Kinder Grade 1 Grade 2 Grade 3 Grade 4 Grade 5
(Katayuan (Nagtratrab (Cellphone/
pumapasok
sa Trabaho) aho sa Telephone)
ang bata sa
bahay dahil
paaralan?
sa ECQ)
Piliin ang
Public Com
lahat ng
Family-own
naaangkop) 1
Yes 999526115Walking (N 1 1
Public Com
Yes 092078967 No (Hindi) Walking (N
No 090992784 No (Hindi) School Ser 1
No 093511361 No (Hindi) School Ser
No 095097633 No (Hindi) Family-own
 can provide
What
instructiona
devices are
l support to
available at
the child's
home that
distance
the learner
learning?
can use for
Choose all
learning?
that
Check all
applies.
that
(Sino-sino
Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 Others applies.
sa
(Anong
miyembro
mga
ng inyong
kagamitan
tahanan
sa tahanan
1 1 Parents/Gu
ang Smartphon
ang
maaaring
Parents/Gu
tumulong Cable TV,
magagamit
ng bata
sa distance Non-Cable
Parents/Gu para sa
learning na
pag-aaral)
1 Parents/Gu
pag-aaral Smartphon
ng bata?
Piliin ang
1 1 lahat ng
naaangkop)

1 1
 child's to
learning herein shall
learning create/upda
modality/ies be treated
progress Do you te your
do you as
How do you through certify that child's
prefer for confidential
connect to distance all the learner
Do you your child? in
the education? information profile in
have a way Choose all compliance
internet? Choose all given are the Learner
to connect that with the
Choose all that true and Information
to the applies. Data
that applies. / correct? System
internet? (Ano-anong Privacy Act
Other. (Iba applies. other (iba Anong mga Others (iba (Ikaw ba'y (LIS)? (Ikaw
Mayroon ka pamamaraa of 2012.
pa) (Paano ka pa) hadlang pa) nangangak ba ay
bang n ng (Lahat ng
nakaka- ang o na ang pumapayag
paraan para “distance impormasy
connect sa maaaring lahat ng na gamitin
maka- learning” on dito ay
internet? makaapekto data na ng
connect sa ang nais dapat na
No (Wala)
internet
own
Pillinmobile
ang modular le
mo para sa
insufficien
sa proseso Yes (Oo)
iyong Yes (Oo)
Kagawaran I agree
ituring na
(S
lahat ng ng ibinigay at ng
Yes (Mayroown mobileonline
naangkop)
iyonglear unstable
pagkatutomo Yes
tunay(Oo)
at Yes (Oo) Ikumpidensi
Edukasyon agree (S
anak? Piliin yal at
Yes (Mayroown mobilemodular ng iyong tama?) ang
ang lahatle unstable mo Yes (Oo) Yes (Oo) Inaaayon agree (S sa
anak gamit impormasy
ng Data
No (Wala) own mobilemodular
naaangkop.
le insufficien
ang Yes (Oo) Yes (Oo)
on na ito I agree (S
Privacy Act
distance para i-
)
Parents/Gu Non-Cable education? Yes (Mayroown mobilemodular le of 2012.)
update ang
Parents/GuNone (Wala Piliin ang No (Wala) none/wala modular profile ngle
lahat ng mag-aaral
Parents/GuSmartphon naaangkop Yes (Mayroown broadba modular
sa Learner le
Information
Parents/GuTablet Yes (Mayroown mobilemodularSystem le
(LIS)?)
 If yes,
please
specify Subdivision
(Kung / baryo/
MAYROON, purok/ sitio
isulat kung
ano ito)
Sunnydale No (Hindi)
Estrella H No (Hindi)
Narra Hom No (Hindi)
Sunnydale No (Hindi)
unstable mo Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
lack of ava Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
insufficien Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)
insufficien Yes (Oo) Yes (Oo) I agree (Sumasang-ayon ako)