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School ID : :342355 Contact

:__________09228413586
No. :
Name of School : MAMATID SHS Date: 5/6/22_____

Email Address :

FORM 1: (Division Level only)


Request: (A) LRN Approval (B)Enrolment W/Gap (C) Enrolment of Ineligible

1. Fill up the necessary details in the Learner's Information Columns.


Instructions: 2. Indicate the letter of request (sample: (A)).
3. Present the following documents for approval of the request

1 For Proof Of Identity: 2 For Proof of Grade Level:


Present any of the following document (per learner):
Present any of the following document (per learner): - SF10/F137 (Last School Year Attended)
- Birth Certificate (PSA/NSO or Certificate of Live Birth) - SF9/Report Card/F138 (Last School Year Attended)
- Barangay Certification (containing Learner's Full Name,Birthday & Gender) - Certificate of Completion
- Notarized Affidavit of Undertaking
- Passport (for foreign students) - PEPT Result
- A&E Result

A = Approved DA = Disapproved INC (NPI) - Incomplete Attachment (No Proof of Identity)


INC (NPGL) - Incomplete Attachment (No Proof of Grade Level)

Level Check the box if the To be filled up


Learner's Name documents are by Division
(Elem / presented Issues or Personnel
Secondary Proof of Proof of Concern
Middle Extensio
Last name First Name / Identity Grade level Remarks
Name n Name 1 2
SHS)
 MEDINA  LAWREN  SOMBILLO            

                 

Requested by: Recommended by:

MA. NINA S. GACHEZ


JOSE CHARLIE S. ALOQUIN, Ph.D.
Signature over Printed Name
OIC, Chief - SGOD
Principal Planning Officer III

Approved:

_____________________________________________
HEREBERTO JOSE D. MIRANDA, CESO VI
Schools Division Superintendent

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