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    Stenex Beef

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    Akeah Nero
    This form collects essential information about a student enrolling in the Santa Rosa Science and Technology High School. It requests the student's personal details like name, birthdate, address and contact information. It also asks for parental/guardian details such as name, occupation, educational attainment and contact information. Finally, it requires the student's health concerns and consent from the parent to share the student's information with the Department of Education for creating a learner profile.

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    Stenex Beef

    Uploaded by

    Akeah Nero
    22 views1 page
    This form collects essential information about a student enrolling in the Santa Rosa Science and Technology High School. It requests the student's personal details like name, birthdate, address and contact information. It also asks for parental/guardian details such as name, occupation, educational attainment and contact information. Finally, it requires the student's health concerns and consent from the parent to share the student's information with the Department of Education for creating a learner profile.

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    This form collects essential information about a student enrolling in the Santa Rosa Science and Technology High School. It requests the student's personal details like name, birthdate, address and contact information. It also asks for parental/guardian details such as name, occupation, educational attainment and contact information. Finally, it requires the student's health concerns and consent from the parent to share the student's information with the Department of Education for creating a learner profile.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    22 views1 page

    Stenex Beef

    Uploaded by

    Akeah Nero
    This form collects essential information about a student enrolling in the Santa Rosa Science and Technology High School. It requests the student's personal details like name, birthdate, address and contact information. It also asks for parental/guardian details such as name, occupation, educational attainment and contact information. Finally, it requires the student's health concerns and consent from the parent to share the student's information with the Department of Education for creating a learner profile.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Form 1

    DEPARTMENT OF EDUCATION
    SANTA ROSA SCIENCE AND TECHNOLOGY HIGH SCHOOL

    ENHANCED BASIC EDUCATION ENROLLMENT FORM


    THIS FORM IS NOT FOR SALE.
    -

    School Year: - Check the appropriate box only

    Grade Level to enroll: 1. With LRN? □ Yes □ No 2. Returning (Balik-Aral) □ Yes □ No 3. Transferee (Gr.8-12) □ Yes □ No
    Current Name of School: _______________________________________________________________________________________________ School ID: ____________________

    School Address : _____________________________________________________________________________________________________ School Type: □ Public □ Private


    INSTRUCTIONS:
    Print legibly all information required in CAPITAL letters. Submit the completed form to the Teacher/Person-in-Charge. For items not applicable, write N/A. Use
    black or blue pen only.

    STUDENT INFORMATION

    PSA Birth Certificate No. (if available upon registration) _____________________________ Learner Reference No. (LRN)

    Last Name Date of Birth (Month/Day/Year) / /


    Place of Birth (Municipality/City)
    First Name

    Age: Sex: Male Female


    Middle Name
    Mother Tongue:

    Extension Name e.g. Jr., III (if applicable): _______________________________ Religion:


    Belonging to any Indigenous Peoples (IP) Community/Indigenous Cultural Community?
    □ Yes □No If Yes, please specify: _______________________________________
    Is your family a beneficiary of 4Ps? □ Yes □ No If yes, write the 4Ps Household ID Number:

    Contact number/s (cellphone/ telephone): Facebook Name: Top 3 career choices in the future:

    1. _______________________________________
    Email address: Planning or have a pending migration application? 2. _______________________________________
    □YES □ None 3. _______________________________________

    ADDRESS
    House Number and Street Subdivision/ Village/ Zone Barangay

    ______________________________________________________________________________________________________________________________________________
    City/ Municipality Province Region Zip Code

    _______________________________________________________________________________________________________________________________________________________________________________

    PARENT/ GUARDIAN INFORMATION


    Father Mother Guardian
    Full Name (last name, first name, middle name) Full Maiden Name (last name, first name, middle name) Full Name (last name, first name, middle name)

    Highest Educational Attainment Highest Educational Attainment Highest Educational Attainment

    Elementary graduate Elementary graduate Elementary graduate


    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
    Others: _______________ Others: _______________ Others: _______________
    Employment Status Employment Status Employment Status
    Government Government Government
    Private Private Private
    OFW OFW OFW
    Full time Full time Full time
    Part time Part time Part time
    Self-employed (i.e. family business) Self-employed (i.e. family business) Self-employed (i.e. family business)
    Not working Not working Not working

    Contact number/s (cellphone/ telephone) Contact number/s (cellphone/ telephone) Contact number/s (cellphone/ telephone)

    Health Concern/s (Physical, Mental, Psychological) – If none kindly write N/A.

    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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