Department of Education

ALTERNATIVE LEARNING SYSTEM

MASTERLIST OF MAPPED AND POTENTIAL LEARNERS (AF1)

District Division Region Calendar Year

COMPLETE HOME ADDRESS PARENTS REMARKS

If already
Last Grade enrolled in
Sex Date of IP Mother’s Contact Date
NAME Father’s Name Level ALS,
(M Birth Mother (Yes House No./ Maiden Name Number of Mapped Interested If Yes
(Last Name, First Name, Name Age Religion Municipality (Last Name, Completed provide
/F) (mm/dd Tongue or Street/ Barangay Province (Last Name, Learner (if (mm/dd in ALS? Preferred
Extension, Middle Name) / City First Name, in Formal date of first
/yyyy) No) Sitio/ Purok First Name, available) /yyyy) Yes or No Program
Middle Name) School attendance
Middle Name)
(DOFA) and
LRN

Prepared By: ____________________________________

MAPPED LEARNERS as of ENROLLED LEARNERS as of
(MM/DD/YYYY) (MM/DD/YYYY)
Signature of Facilitator over Printed Name
MALE MALE
Certified Correct: __________________________________
FEMALE FEMALE
Signature of PSDS over Printed Name
TOTAL TOTAL
SFRT 2017