A

(This replaces Form 1, Master List & STS Form 2-Family Background and Profile) P
R
O
G
School ID Region I Division Pangasinan II, Binalonan R
A
M
School Name School Year 2020 - 2021 Grade Level Grade 7 (Year Section
I
GUARDIAN
Age MOTHER ADDRESS PARENTS
(if NotNParent)

Sex (M/F)
IP
LRN
NAME BIRTH DATE as of TONGUE (Ethnic
RELIGIO
Father's Name Mother's Maiden
(Last Name, First Name, Middle Name) (mm/dd/yyyy) Octob (Grade 1 N House #/
Group) Municipality/ (Last Name, First Name (Last Name, M
er 31 to 3 Only) Street/ Sitio/ Barangay
City
Province
Name, Middle First Name, Middle
Name Relationship
Purok
Name) Name)
A
T
ANCHETA, BITIBIT,CATHE H
Christiani
400243150085 ANCHETA,MARTH CREAVIN, BITIBIT M 12-12-2007 12 Ilocano
ty
LEGASPI TAYUG PANGASINAN MARK ALDWIN LYN,BELARMI E
MACARAEG NO, M
A
T
102066140055 ANDRES,MARK JERIEL, LOPEZ M 06-17-2008 12 Iloko
Christiani
TOKETEC TAYUG PANGASINAN
ANDRES, LOPEZ,MAGDA I
ty WILLY ESCANO LENA,LEGASPI, C
S
Christiani CAMU, PERRY SARMIENTO,JO
102066130115 CAMU,PEEJAY, SARMIENTO M 07-08-2008 12 Iloko AGNO TAYUG PANGASINAN
ty JUAN AN,VIDAL,
SAN CASUGA,
Christiani GALISTE,MAR
101843130011 CASUGA,CHRISTIAN KYLE, GALISTE M 09-26-2008 12 Iloko MACARIO NATIVIDAD PANGASINAN SONNY
ty UJA,,
SUR LOVINA
CONSUL, BATADISTA,M
Christiani SANTO
102066150173 CONSUL,PRINCE HARLEY, BATADISTA M 03-26-2008 12 Ilocano TAYUG PANGASINAN RONALDO ARY
ty DOMINGO
CARACAS ANN,TIPON,
DE GUZMAN,
CABALAOA SAN TOMINES,CHER
400243150224 DE GUZMAN,JACOB DOMINIC, TOMINES M 11-16-2007 12 Ilocano Others PANGASINAN EDMUNDO
NGAN QUINTIN RY,LIBUNGAN,
VICTORINO

Christiani TRENCHER GALERA, QUILANG,SHIR

102066130191 GALERA,BENZ YVES, QUILANG M 10-17-2008 12 Iloko TAYUG PANGASINAN
ty A RANILO JAVIER LEY,BATULAN,

IGTOS, REMORIN,EVA
Christiani
102066140062 IGTOS,JOHN IVAN, REMORIN M 06-05-2008 12 Iloko CARRIEDO TAYUG PANGASINAN DIONISIO NGELINE,BILL
ty
GALGALAN ENA,
JUANITEZ,
Christiani TRENCHER GILBERT LACADEN,MAR
102066130187 JUANITEZ,MARK GIRO, LACADEN M 09-06-2007 13 Iloko TAYUG PANGASINAN
ty A ROMMEL Y JOY,VIDAL,
BUYAO
PACARIEM,
TABAMO,MAR
Christiani CABITNONG SAN CONRADO
101987130032 PACARIEM,JABES JON, TABAMO M 10-17-2008 12 Ilocano PANGASINAN Y
ty AN NICOLAS MATUSALEM
JANE,ACOSTA,
JR

PARAYNO, DUYAG,JACQU
Christiani PANGANIBA
102066140067 PARAYNO,EARL KEIRULF, DUYAG M 12-30-2007 12 Iloko TAYUG PANGASINAN RODOLFO ELINE,MAGDA
ty N
LAROCO LDALARO,

REBOLLEDO, DELA
Christiani
102075130047 REBOLLEDO,GABRIEL NOAH, DELA VEGA M 03-19-2008 12 Iloko LAWAK TAYUG PANGASINAN DANILO VEGA,LORNA,S
ty
PAJARILLO ANTILLAN,

RUFINTA,
MARK
Christiani MANGAOANG,
102037130036 RUFINTA,KING HARVEY, MANGAOANG M 07-04-2008 12 Iloko ZAMORA TAYUG PANGASINAN ANTHONY
ty MAI,BARUIZ,
FLORES
RUFINTA
 Contact REMARKS
Number of Learning
Parent or Modality (Please refer to
Guardian the legend on last
page)

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 Christiani BARANGAY SAMERA, VIERNES,MELO
400242150054 SAMERA,JESTHER LOUIS, VIERNES M 10-26-2008 12 Ilocano TAYUG PANGASINAN
ty B (POB.) HENRY DY,,

SANCHEZ,
Christiani BLADYMER UGMA,NIDA,C
102061130033 SANCHEZ,BLADYMER, JR UGMA M 04-16-2008 12 Ilocano AGNO TAYUG PANGASINAN
ty ALCANTARA ABANIZAS,
SR
Christiani BARANGAY TAN,KIRSTINE,
102066140026 TAN,KURTNINE JOEB, - M 08-09-2008 12 Iloko TAYUG PANGASINAN
ty A (POB.) PASCUA,

TUGADE, BAYLON,JOCE
Christiani C.
102069130016 TUGADE,ADRIELLE, BAYLON M 10-01-2008 12 Iloko TAYUG PANGASINAN BAGNOS LYN,MACARAE
ty LICHAUCO
DELOS SANTOS G,

17 <=== TOTAL MALE

BANIQUED,
Christiani FLORES,RUBY
102077140021 BANIQUED,PAULA NICOLE, FLORES F 02-18-2008 12 Iloko ZAMORA TAYUG PANGASINAN PAUL JANSEN
ty JOY,VALDEZ,
CABIGAS
GARCIA,CRISTI
Christiani BERNAL,
102063130017 BERNAL,JAIRYLLE ANDREA, GARCIA F 07-07-2008 12 Iloko CARRIEDO TAYUG PANGASINAN NE,ANDREW,PI
ty JERYL CASILLA
D

CAÑAVERAL,
Christiani TUGADE,EMIE
412062150048 CAÑAVERAL,ALEJAH GENLEN, TUGADE F 11-04-2007 12 Iloko LIBERTAD TAYUG PANGASINAN GENESIS
ty LYN,BERNABE,
ANCHETA

CATAMBING,
Christiani NAMAGBAG SANTA PALCE,ROWEN
412064150054 CATAMBING,AIRA NICOLE, PALCE F 02-21-2008 12 Ilocano PANGASINAN ALVIN
ty AN MARIA A,TAGANA,
PAMINTUAN
DELA PEÑA,
Christiani C. TUBIERA,GEM
102069130021 DELA PEÑA,JUMAE, TUBIERA F 10-20-2007 13 Iloko TAYUG PANGASINAN JUNE
ty LICHAUCO MA,SALAZAR,
BANIQUED
DIAZ,
Christiani BAUZON,GINA,
102066140078 DIAZ,VICKTORIA MAE, BAUZON F 11-05-2007 12 Iloko AGNO TAYUG PANGASINAN HERMELITO
ty SOTELO,
SABANGAN

Christiani C. JACOB,DAISY,
102069130029 JACOB,JAYSY CASSANDRA JOY, OCHINANG F 08-18-2008 12 Iloko TAYUG PANGASINAN
ty LICHAUCO OCHINANG,

Christiani POBLACION LAUREANO, MIRANDA,AUB

400215150068 LAUREANO,AYANNA CELINE, MIRANDA F 05-12-2008 12 Ilocano NATIVIDAD PANGASINAN
ty WEST CROMWELL REY,,
MACAALAY, BERGONIA,VA
Christiani TRENCHER
102066130234 MACAALAY,JIEWEL KAILEEN, BERGONIA F 10-27-2008 12 Iloko TAYUG PANGASINAN JEFFREY NESSA LOU,DE
ty A
SANCHEZ GUZMAN,

Christiani BARANGAY CELEBRE,LORI

412016150076 MASON,KHIZ SHARPAY, CELEBRE F 02-03-2008 12 Filipino TAYUG PANGASINAN
ty C (POB.) ELLE,-,

MURLA,
Christiani SANTA CASIGNIA,JUDI
102046130017 MURLA,JONADITH FAITH, CASIGNIA F 07-07-2008 12 Iloko PATAQUID PANGASINAN JONATHAN
ty MARIA TH,AGUILAR,
ESPIRITU
PADILLA, DELICA,MYRN
Christiani MAGALLAN
108475140030 PADILLA,KRIZL ALTHEA, DELICA F 01-07-2008 12 Tagalog TAYUG PANGASINAN ROMIL A,LUMANGLAS
ty ES
QUITOLA ,

Christiani POBLACION RUIZ, RIVERA,GLAD

400215150070 RUIZ,KRISTEL CASSEY, RIVERA F 02-23-2007 13 Ilocano NATIVIDAD PANGASINAN
ty EAST RUDYMILIO G YS,,
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 YLARDE, IRIS
Christiani SAN HIMOR,WELBE
102011130062 YLARDE,SIMLAH NHOVEM, HIMOR F 11-19-2007 12 Iloko LAGASIT PANGASINAN FRANCIS
ty QUINTIN RTA,AQUINO,
AREOLA

14 <=== TOTAL FEMALE

31 <=== COMBINED

List and Code of Indicators under REMARKS column

Indicator Code Required Information Indicator Code Required Information REGISTERED BoSY EoSY Prepared by; Certified Correct:

Transfered Out T/O Name of Public (P) Private (PR) School & Effectivity Date CCT Receipient CCT CCT Control/reference number & Effectivity Date MARK ROMERO
MALE 16
Name of Public (P) Private (PR) School & Effectivity Date Balik Aral B/A Name of school last attended & Year
Transfered In T/I JOSHUA CASER VIERNES
Reason and Effectivity Date Learner With LWD Specify (Signature of School Head
(Signature of Adviser over Printed Name)
Reason (Enrollment beyond 1st Friday of June) Disability FEMALE 14
Dropped DRP Accelerated ACL Specify Level & Effectivity Data
Late Enrollment LE
BoSY Date:
TOTAL 30
BoSY Date: EoSY Date:

Generated th
Generated on: Saturday, August 7, 2021
 T/I
Modular
DATE:2020-
Digital
10-05

rrect:

ARK ROMERO MARTINEZ

e of School Head over Printed Name)

EoSY Date:

Generated thru LIS