REGINO MERCADO NIGHT HIGH SCHOOL

Panganiban Street, Cebu City

School ID: 303154

INDIVIDUAL REGISTRATION FORM GRADE

DATA PROCESSING:
BASIC PROFILE One letter per box

Learner Reference Number (LRN): ` Date of Registration:

FAMILY NAME

FIRST NAME ____________________________

MIDDLE NAME Registration In - Charge

DATE OF BIRTH GENDER

m m d d y y y y (M/F)
Date of Entrance:

ADDRESS:
STATUS Other Details: ____________________________
Regular Mother Tongue: 4Ps Class Adviser

Transferee Religion: Ips

Balik - Aral Ethnicity: ECD Date Enrolled in L.I.S.

Repeater Dialect: PWD

____________________________
ENROLMENT PROFILE L.I.S. In - Charge

Previous Enrolment Remarks:

School ID No.: Grade Level: PWD State below:

Name of School:

Name of Adviser:
PARENT'S/GUARDIAN INFORMATION Documents Submitted:
Birth Certificate
Father's Name NSO Copy

FAMILY NAME: LCR Copy

FIRST NAME: DepED Form 137

MIDDLE NAME: DepED Form 138

Good Moral Cert.

Mother's Maiden Name Clearance

FAMILY NAME:

FIRST NAME:

MIDDLE NAME: Other Notes:

 REGINO MERCADO NIGHT HIGH SCHOOL
Panganiban Street, Cebu City
School ID: 303154

Guardian's Name

FAMILY NAME:

FIRST NAME:

MIDDLE NAME:

RELATIONSHIP: