Republic of the Philippines

Department of Education
Caraga Region
SCHOOLS DIVISION OF SURIGAO DEL SUR

REQUEST FOR LEARNER INFORMATION SYSTEM (LIS) DATA CORRECTION

FOR SCHOOL YEAR 2020-2021

Date Requested: October 29, 2021

School: Libas Sud Integrated School District: San Miguel 1

Name of School Head: Joanne S. Espinosa School ID: 500576
Name of Requesting Personnel: Liezel D. Intas Contact Number: 09510269113
Position/ Designation: Teacher II / LIS Coordinator

Please check the type of data correction(s) needed:

_____ Correction of Learner Profile _____ Correction of LRN
_____ Correction of Grade Level _____ Request for Unenroll
_____ Correction of 1 Date of Attendance for Transfer-In
st
_____ Deactivation of LRN
_____ LRN Approval _____ Enrolment of Ineligible
__√__ Enrolment of w/ Gap

Please state the nature of request.

1. Naul, Joselito M. – 500576180067 Enrolment w/ gap (see attached SF 10 and Birth Certificate)
Last School Year attended 2019-2020 Retained

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Date Received in the Division Planning Office: ______________
Date Resolved: ______________________

Ways to Resolve (From the Division LIS Coordinator)

Please confirm my request.

Balilahan, Mabua, Tandag City, Surigao del Sur, 8300

(086) 211-3225
surigaodelsur.division@deped.gov.ph
ISO Cert. No. AW/PH909100102