AF2 Republic of the Philippines

Department of Education
ALTERNATIVE LEARNING SYSTEM
ALS ENROLMENT FORM (AF2)
Learner’s Basic Profile
Date : 6/1/2022___________ LRN (if available) : _____

Personal Information (Part I)

____________________
Isuga ____________________
Danica Jones ____________________
Somo ____________________
Last Name First Name Middle Name Name Extension

● Address: 87 Mindanao Avenue

______________________ Bagong Pag asa
__________________ Quezon City
___________________ Quezon City
__________________
House No./Street/Sitio Barangay Municipality Province

● Birthdate (mm/dd/yyyy): 8/16/1992

__________ Tapaz,Capiz
Place of Birth (Municipality/City) ___________________

Female
● Sex: __________ Civil Status: SIngle
________________

● Religion: Catholic
___________________ IP (Specify ethnic group): _____________ Mother Tongue: Tagalog/English
______________ No
PWD: __________

● Contact Number/s: 09197741804

______________ No
4Ps: __________

● Name of Father/Legal Guardian

Isuga
_______________________ Joel
_____________________ Labosana
_____________________ Isuga
__________________
Last Name First Name Middle Name Occupation
● Mother’s Maiden Name
Somo
_______________________ Josephine
_____________________ Villaruz
_____________________ Somo
_____________________
Last Name First Name Middle Name Occupation

Educational Information (Part II)

● Last grade level completed G-8

Elementary : K G-1 G-2 G-3 G-4 G-5 G-6

Junior High School : G-7 G-8 G-9 G-10

Senior High School: G-11

● Why did you drop out of school? (For OSY only) Needed to help family
No school in Barangay Schol too far from home Needed to help family
Unable to pay miscellaneous and other expenses Others: ___________________________________________________

● Have you attended ALS learning sessions before? YES NO

If Yes:
Name of the Program: Level of Literacy: Basic Elem. JHS SHS InfEd
Year Attended: Have you completed the Program? (Yes/No)
If NO, state the reason:
● What learning modalities do you prefer? Choose all that applies. Online Television Radio Modular Learning
Online Combination of face to face with other modalities Others:

Accessibility and Availability (Part III)

● How far is it from home to your learning center? 2 hrs ________________ in kms ___________ in hours and mins.
● How do you get from your learning center? Walking Walking Motorcycle Bicycle Others (Pls. Specify)
●When can you attend your Learning Session? Monday

What specific time Monday Tuesday Wednesday Thursday Friday Saturday Sunday
can you be at your
Learning Center?

9:00:00 AM

Barangay Pag-asa/Mam Abay Dicatanongan Danica Jones S.Isuga

ALS Teacher/Community ALS Implementer/Learning Facilitator: Signature and Date Learner: Signature and Date

SFRT 2017