Definition: is a process of removing ineligible learners from the masterlis

Submit to: Division Planning Officer, Schools Governance and Operatio

Note: Endorsement of School Head is required (signed and scanne

Present and Correct Enrollment

Region-Division School Name School ID

Region IV-A-Sta. Rosa City Aplaya Elementary School 108469

Region IV-A-Sta. Rosa City Aplaya Elementary School 108469
Aplaya Elementary School 108469
Aplaya Elementary School 108469
Aplaya Elementary School 108469
Aplaya Elementary School 108469
Aplaya Elementary School 108469
Aplaya Elementary School 108469
Aplaya Elementary School 108469

Teacher/ICT Coordinator
Requested by
Sheena Joy L. Ynion
Position/Designation School LIS Coordinator
Note for school:
1. Fill-up the form correctly and completely
2. Attach this form as Excel file.
3. Attach a scanned copy of the form with School Head signa
4. Attach the following copies:
a. Birth Certificate
b. Form 137/School Form 10 and/or Form 138/School For
5. Encode the correct codes
6. If system error, provide screenshot

Note for Division Planning Officer:

1. Consolidate requests by school by issue
earners from the masterlist.
Governance and Operations Division
quired (signed and scanned). Please use worksheet/excel format for the matrix.

ect Enrollment

Date of First Attendance

Grade Section LRN
(MM/DD/YYYY)

1 Makopa 8/22/2022 108469210147

1 Mansanas 8/22/2022 108469210215
1 Mansanas 8/22/2022 108469210217
1 Mansanas 8/22/2022 108469210224
1 Mansanas 8/22/2022 108469170069
1 Mansanas 8/22/2022 108469210216
1 Mansanas 8/22/2022 107900200059
1 Mansanas 8/22/2022 108469210191
4 Venus 8/22/2022 108469180136

dinator School's Email Address

108469@deped.gov.ph
mpletely

m with School Head signature

d/or Form 138/School Form 9

by issue
 ICTS - User Support Division
Learner Information System (LIS) and Basic Education Information
National Helpdesk
Unenrollment of Learner (Request Form 09)

Learner's Personal Information

First Name Middle Name Last Name

AKCEL JONROZ ALMAZAR

ADRIAN ZAMOCO GALICIA
JHAYWARD ZAMOCO GALICIA
JAN DENVER VEGA PALINES
CYRUZ DANIELLE TORRES GERONIMO
CINDY ZAMOCO GALICIA
MARY JANE SOROÑO SANIPA
ARABELLA TOBIAS TANCHICO
DANICA ANN MANUEL GALON

School's Contact Number School Head/System Admin Username

guadzfactoriza
er Support Division
d Basic Education Information System (BEIS)
nal Helpdesk
earner (Request Form 09)

Date of Birth
Ext Name Sex Region-Division
(MM/DD/YYYY)

7/30/2010 Male Region IV-A-Sta. Rosa City

4/22/2015 Male Region IV-A-Sta. Rosa City
8/2/2013 Male Region IV-A-Sta. Rosa City
2/7/2016 Male Region IV-A-Sta. Rosa City
7/22/2010 Male Region IV-A-Sta. Rosa City
7/22/2015 Female Region IV-A-Sta. Rosa City
10/28/2015 Female Region IV-A-Sta. Rosa City
4/5/2016 Female Region IV-A-Sta. Rosa City
2/19/2012 Female Region IV-A-Sta. Rosa City

Date Requested Endorsed by Signature

4/3/2023 School Head Name GUADALUPE R. FACTORIZA
 Unenrolled From

School Name School ID Grade Section School Year

Aplaya Elementary School 108469 1 Makopa 2022-2023

Aplaya Elementary School 108469 1 Mansanas 2022-2023
Aplaya Elementary School 108469 1 Mansanas 2022-2023
Aplaya Elementary School 108469 1 Mansanas 2022-2023
Aplaya Elementary School 108469 1 Mansanas 2022-2023
Aplaya Elementary School 108469 1 Mansanas 2022-2023
Aplaya Elementary School 108469 1 Mansanas 2022-2023
Aplaya Elementary School 108469 1 Mansanas 2022-2023
Aplaya Elementary School 108469 4 Venus 2022-2023

ACTORIZA
 Reason for Unenrollment

1. Incorrect Grade Level (SHS)

2. 1st Sem Declined
3. Multiple Enrollment
4. Mistakenly Enrolled If Others, please
For SHS 5. No Appearance Since BOSY specify:
(Semester) 6. System Error
7. PEPT/ALS Passer
8.Tagging of Temporary Enrollment
9. Others

5. No Appearance since BOSY

5. No Appearance since BOSY
5. No Appearance since BOSY
5. No Appearance since BOSY
5. No Appearance since BOSY
5. No Appearance since BOSY
5. No Appearance since BOSY
5. No Appearance since BOSY
4. Mistakenly enrolled