Annex A

Learner Information System (LIS) and Basic Education Information System (BEIS)
Division Helpdesk

School ID: 304270

Name of School: DAVAO DEL SUR SCHOOL OF FISHERIES

TYPE OF ENROLLMENT PENDING ISSUE DOCUMENTS ATTACHED

Learner's Personal Information
(Please Check) (Please Check)
Certificate of Rating
Correction of
Name of Learner Date of Birth Grade Enrolment Enrolment of Temporary Correction of Request for Birth SF10/ Form
LRN Currently used Sex Section Learner SF 9 ALS Portfolio
(Last Name, First Name, Middle Name) (MM/DD/YYYY) Level with Gap Ineligible Enrolment
Profile
Grade Level Disapproval Certificate 137
ALS A & E PEPT

129112110008 BETONIO, JOSIE COLLAMAR 09/11/2006 Female 11 GRADE 11- EYELIGHT FISH / /
129554100093
CODILLA,ERLIE LOUIE SUPATAN 05/26/2005 Male 11 GRADE 11- EYELIGHT FISH / /
136485120983 ROYA,ROYEL SASUMAN 11-28-2003 Male 11 GRADE 11- EYELIGHT FISH / /

Reported by: APRILYN J. LIMOSNERO Indorsed by: RAYKI A. BUAT, Ph.D. Remarks: (For Division Personnel)
Teacher/ICT Coordinator/SHS-LIS Coor. Designate Name and Signature of School Head

Note for school:

1. Consolidate requests by school by issue
2. Fill-up the form correctly and completely
3. Attach this form as Excel file.
4. Attach a scanned copy of the form with School Head signature
5. Attach the supporting documents accoding to the name listed in the request form
ATTACH HERE THE SCANNED Request Form
SIGNED BY THE SCHOOL HEAD
ATTACH HERE THE SCANNED DOCUMENTS
OF THE LEARNER
CUMENTS
ATTACH HERE THE SCANNED DOCUMENTS
OF THE LEARNER
CUMENTS