Republic of the Philippines

Department of Education
Ministry of Basic, Higher and Technical Education
ALTERNATIVE LEARNING SYSTEM

LEARNER'S PERMANENT RECORD (AF-5)

DISTRICT: DIVISION: REGION:

LEARNER'S INFORMATION LRN:__________________________

LAST NAME: FIRST NAME: _____________________ NAME EXTENSION: _____MIDDLE NAME: _______________
ADDRESS:
HOUSE NO./ SITIO / ST. BARANGAY MUNICIPALITY/CITY PROVINCE
BIRTHDATE: MONTH _____/ DATE__________ / YEAR______________ SEX: Male Female
PLACE OF BIRTH:

LEARNER'S EDUCATIONAL STATUS

Program Enrolled : Program Enrolled :
Delivery Mode : Delivery Mode :
CLC Name : CLC Name :
CLC Address : CLC Address :
Name of ALS Teacher/Community Name of ALS Teacher/Community
ALS Implementor/Learning Facilitator : ALS Implementor/Learning Facilitator :
School Year : School Year :
Score Score
ASSESSMENT RESULTS ASSESSMENT RESULTS
Pre Post Pre Post
PIS Score PIS Score
Assesment for Basic Literacy (ABL) Pre Post Assesment for Basic Literacy (ABL) Pre Post
Neo Literate Neo Literate
Post Literate Post Literate
Functional Literacy Assessment (FLT) Pre Post Functional Literacy Assessment (FLT) Pre Post
LS 1 - Communication Skills (English) LS 1 - Communication Skills (English)
Multiple Choice Multiple Choice
Writing Writing
Listening/Speaking Listening/Speaking
LS 1 - Communication Skills (Filipino) LS 1 - Communication Skills (Filipino)
Multiple Choice Multiple Choice
Pagsulat Pagsulat
Pakikinig/Pagsasalita Pakikinig/Pagsasalita
LS 2 - Scientific Literacy and Critical Thinking Skills LS 2 - Scientific Literacy and Critical Thinking Skills
LS 3 - Mathematical and Problem Solving Skills LS 3 - Mathematical and Problem Solving Skills
LS 4 - Life and Career Skills LS 4 - Life and Career Skills
LS 5 - Understanding the Self and Society LS 5 - Understanding the Self and Society
LS 6 - Digital Citizenship LS 6 - Digital Citizenship
Overall Score Overall Score
PRESENTATION PORTFOLIO ASSESSMENT Remarks PRESENTATION PORTFOLIO ASSESSMENT Remarks
Date of Assessment Date of Assessment
Presentation Portfolio Assessment Score Presentation Portfolio Assessment Score
Final Assessment Final Assessment
LS 1 - Communication Skills (English) LS 1 - Communication Skills (English)
LS 1 - Communication Skills (Filipino) LS 1 - Communication Skills (Filipino)
LS 2 - Scientific Literacy and Critical Thinking Skills LS 2 - Scientific Literacy and Critical Thinking Skills
LS 3 - Mathematical and Problem Solving Skills LS 3 - Mathematical and Problem Solving Skills
LS 4 - Life and Career Skills LS 4 - Life and Career Skills
LS 5 - Understanding the Self and Society LS 5 - Understanding the Self and Society
LS 6 - Digital Citizenship LS 6 - Digital Citizenship
TOTAL WORK SAMPLES RAW SCORE TOTAL WORK SAMPLES RAW SCORE
Inter-District Revalida Inter-District Revalida
Oral Reading (Total of Filipino and English Raw Scores) Oral Reading (Total of Filipino and English Raw Scores)
Writing (Total of Filipino and English Raw Scores) Writing (Total of Filipino and English Raw Scores)
Interview Interview
TOTAL INTER-DISTRICT REVALIDA RAW SCORE TOTAL INTER-DISTRICT REVALIDA RAW SCORE
Total Presentation Portfolio Assessment Raw Score Total Presentation Portfolio Assessment Raw Score
FINAL SCORE PERCENTAGE GRADE FINAL SCORE PERCENTAGE GRADE

Certificate of Transfer Certificate of Transfer

Eligible for Admission to : Eligible for Admission to :

Certificate of Good Moral Character Certificate of Good Moral Character

This is to certify that the above-named is a learner of good moral character. This is to certify that the above-named is a learner of good moral character.
This certification is issued upon request of the concerned individual due to This certification is issued upon request of the concerned individual due to
his/her desire to pursue formal schooling/other CLC or for employment. his/her desire to pursue formal schooling/other CLC or for employment.

Prepared By: Certified Correct By: Prepared By: Certified Correct By:

NUR-AISHAA. GONZALES
Division ALS Focal Person Division ALS Focal Person
ALS Teacher/Community ALS ALS Teacher/Community ALS
Implementor/Learning Facilitator Implementor/Learning Facilitator