Enrollment Form SY 2022-2023

A.
Grade Level and School Information
A. 3
A2. Check the Returning A4. Grade A5. Last
Date of Enrollment A1. School appropriate (Balik Level to Grade Level
No. (YYYY/MM/DD) Level Year boxes only Aral) Enrol Completed
1 2022 8 22 Junior High 2022-2023 With LRN NO Grade 7 Grade 6
36
37
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42
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52
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FOR SE
A6. Last
School
Year A7. Last A10. A11. A13:
Complete School A8. School A9. School School School to A12. School A14.
d: Attended: ID: Address: Type: enrol in: School ID: Address Semester
2021 - 2022 STO. ROSARI
Public STO. ROSAR 314319 STO. ROSARIO, R.T. LIM, ZSP
2021-2022 STO. ROSARI
2021-2022 PRENZA I, Public STO. ROSAR 314319 STO. ROSARIO, R.T. LIM, ZSP
2021-2022 BONGAO, TPublic STO. ROSAR 314319 STO. ROSARIO, R.T. LIM, ZSP
B. Student Information
FOR SENIOR HIGH SCHOOL ONLY
B1. PSA Birth

Certificate No. (If
availale upon
A15. Track A16. Strand TVL Qualification enrolment)
IO, R.T. LIM, ZSP
IO, R.T. LIM, ZSP
IO, R.T. LIM, ZSP
IO, R.T. LIM, ZSP
IO, R.T. LIM, ZSP
IO, R.T. LIM, ZSP
IO, R.T. LIM, ZSP
IO, R.T. LIM, ZSP
IO, R.T. LIM, ZSP
IO, R.T. LIM, ZSP
IO, R.T. LIM, ZSP
IO, R.T. LIM, ZSP
IO, R.T. LIM, ZSP
IO, R.T. LIM, ZSP
IO, R.T. LIM, ZSP
IO, R.T. LIM, ZSP
IO, R.T. LIM, ZSP
IO, R.T. LIM, ZSP
IO, R.T. LIM, ZSP
IO, R.T. LIM, ZSP
IO, R.T. LIM, ZSP
IO, R.T. LIM, ZSP
IO, R.T. LIM, ZSP
IO, R.T. LIM, ZSP
IO, R.T. LIM, ZSP
IO, R.T. LIM, ZSP
IO, R.T. LIM, ZSP
IO, R.T. LIM, ZSP
IO, R.T. LIM, ZSP
IO, R.T. LIM, ZSP
IO, R.T. LIM, ZSP
IO, R.T. LIM, ZSP
IO, R.T. LIM, ZSP
IO, R.T. LIM, ZSP
IO, R.T. LIM, ZSP
ent Information
B2. Learner Reference Number

(LRN) B3. Last Name B4. First Name B5. Middle Name
125796150009 ABATAYO JEMAR RESABA
124814150026 ATSOY MARK ERIC LUMINGGAS
133011150001 DABALOS JAMES CLARION
125805150010 DAHUYA DAVE RODRIGUEZ
125803150003 DOMEN REMIER ROBEL
125803140042 DUHAYLUNGSOD REX FEROLINO
125803150006 FEROLIN ARNEL JHON DOMEN
125805150007 JUMALON JOVANIE SUMALPONG
196508140009 LEGIS JOHN CARLO
125805150008 LONTAYO LLOYD BULARON
125805150012 OTLANG CLOID SALIGA
125805140019 REMOLLO RIO ROSATASI
125803150037 EMBLAN KENE REBONANZA
125796150007 GALADLAS NATHANIEL JAICTIN
125803150014 REPAL NIK GABAYAN
196508150002 RODRGUEZ JOREN BUSTAMANTE
125789150064 TALLEDO JHONREY
125796130024 TORNANDIZO DEXTER DAVE TEVES
125806150011 ZAMOSA CRIS CANAO
125805150005 BARICUATRO JIMMER ABASTILLAS
125803130051 ALONDAN RODJANE DUNGGAS
125805150004 VELASCO JOEY HELARBE
196506150005 ABUEVA QUEENDILYN CRISTOBAL
196506150011 ARENOS DAISY PERATER
125803150006 BACOR KATHREEZE TUSING
196506150006 DEL ROSARIO CHIARA GAIL ROBLEDO
125803160031 HOMOC ANGEL OMBAC
125803120040 LUMIKAT ANGELA ENGUITO
125803150023 MARQUEZ PRINCESS KYLE PASIGNAHIN
196508150007 MARTINEZ JENELYN GAVIOLA
125805150024 MAUDE QUEEN CLYDE TARUC
125803150024 TALABE JELAICA LUMIKAT
125805150023 TARMAN ANGELMAY
125899150027 VILLEGAS CYRELLE ALUNDAN
125803150009 ZAMORA CHAROL BOLANDO
B10. Belong to
B6. Indigenous
Extension peoples (IP)
Name e.g. B9.1. B9.2. Community/Indige
Jr., III (if B7. Date of Birth Weight Height nous cultural
Applicable (Month/Day/Year) B8. Age B9. Sex (Kilos) (cm) Community
3 7 2010 12 Male 33 135 YES
3 1 2010 12 Male 30 141 YES
4 6 2010 12 Male 29 142 NO
10 22 2010 11 Male 45 130 NO
7 20 2010 12 Male 49 136 YES
8 2 2009 13 Male 71 151 YES
11 22 2009 13 Male 38 145 YES
6 8 2010 12 Male 41 128 NO
1 6 2009 13 Male 36 135 YES
1 16 2010 12 Male 45 141 NO
12 23 2009 12 Male 52 132 NO
7 1 2009 13 Male 47 131 NO
6 23 2009 13 Male 33 137 NO
10 7 2009 12 Male 32 138 YES
5 24 2010 12 Male 40 153 YES
5 20 2010 12 Male 50 130 NO
1 14 2010 12 Male 49 145 YES
12 13 2007 15 Male 64 154 NO
5 22 2010 12 Male 32 132 NO
10 25 2009 12 Male 39 129 NO
1 17 2005 17 Male 43 151 YES
5 10 2007 15 Male 45 150 NO
9 17 2010 12 Female 43 142 NO
12 26 2009 12 Female 47 147 NO
2 20 2010 12 Female 41 131 YES
8 12 2010 12 Female 42 149 NO
8 14 2010 12 Female 40 127 YES
11 16 2006 16 Female 38 146 YES
12 31 2008 13 Female 42 149 NO
2 21 2010 12 Female 50 132 NO
7 3 2010 12 Female 41 133 NO
9 6 2010 12 Female 42 129 YES
6 11 2009 13 Female 38 143 NO
11 12 2009 12 Female 42 147 NO
1 31 2010 12 Female 54 143 YES
For Learners with Special Educaiton Needs.
B14. Does the Learner have B16. Do you have any

special education needs? (i.E B15. If assistive technology
B12. physical, mental. Social yes, devices available at
B11. If Yes, Mother diability, mdical condition, please home? (i.e. screen
Specify: Tongue. B13. Religion giftedness, among others. specify: reader, Braille, DAISY)
SUBANEN CEBUANO CHRISTIANITY No
CEBUANO CHRISTIANITY No
Address:
B19. House B20.

B17. If yes B18. Email Number and Subdivision/Village/Z
please specify: Address: Street one B21. Barangay
PALMERA
STO. ROSARIO
STO. ROSARIO
TARUC
STO. ROSARIO
STO. ROSARIO
STO. ROSARIO
TARUC
STO. ROSARIO
TARUC
TARUC
TARUC
STO. ROSARIO
PALMERA
STO. ROSARIO
STO. ROSARIO
STO. ROSARIO
PALMERA
STO. ROSARIO
TARUC
STO. ROSARIO
TARUC
SAN ISIDRO
SAN ISIDRO
STO. ROSARIO
SAN ISIDRO
STO. ROSARIO
STO. ROSARIO
STO. ROSARIO
STO. ROSARIO
TARUC
STO. ROSARIO
TARUC
STO. ROSARIO
STO. ROSARIO
C. Parent/Guardian Information
Address: Father
C1. Fullname C2. Highest

(Last, First Name, Educational
B22. City/Municipality B23. Province B24. Region Middle Name) Attainment
R.T.LIM ZAMBOANGA SIBUGAY IX ABATAYO, JIMMY, Elementary level
R.T.LIM ZAMBOANGA SIBUGAY IX ATSOY, INACO JR Elementary level
R.T.LIM ZAMBOANGA SIBUGAY IX DABALOS, JIMMY, Elementary level
R.T.LIM ZAMBOANGA SIBUGAY IX DAHUYA, MELVENCElementary level
R.T.LIM ZAMBOANGA SIBUGAY IX DOMEN, REGIDOR, Elementary level
R.T.LIM ZAMBOANGA SIBUGAY IX DUHAYLUNGSOD, WHigh School Level
R.T.LIM ZAMBOANGA SIBUGAY IX FEROLIN, ARNEL, Elementary level
R.T.LIM ZAMBOANGA SIBUGAY IX JUMALON, FRANKLIElementary level
R.T.LIM ZAMBOANGA SIBUGAY IX MANOT, NOEL, TULElementary level
R.T.LIM ZAMBOANGA SIBUGAY IX LONTAYAO, GENIE After High School Education (College/
R.T.LIM ZAMBOANGA SIBUGAY IX OTLANG, JOSE, MARTIN
R.T.LIM ZAMBOANGA SIBUGAY IX REMOLLO, REGIE, AHigh School Level
R.T.LIM ZAMBOANGA SIBUGAY IX EMBLAN, CARLITO, High School Graduate
R.T.LIM ZAMBOANGA SIBUGAY IX Elementary level
R.T.LIM ZAMBOANGA SIBUGAY IX REPAL, MARIO, LU Elementary level
R.T.LIM ZAMBOANGA SIBUGAY IX RODRIGUES,JOMAR, LIMBAGA
R.T.LIM ZAMBOANGA SIBUGAY IX High School Level
R.T.LIM ZAMBOANGA SIBUGAY IX TORNANDIZO, JUMA Elementary level
R.T.LIM ZAMBOANGA SIBUGAY IX ZAMOSA, RONNIE, BASTIDA
R.T.LIM ZAMBOANGA SIBUGAY IX BARICUATRO, JERR Elementary Graduate
R.T.LIM ZAMBOANGA SIBUGAY IX ALONDAN, MARCELElementary level
TITAY ZAMBOANGA SIBUGAY IX High School Level
TITAY ZAMBOANGA SIBUGAY IX Elementary level
R.T.LIM ZAMBOANGA SIBUGAY IX High School Graduate
TITAY ZAMBOANGA SIBUGAY IX Elementary level
R.T.LIM ZAMBOANGA SIBUGAY IX
R.T.LIM ZAMBOANGA SIBUGAY IX After High School Education (College/
ation
Mother Guardian
C3. Contact C6. Contact

number/s number/s
(Cellphone/Teleph C4. Fullname C5. Highest (Cellphone/Teleph C7. Fullname
one)/email (Last, First Name, Educational one)/email (Last, First Name,
address Middle Name) Attainment address Middle Name)
RESABA, MARCOSAHigh School Level
LUMINGGAS, ARLY Elementary level
CLARION, ALIFE, G Elementary level
RODRIGUES, BABYLElementary level
ROBEL, MICHELLE, High School Level
FEROLINO, CHANDRHigh School Level
DOMEN, JUDILYN, Elementary level
SUMALPONG, ANALIHigh School Graduate
LEGIS, RESILLA, B Elementary level
gh School Education (College/P BULARON, MANANIN High School Level
SALIGA, RETSEL, BUSCATO
ROSATASI, LEONISAHigh School Level
hool Graduate REBONANZA, CRESEElementary level
GALADLAS, GRECHEN After High School Education (College/Post Grade) or Techincal/Vocational
GABAYAN, JOVELYNElementary level
BUSTAMANTE, IRENE, CASERES
TALLEDO, JENALYN High School Graduate
TEVES,RETCHEL, C Elementary level
CANAO, LUCENA, PAT
tary Graduate ABASTILLAS, MYRN Elementary level
DONGGAS, ESTRELLA Elementary level
High School Level
Elementary level
hool Graduate
High School Level
Elementary level
Elementary level
Elementary level
Elementary level
Elementary level
gh School Education (College/Post Grade) or Techi Elementary Graduate

D. Household Capacity and Access to distance learning.
Guardian
C9. Contact
number/s C.10 Kabilang ba
C8. Highest (Cellphone/Teleph ang inyong
Educational one)/email pamilya sa 4Ps ng D6. What distance learning modaility/ies do you prefer for your
Attainment address DSWD? applies.
Face to Face
Face to Face
Face to Face
Face to Face
Face to Face
Face to Face
Face to Face
Face to Face
Face to Face
Face to Face
Face to Face
Face to Face
Face to Face
de) or Techincal/Vocational Face to Face
Face to Face
Face to Face
Face to Face
Face to Face
Face to Face
Face to Face
Face to Face
Face to Face
Face to Face
Face to Face
Face to Face
Face to Face
Face to Face
Face to Face
Face to Face
Face to Face
Face to Face
Face to Face
Face to Face
Face to Face
Face to Face
s to distance learning.
E. Vaccination Status F. TRANSFEREE
daility/ies do you prefer for your child? Choose all that Vaccine
applies. Vaccinated Doze Name Yes/No If Yes
No YES
No YES
No YES
No YES
No YES
No YES
No YES
No YES
No YES
No YES
No YES
No YES
No YES
No YES
No YES
No YES
No YES
No YES
No YES
No YES
No YES
No YES
No YES
No YES
No YES
No YES
No YES
No YES
No YES
No YES
No YES
No YES
No YES
No YES
No YES
CREDENTIALS PRESENTED
REQUIRED GRADE 1 OTHER GRADE LEVELS
PSA Birth LCR Birth Brgy Kindergarten Portfolio

Certificate of SF 9 Assessment
Certificate Cert Certification Completion Certificate
Yes Yes
Yes Yes
Yes Yes
Yes Yes
Yes Yes
Yes Yes
Yes Yes
Yes Yes
Yes Yes
Yes Yes
Yes Yes
Yes Yes
Yes Yes
Yes Yes
Yes Yes
Yes Yes
Yes Yes
Yes Yes
Yes Yes
Yes Yes
Yes Yes
Yes Yes
Yes Yes
Yes Yes
Yes Yes
Yes Yes
Yes Yes
Yes Yes
Yes Yes
Yes Yes
Yes Yes
Yes Yes
Yes Yes
Yes Yes
Yes Yes
STATUS IN THE LIS HEALTH
Deworm
Select One below
(Leave blank for NO)
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Enrollment Form SY 2022-2023

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Enrollment Form SY 2022-2023

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A.

Grade Level and School Information

B1. PSA Birth

B2. Learner Reference Number

B14. Does the Learner have B16. Do you have any

B19. House B20.

C1. Fullname C2. Highest

C3. Contact C6. Contact

gh School Education (College/Post Grade) or Techi Elementary Graduate

PSA Birth LCR Birth Brgy Kindergarten Portfolio

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