BASIC EDUCATION ENROLMENT FORM

THIS FORM IS NOT FOR SALE

Check the appropriate box only:
School Year - No LRN With LRN Returning (Balik-Aral)

INSTRUCTIONS: Print legibly all information required in CAPITAL letters. Submit accomplished form to the Person-in-
Charge/Registrar/Class Adviser. Use black or blue pen only.

STUDENT INFORMATION
PSA Birth Certificate No. ________________________
Learner Reference No. (LRN)

LAST NAME

FIRST NAME

MIDDLE NAME
EXTENSION NAME e.g. Jr., III (if applicable) ___________________
DATE OF BIRTH / / SEX MALE FEMALE AGE _____
(Month/Day/Year)

Belonging to any Indigenous People (IP) No Yes If Yes, please specify: ____________________
Community/Indigenous Cultural Community?

Mother Tongue ___________________________________________

ADDRESS
House Number and Street
______________________________________________________________________________________________________________________________________
Barangay
______________________________________________________________________________________________________________________________________
City/Municipality/Province/Country

_____________________________________________________________________________________________ Zip Code

PARENT’S/GUARDIAN’S INFORMATION
Father’s Name (Last Name, First Name, Middle Name) Mother’s Name (Last Name, First Name, Middle Name)
_______________________________________________________________ _______________________________________________________________
Guardian’s Name (Last Name, First Name, Middle Name)
_______________________________________________________________

Telephone No. _________________________________ Cellphone No. ________________________________

For Returning Learners (Balik-Aral) and Those Who Shall Transfer/Move In
Last Grade Level Completed _____________________ Last School Year Completed _____________________
School Name ____________________________________________________ School ID
School Address _________________________________________________________________________________

For Learners in Senior High School

Semester 1st Sem 2nd Sem
Track ______________________ Strand (if any) _____________________________________________________

I hereby certify that the above information given are true and correct to the best of my knowledge and I
allow the Department of Education to use my child’s details to create and/or update his/her learner profile in the
Learner Information System. The information herein shall be treated as confidential in compliance with the Data
Privacy Act of 2012.
___________________________________________________ ________________________________
Signature Over Printed Name of Parent/Guardian Date

For use of DepEd Personnel Only. To be filled up by the Class Adviser.

DATE OF FIRST ATTENDANCE / /

(Month/Day/Year)

Grade Level __________________________________ Track (for SHS) _______________________

AFFIDAVIT OF UNDERTAKING
I, ______________________________________________________________ of legal age, a resident of
Name of Parent/Guardian

________________________________________________________________________________________________________________
Address

and the parent/guardian of ______________________________________________________________

Name of Learner

Hereby signs this document freely and with full understanding of its contents.

The present circumstances are:

1. I choose to enroll my child at ___________________________________________________.
Name of School
2. I certify that my child was previously enrolled at ____________________________________
Name of Previous School
and passed the grade level of _____________.
3. Due to ____________________________________________, I cannot submit the transfer
credentials of my child to this school.
4. I understand that my child shall be temporarily enrolled because I have not submitted the
required credentials.

With these circumstances, I undertake to:

1. Do what is legally permissible for the release of the credentials of my child from the
previous school.
2. Submit the transfer credentials of my child on or before ___________________________.
3. I agree that the official record from this school shall only be released until the submission of
school credentials from the previous school.
4. I understand that the school shall only issue a temporary progress report card signed by the
adviser to monitor the progress of my child and that it is inadmissible for transfer and
enrolment purposes.

Without the transfer credentials of my child I fully understand that:

1. My child is only temporarily enrolled.
2. My child cannot be officially promoted to a higher grade level.
3. My child cannot officially graduate from this school.
4. Should my child attain the qualifying average and other criteria for academic honors, he/she
will not be recognized.

With all the foregoing, I shall hold free from any liability, whether civil or administrative, DepEd
Personnel who are involved in the acceptance and enrollment of my child, and the enforcement of any
law or rule and the obligations provided in this document.

Attested this ____ day of ______________ at ___________________.

_____________________________________________________
Signature Over Printed Name of Parent/Guardian

Gov’t ID Presented: _______________

ID Number: _____________________
Date Issued: _____________________
 TEMPORARY PROGRESS REPORT CARD FOR JHS

Learner Reference No. (LRN)

Name: _____________________________________ Date of Birth: ___________________ Age: ___

Sex: _____ Grade: _____ Section: ____________________ School Year: _____________________

Dear Parent/Guardian:
Your child is only temporarily enrolled due to deficiencies in submission of documentary requirements. As such, your child will
not be issued an official progress report card. This temporary progress report card is issued only to monitor the progress of your child.
Official academic records shall not be released by this school until submission of the required documents (SF 10 formerly Form 137 /
School Permanent Record) from the previous school. This temporary progress report card is inadmissible for transfer and enrollment
purposes.

REPORT ON LEARNING PROGRESS AND ACHIEVEMENT REPORT ON LEARNER’S OBSERVED VALUES

Quarter Final Quarter
Learning Areas Remarks Core Values Behavior Statements
1 2 3 4 Grade 1 2 3 4
Expresses one’s spiritual beliefs
Filipino
while respecting the spiritual
English 1. Maka-Diyos beliefs of others.
Mathematics Shows adherences to ethical
principles by upholding truth.
Science Is sensitive to individual, social,
Araling Panlipunan (AP) and cultural differences.
2. Makatao
Demonstrates contributions
Edukasyon sa
toward solidarity.
Pagpapakatao (EsP)
Cares for the environment and
Technology & Livelihood
3. Makakalikasan utilizes resources wisely,
Education (TLE)
judiciously, and economically.
MAPEH Demonstrates pride in being a
Music Filipino, exercises and
responsibilities of a Filipino
Arts citizen.
PE 4. Makabansa
Demonstrates appropriate
Health behavior in carrying out activities
in the school, community and
country.

General Average

Descriptors Grading Scale Remarks Marking Non-numerical Rating

Outstanding 90-100 Passed AO Always Observed
Very Satisfactory 85-89 Passed SO Sometimes Observed
Satisfactory 80-84 Passed RO Rarely Observed
Fairly Satisfactory 75-79 Passed NO Not Observed
Did not meet expectations Below 75 Failed

REPORT ON LEARNER’S ATTENDANCE

June July Aug Sept Oct Nov Dec Jan Feb March April Total
No. of school days
No. of days present
No. of days absent

Reported by: __________________________________

Signature Over Printed Name of Class Adviser

To the Parent or Guardian:

Please carefully read the comments below on your child’s performance. Sign on the space provided to signify that
you have received this. We encourage you to consult with the Class Adviser for any concern.

QUARTER COMMENTS PARENT’S/GUARDIANS SIGNATURE

First
Second
Third
Fourth
 TEMPORARY PROGRESS REPORT CARD FOR SHS

Learner Reference No. (LRN)

Name: _____________________________________ Date of Birth: ___________________ Age: ___

Sex: _____ Grade: _____ Section: ____________________ School Year: _____________________

Dear Parent/Guardian:
Your child is only temporarily enrolled due to deficiencies in submission of documentary requirements. As such, your child will not be issued an
official progress report card. This temporary progress report card is issued only to monitor the progress of your child. Official academic records shall not be
released by this school until submission of the required documents (SF 10 formerly Form 137 / School Permanent Record) from the previous school. This
temporary progress report card is inadmissible for transfer and enrollment purposes.

REPORT ON LEARNING PROGRESS AND ACHIEVEMENT REPORT ON LEARNER’S OBSERVED VALUES

First Semester Quarter
Semester Core Values Behavior Statements
Quarter 1 2 3 4
Subjects Final Grade Expresses one’s spiritual beliefs while
1 2 respecting the spiritual beliefs of others.
1. Maka-Diyos
Core Subjects Shows adherences to ethical principles
by upholding truth.
Is sensitive to individual, social, and
cultural differences.
2. Makatao
Demonstrates contributions toward
solidarity.
Cares for the environment and utilizes
Applied and Specialized Subjects 3. Makakalikasan resources wisely, judiciously, and
economically.
Demonstrates pride in being a Filipino,
exercises and responsibilities of a
Filipino citizen.
4. Makabansa
Demonstrates appropriate behavior in
carrying out activities in the school,
General Average for the Semester community and country.
Second Semester
Marking Non-numerical Rating
Semester AO Always Observed
Quarter Final Grade
Subjects SO Sometimes Observed
1 2 RO Rarely Observed
Core Subjects NO Not Observed

Descriptors Grading Scale Remarks

Outstanding 90-100 Passed
Very Satisfactory 85-89 Passed
Satisfactory 80-84 Passed
Fairly Satisfactory 75-79 Passed
Did not meet expectations Below 75 Failed

Applied and Specialized Subjects

REPORT ON LEARNER’S ATTENDANCE
Nov

Total
Aug

Dec
Sep

Feb

Mar

Apr
Oct

Jan
Jul
Jun

No. of school
days
No. of days
General Average for the Semester present
No. of days
absent

Reported by: __________________________________

Signature Over Printed Name of Class Adviser

To the Parent or Guardian:

Please carefully read the comments below on your child’s performance. Sign on the space provided to signify that
you have received this. We encourage you to consult with the Class Adviser for any concern.
QUARTER COMMENTS PARENT’S/GUARDIANS SIGNATURE
First
Second
Third
Fourth