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    Form For Lis

    Uploaded by

    Welmar Mendoza

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Form For Lis

    Uploaded by

    Welmar Mendoza
    18 views1 page

    Original Title

    FORM FOR LIS

    Copyright

    © © All Rights Reserved

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    Copyright:

    © All Rights Reserved
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    Download as docx, pdf, or txt
    18 views1 page

    Form For Lis

    Uploaded by

    Welmar Mendoza

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    Please fill in with the correct information and Please fill in with the correct information and

    submit to the office ASAP for LIA Encoding submit to the office ASAP for LIA Encoding

    GRADE/STRAND: _________________________ GRADE/STRAND: _________________________


    PREVIOUS SCHOOL: _______________________ PREVIOUS SCHOOL: _______________________
    (For TRANSFEREE ONLY) (For TRANSFEREE ONLY)
    IRREGULAR: (YES/NO) IRREGULAR: (YES/NO)
    LRN: ___________________________________ LRN: ___________________________________
    Last Name_______________________________ Last Name_______________________________
    First Name: ______________________________ First Name: ______________________________
    Middle Name: ____________________________ Middle Name: ____________________________
    Birth Date: _______________________________ Birth Date: _______________________________
    Gender: _________________________________ Gender: _________________________________
    Date of first Attendance: ____________________ Date of first Attendance: ____________________

    Guardian Guardian
    Last Name________________________________ Last Name________________________________
    First Name: _______________________________ First Name: _______________________________
    Middle Name: _____________________________ Middle Name: _____________________________
    Extension Name: ___________________________ Extension Name: ___________________________
    Relationship: ______________________________ Relationship: ______________________________

    Mother’s Maiden Name Mother’s Maiden Name


    Last Name_________________________________ Last Name_________________________________
    First Name: ________________________________ First Name: ________________________________
    Middle Name: ______________________________ Middle Name: ______________________________

    Father’s Name Father’s Name


    Last Name_________________________________ Last Name_________________________________
    First Name: ________________________________ First Name: ________________________________
    Middle Name: ______________________________ Middle Name: ______________________________

    Is the learner a member of IP Community? _______ Is the learner a member of IP Community? _______
    Mother Tongue: ____________________________ Mother Tongue: ____________________________
    Other Spoken Languages: ____________________ Other Spoken Languages: ____________________
    Religion: __________________________________ Religion: __________________________________

    Residence Residence
    Province: __________________________________ Province: __________________________________
    City/Municipality: ___________________________ City/Municipality: ___________________________
    Barangay: _________________________________ Barangay: _________________________________

    Prepared by: Prepared by:


    ____________________________ ____________________________
    Name and Signature of Adviser Name and Signature of Adviser

    Noted By: Noted By:

    GLADY E. PAGUNSAN, PhD GLADY E. PAGUNSAN, PhD


    HT-III, OIC Asst. Principal II, OLS HT-III, OIC Asst. Principal II, OLS

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