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    Annex 2 - Modified ALS AF2

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    mrsiena014

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    © All Rights Reserved
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    Annex 2 - Modified ALS AF2

    Uploaded by

    mrsiena014
    10 views2 pages

    Original Title

    Annex-2_Modified-ALS-AF2

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    Download as docx, pdf, or txt
    10 views2 pages

    Annex 2 - Modified ALS AF2

    Uploaded by

    mrsiena014

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    ANNEX 2

    AF2
    Republic of the Philippines
    Department of Education
    ALTERNATIVE LEARNING SYSTEM
    MODIFIED ALS ENROLLMENT FORM
    (AF2) Learner's Basic Profile

    Date LRN (if available)

    Personal Information (Part I)

    Last Name First Name Middle Name Name Extension

    Not for Sale


    CURRENT ADDRESS
    House No./Street/Sitio Barangay Municipality/City Province

    PERMANENT ADDRESS Same with your Current Address? □ Yes □ No


    House No./Street/Sitio Barangay Municipality/City Province

    Birthdate (mm/dd/yyyy) Sex Place of Birth (Municipality/City) Civil Status


    / /
    □ Male □ Single □ Separated □ Solo Parent
    □ Female □ Married □ Widow/er
    Religion IP (Specify ethnic group) : Mother Tongue Contact Number/s

    PWD □ Yes □ No
    If Yes, specify the type of disability:
    □ Autism Spectrum Disorder □ Hearing Impairment □ Learning Disability □ Physical Disability
    □ Intellectual Disability □ Visual Impairment □ Multiple Disabilities □ Others

    Is your family a beneficiary of 4Ps? □ Yes If Yes, write the 4Ps Household ID Number below
    □ No

    Name of Father/Legal Guardian


    Last Name First Name Middle Name Occupation

    Mother's Maiden Name


    Last Name First Name Middle Name Occupation

    Educational information (Part II)

    Last grade level completed (Check only if applicable)


    Elementary Junior High School Senior High School
    □ Kinder □ □
    Grade 1 □
    Grade 3 Grade 5 Grade 7□ □
    Grade 9 □ Grade 11
    □ Grade 2 □ Grade 4 □ Grade 6 □ Grade 8 □ Grade 10

    Why did you not attend/complete schooling? (For OSY only) Have you attended ALS learning sessions before? Yes □ □ No
    □ No school in Barangay If Yes, check the appropriate program:
    □ School too far from home □Basic Literacy □
    A&E Secondary
    □ Needed to help family □ A&E Elementary □ ALS SHS
    □ Unable to pay for miscellaneous and other expenses
    Others: Have you completed the program? □ Yes □ No
    If No, state the reason:
    What learning Modality/ies do you prefer? Choose all that apply.
    □ Modular (Print) □
    Online □ Radio-Based Instruction □ Face to Face
    □ Modular (Digital) □ Educational TV □ Blended
    Accessibility and Availability of CLC (Part III)

    How far is it from your home to your Learning Center? in kms in hours and mins.
    How do you get from your home to your Learning Center? □ Walking □ Motorcycle □ Bicycle □ Others (Pls. specify)
    When can you attend your Learning Session?
    Monday Tuesday Wednesday Thursday Friday Saturday Sunday
    What specific time
    can you be at
    your Learning
    Center?

    Not for Sale


    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.

    ALS Teacher/Community ALS Implementor/Learning Facilitator: Signature and Date Learner: Signature and Date

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