Enclosure No. 3 to DepEd Order No. 4, s.

2012 Form 2B

SCHOOLPLAN TO ADDRESS NEEDS

Name of Elementary School _______________________

Division ________________________ Region ________________
Date Accomplished ________________________

YEAR LEVEL TENTATIVE ENROLMENT A.Additional Inputs Needed (In case theres shortage). (Please
indicate number only)
MALE FEMALE Classrooms Teachers Textbooks Seats
1 Grade 1
2 Grade 2
3 Grade 3
4 Grade 4
5 Grade 5
6 Grade 6
LEARNERS UNDER THE ADM/ALS TENTATIVE ENROLMENT B.Inputs Needs (In case theres sortage)

Teacher-Facilitator Modules

Age 6
Age 7
Age 8
Age 9
Age 10
Age 11
Age 12
C. Additional Inputs Needed (Please indicatenumber)
CATEGORIES OF DISABILIY TENTATIVE ENROLLMENT
Classrooms Teachers Textbooks Seats
Children with:
Visual Imparement
Hearing Imparement
Intellectual Disability
Learning Disability
Speech/language Imparement
Serious Emotional Disturbance
Autism
Orthopedic Imparement
Speech Health Problem
Multiple Disabilities
TOTAL:

D. Proposed Differentiated Program Intervention E. Assistance Needed

1. Formal Delivery System
2. ADMs/ALS:
3. Special Education in Inclusive Setting
Submitted by:
______________________________________________________
Name and signature of School Head

_______________________________________________________
Designation

Cellphonenumber ______________________________________
Email Address ______________________________________

Note: Please encode online the accomplished Form 2B at http://210.213.201.147/earlyreg/

Enclosure No. 2 to DepEd Order no. 4, s. 2012 FORM 1

DEPARTMENT OF EDUCATION
EARLY REGISTRATION FORM

School ID: ________________________________________ Region: ________________________

School Name: _______________________________________ Division: _________________________
School District: ____________________

Category of C/Y
WITH DISABILITY Remarks for Grade
SEX
No. NAME AGE BIRTHDATE ADDRESS (for children/youth 1*Registrants and
(M/F) with disabilities ALS**
only
Municipality/
Barangay City
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
M_____
F _____

Remarks:
1. "For Grade 1 Registrants - ATTENDED/NOT ATTENDED Kindergarten Class
2. **For ALS: Information whether the child/youth prefers to learn through:
ADM- alternative delivery mode (MIMOSA, e-IMPACT, DORP)
ALS- alternative learning system
Category C/Y with Disability***
VI - Visual Imparement SED - Serious Emotional Disturbance
HI - Hearing Imparement A- Autism
ID - Intellectual Disability OI - Orthopedic Imparement
LD - Learning Disability SHP - Special Health Problem
S/LI - Speech/LanguageImparement MD - Multiple Disabilities

Prepared by: Certified True & Correct

__________________________________ _____________________________________

Note: For School vopy only.No need to submit hardcopy to Division office
 REPUBLICOF THE PHILIPPINES
DEPARTMENT OF EDUCAION
REGION X
Zone 1, Upper Balulang, Cagayan de Oro City
Telephone No..: (088)880-7072,880-7071, Telefax (08822) 72-26-51, website:depedreg10.net

Template 1

DIVISION DATA ON TENTATIVE ENROLMENT OF LEARNERS

(Elementary Level)

TotalNumber of Elementary Schools

TotalNumber of Schools with Increased Enrolment

Variance (Tentative
Tentative Enrolment (2019-
Level Enrolment (2018-2019) Enrolment 2019-2020-
2020) Enrolment 2018-2019)

Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Total:

Prepared by:

_______________________________________
Division Planning Officer

Noted by:

__________________________________________
Schools Division Superintendent
 REPUBLICOF THE PHILIPPINES
DEPARTMENT OF EDUCAION
REGION X
Zone 1, Upper Balulang, Cagayan de Oro City
Telephone No..: (088)880-7072,880-7071, Telefax (08822) 72-26-51, website:depedreg10.net

Template 5

DIVISION DATA ON TENTATIVE ENROLMENT OF LEARNERS

(Special Education)

Variance (Tentative
Tentative Enrolment Enrolment
Category of Disability Enrolment (2018-2019) 2019-2020-
(2019-2020) Enrolment 2018-2019)

Children/Youth with:
Visual Imparement
Hearing Imparement
Intellectual Disability
Speech/language Imparement
Serious Emotional Disturbance
Autism
Orthopedic Imparement
Special Health Problems
Multiple Disabilities
TOTAL:

Prepared by:

_______________________________________
Division Planning Officer

Noted by:

__________________________________________
Schools Division Superintendent
 REPUBLICOF THE PHILIPPINES
DEPARTMENT OF EDUCAION
REGION X
Zone 1, Upper Balulang, Cagayan de Oro City
Telephone No..: (088)880-7072,880-7071, Telefax (08822) 72-26-51, website:depedreg10.net

Template 4

DIVISION DATA ON TENTATIVE ENROLMENT OF LEARNERS

(Special Education)

Variance (Tentative
Enrolment (2018-2019) Tentative Enrolment Enrolment
Age Level 2019-2020-
(2019-2020) Enrolment 2018-2019)

9
10
11
12 and above
TOTAL:

Prepared by:

_______________________________________
Division Planning Officer

Noted by:

__________________________________________
Schools Division Superintendent