Sunteți pe pagina 1din 2

Republic of the Philippines

Department of Education
Region II – Cagayan Valley
Schools Division of Cagayan
LIS CHANGE REQUEST AND ISSUANCE OF LRN FORM

Control Number: ___________________ Date:_______________________


CLIENT INFORMATION CHANGE REQUEST
Name:____________________________________ Enrolment with gap
Position/Designation:________________________ Reason/s for the gap (pls specify) ___________
School ID and Name:________________________ _________________________________________
Contact Number:___________________________ _________________________________________
E-mail address: ____________________________ Enrolment of ineligible
ISSUANCE OF NEW LRN Erroneously tag EOSY/no status
Name of the learner: ________________________
Correct status: _________________________
Section: __________________________________
Reasons for not having LRN: Reason for the correction:_________________
1. From accredited/recognized school _________________________________________
School year last attended: _________________ _________________________________________
School last attended: _____________________ Others (pls specify): ________________________
2. Undergone catch-up program and assessed _________________________________________
school readiness
_________________________________________
Result of the assessment: __________________
_________________________________________
_______________________________________
_________________________________________
3. From not accredited local school
Certification/Accreditation/Equivalency Exam:
a. PEPT Certificate no. _______________
(For Planning Officer’s use only)
b. PVT Certificate no. ________________
4. From foreign/Philippine school abroad Approved Disapproved
Last school year attended: _________________ REMARKS/ ACTION TAKEN
Last school attended: _____________________ _________________________________________
Country: _______________________________ _________________________________________
Date Acted: _______________________________________
5. From ALS
Certification/Accreditation/Equivalency Exam:
a. PEPT Certificate no. _________________ Received/Acted by:
b. PVT Certificate no. _________________
6. Others (pls specify) ___________________
Planning Officer III
___________________________________

Address: Regional Government Center, Carig Sur, Tuguegarao City, 3500


Telephone Nos.: PLDT (078) 377-1065; Globe Landline (078) 255-5317, (078) 255-5318
Email Address: sdo.cagayan@deped.gov.ph
Doc Code: FM-SGO-PLA-001 Rev: 00
Website: deped-sdocagayan.com.ph As of: July 2, 2018 Page: 1
Republic of the Philippines
Department of Education
Region II – Cagayan Valley
Schools Division of Cagayan

Address: Regional Government Center, Carig Sur, Tuguegarao City, 3500


Telephone Nos.: PLDT (078) 377-1065; Globe Landline (078) 255-5317, (078) 255-5318
Email Address: sdo.cagayan@deped.gov.ph
Doc Code: FM-SGO-PLA-001 Rev: 00
Website: deped-sdocagayan.com.ph As of: July 2, 2018 Page: 2

S-ar putea să vă placă și