List and code of Indicators under REMARK column Indicator
Code
Required Information
Indicator
Code
Required Information
BoSY
EoSY
Prepared by:
Certified Correct:
LRN
NAME (Last Name, First Name, Middle Name)
BIRTH Sex DATE (mm/ (M/F) dd/yy)
AGE as of 1st Friday of June (nos. of years as per last birthday)
ADDRESS BIRTH PLACE (Province)
MOTHER TONGUE
IP (Specify Ethnic Group)
NAME OF PARENTS
GUARDIAN (If not Parent) Contact Number (Parent /Guardian)
RELIGION House # / Street/Sitio/ Purok
Barangay
Municipality/ City
Province
Transferred Out T/O
Name of Public (P) Private (PR) School & Effectivity Date CCT Recipient
CCT
CCT Control/reference number & Effectivity Date
MALE
Transferred IN T/I Dropped DRP Late Enrollment LE
Name of Public (P) Private (PR) School & Effectivity Date Balik-Aral Reason and Effectivity Date Learner With Dissability Reason (Enrollment beyond 1st Friday of June) Accelarated
B/A LWD ACL
Name of school last attended & Year Specify Specify Level & Effectivity Data
FEMALE TOTAL
Father (1st name only if family name identical to learner)
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