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LIS Request Form

This document is a form from the Department of Education requesting changes to learner records in their database. It includes fields to provide information about the learner whose record requires updating, the type of change requested such as correcting their enrollment status or issuing a new Learner Reference Number, and spaces for signatures to approve or deny the request.

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335 views1 page

LIS Request Form

This document is a form from the Department of Education requesting changes to learner records in their database. It includes fields to provide information about the learner whose record requires updating, the type of change requested such as correcting their enrollment status or issuing a new Learner Reference Number, and spaces for signatures to approve or deny the request.

Uploaded by

ivonne
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Republic of the Philippines

Department of Education
– Planning Unit
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 (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:
Reason for the correction:
Reasons for not having LRN:
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
School year last attended:
REMARKS/ACTION TAKEN
School last attended:
Country:
5. From ALS
Certification/Accreditation/Equivalency Exam: Date Acted:

a. PEPT Certificate no. _


Received/Acted by:
b. PVT Certificate no. _
6. Others (pls specify)
XYZA C. ZINGAPAN
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
Doc Code: FM-SGO-PLA-001 Rev: 00
Email Address: As of: July 2, 2018 Page: 1

Website:

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