(This replaces Form 1, Master List & STS Form 2-Family Background and Profile)
School I.D.
School Name
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
LRN
MALE
1244071300
49
1244071400
96
1244071300
70
1244071300
05
1244071200
13
1243021000
10
1244071200
19
1244071201
78
1244071200
21
1244071400
93
1244071400
90
1244071200
26
1244071200
28
1244071200
08
124407
Region
IX
Division
LEARNERS NAME
(Last Name, First Name, Middle Name)
Sex
(M/F)
BIRTH DATE
(mm/dd/yy)
6-24-2006
9-05-2007
6-24-2007
3-30-2007
2-02-2007
11-07-2005
1-31-2007
6-13-2006
11-13-2006
11-02-2002
2-14-2007
6-20-2007
3-25-2007
6-08-2007
10-14-2003
9
8
8
8
8
8
9
9
13
8
8
8
8
8
FOUR (4)
LABASON
Section
Place of Birth
(Province)
MOTHER TONGUE
Bisaya
Christian
Tausog
Kalibugan
Bisaya
Christian
Bisaya
Christian
Bisaya
Christian
Bisaya
Christian
Bisaya
Christian
Bisaya
Subanen
Bisaya
Christian
Bisaya
Christian
Bisaya
Subanen
Bisaya
Subanen
Bisaya
Christian
Bisaya
Christian
Tuasog
Tausog
MARBLE
RELIGION
Catholic
Islam
Catholic
Catholic
Catholic
Catholic
Catholic
Subanen
Catholic
Catholic
Subanen
Subanen
Catholic
Catholic
FEMALE
1262100901
06
ARUBIN. AL-SHARIFA T.
12
Islam
1244071200
39
1244071302
3
89
1243111300
4
24
1244071300
5
63
1244071300
6
64
1244071302
7
94
1244071302
8
98
1244071200
9
60
1255981100
10
15
2
BANTILAN, CATHYRENE A.
CAMIN, MICHELLE JASMINE G.
7-27-2007
3-07-2007
DALUMPINAS, FLORDELYN L.
1-22-2006
7-25-2007
HERNANE, LIEZEL C.
8
8
9
8
10-23-2005
10
4-02-2006
12-12-2006
3-07-2007
10-08-2006
9
8
9
Bisaya
Christian
Bisaya
Christian
Bisaya
Christian
Bisaya
Christian
Bisaya
Christian
Bisaya
Christian
Bisaya
Christian
Bisaya
Christian
Bisaya
Christian
ADDRESS
18NAME
(Last Name, First Name, Middle Name)
House # /
Street/Sitio/
Purok
Catholic
Catholic
Alliance
Alliance
Catholic
Catholic
Catholic
Catholic
Catholic
Barangay
Municipality/City
Province
Mother
(Maiden)
Name
Relationship
Contact
Number
(Parent
/Guardian)
RE
MA
RK/
S
(Plea
se
refer
to the
legen
d on
last
page)
MALE
1
Antonino
Labason
Zambo. Norte
Wilfredo
Dabon
Aireene
Mother
BAN, RAYMUND E.
Antonino
Labason
Zambo. Norte
Rodel
Esmael
Kimlan
Mother
CAMPILAN, JHON H.
Antonino
Labason
Zambo. Norte
Felix
Hulwat
Wilma
Mother
CAMPILAN, LEONEL G.
Antonino
Labason
Zambo. Norte
Leonardo
Hulwat
Anita
Mother
DITCHE, JEFFREY G.
Antonino
Labason
Zambo. Norte
Jeron
Gumimao
Anna
Mother
CC
T
CC
T
CC
T
CC
T
CC
T
Antonino
Labason
Zambo. Norte
Vicente
Galeza
Marie
Milagrosa
GEISAR, GRAPIA T.
Antonino
Labason
Zambo. Norte
Cesar
Rabanal
Genelyn
JEMINO, ANTHONY A.
Antonino
List and code of Indicators under REMARK column
Labason
Zambo. Norte
Julito
Timanuno
Leilyn
9
10
11
12
Indicator
Code
Transferred Out
T/O
Required Information
LARGO, JASSEL S.
MAHUSAY, ERNESTO
JR. L.
LE
Reason (Enrollment beyond
Late Enrollment
13
ONIPA, CYRIL P.
14
GALILA, RICHMUN B.
Indicator
Code
Required Information
Antonino
Labason
CCT Recipient
CCT
Balik-Aral
B/A
Learner With
Disability
Accelarated
LWD
Specify
ACL
Antonino
Antonino
Labason
Labason
Zambo. Norte
Dante
BoSY
Zambo. Norte
EoSY
Jimmy
MALE
14
FEMALE
10
TOTAL
24
Zambo. Norte
Prepared by:
Carlito Sr.
Ernesto Sr.
Analane
Anita
Pague
Lorna
Mansanares
Lanie
Luis
Gina
Antonino
Labason
Zambo. Norte
Antonino
Labason
Zambo. Norte
Benjie
Pito
Richelle
Antonino
Labason
Zambo. Norte
Felizardo III
Bag-ao
Annalyn
Date:_____________________________
CC
T
CC
Mother
T
CC
Mother
T
Certified Correct:
CC
Mother
T
CHERRY C. AMPLAYO
CC
Mother
(Signature of School Head over Printed Name) T
CC
Mother
T
CC
Mother
Date:__________________________________ T
CC
Mother
T
CC
Mother
T
Mother
FEMALE
1
ARUBIN. AL-SHARIFA T.
Antonino
Labason
Zambo. Norte
Alding
Tequil
Maria
Mother
BANTILAN, CATHYRENE A.
Antonino
Labason
Zambo. Norte
Ranil
Antiquina
Charina
Mother
Antonino
Labason
Zambo. Norte
Rodolfo
Grucia
Marissa
Mother
DALUMPINAS, FLORDELYN L.
Antonino
Labason
Zambo. Norte
Danilo
Limatoc
Florencia
Mother
Antonino
Labason
Zambo. Norte
Richard
Cabug
Mary Ann
Mother
HERNANE, LIEZEL C.
Antonino
Labason
Zambo. Norte
Antonino
Labason
Zambo. Norte
Cutad
Pague
Nida
Virgie
Mother
Graciano
Romerico
MARAVILLAS, ELMARIE T.
Antonino
Labason
Zambo. Norte
Branlio
Taporco
Laura
Mother
Antonino
Labason
Zambo. Norte
PATOL, ANGELINE C.
Antonino
Labason
Zambo. Norte
Geromo
Camahalan
Eleana
Jolyvie
Mother
10
Reynaldo
Quilinao
Mother
Mother
CC
T
CC
T
CC
T
CC
T
CC
T
CC
T
CC
T
CC
T