Republic of the Philippines AF-5

Department of Education
ALTERNATIVE LEARNING SYSTEM

LEARNER'S PERMANENT RECORD (AF-5)

DISTRICT: DIVISION: REGION:

LEARNER'S INFORMATION LRN:________________________

LAST NAME: FIRST NAME: _____________________ NAME EXTENSION: ______ MIDDLE NAME: _____________________
ADDRESS:
HOUSE NO./ SITIO / ST. BARANGAY MUNICIPALITY/CITY PROVINCE

BIRTHDATE: MONTH _____/ DATE__________ / YEAR______________ SEX: Male Female

LEARNER'S EDUCATIONAL STATUS

Program Enrolled : Program Enrolled :
Delivery Mode : Delivery Mode :
CLC Name : CLC Name :
CLC Address : CLC Address :
Name of Facilitator : Name of Facilitator :
Calendar Year : Calendar Year :

Score Score
ASSESSMENT RESULTS ASSESSMENT RESULTS
Pre Post Pre Post
PIS Score PIS Score
Assesment for Basic Literacy (ABL) Pre Post Assesment for Basic Literacy (ABL) Pre Post
Basic Literate Basic Literate
Neo Literate Neo Literate
Post Literate Post Literate
Functional Literacy Assessment Pre Post Functional Literacy Assessment Pre Post
FLT Score in Reading FLT Score in Reading
FLT Score in Numeracy FLT Score in Numeracy
FLT Score in Writing FLT Score in Writing
FLT Score in Listening & Speaking FLT Score in Listening & Speaking
Overall Score 0 0 Overall Score 0 0
InfEd Remarks InfEd Remarks

A & E STATUS Remarks A & E STATUS Remarks

Program Status Program Status
Test Taken Test Taken
Date of Examination Date of Examination
Testing Center Testing Center
Location of Testing Center Location of Testing Center
Accreditation and Equivalency (A&E) Test Result Accreditation and Equivalency (A&E) Test Result

Certificate of Transfer Certificate of Transfer

Eligible for Admission to : Eligible for Admission to :

Certificate of Good Moral Character Certificate of Good Moral Character

This is to certify that the above-named is a learner of good moral character. This is to certify that the above-named is a learner of good moral character.
This certification is issued upon request of the concerned individual due to This certification is issued upon request of the concerned individual due to
his/her desire to pursue formal schooling/other CLC or for employment. his/her desire to pursue formal schooling/other CLC or for employment.

Prepared By: Certified Correct By: Prepared By: Certified Correct By:

Facilitator PSDS/District Coordinator/EPSA Facilitator PSDS/District Coordinator/EPSA