08/06/2020
SAN ANTONIO ELEMENTARY SCHOOL (121332) Online Registration for SY 2020-2021 (June 1-30, 2020)
For incoming Regular Elementary Pupils, Balik-Aral, and Transferees for SY 2020-2021
* Required
A1. SCHOOL YEAR *
Your answer
A2. Check the appropriate box only: *
With LRN
No LRN
A3. RETURNING (Balik-Aral) *
Yes
No
A4. Grade Level to Enroll: *
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
A5. Grade level completed: *
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
A6. Last School Year attended: *
Your answer
A7. Last School attended: *
Your answer
A8. School ID (A7) *
Your answer
A9. School Address last attended: *
Your answer
A10. School Type: *
Public
Private
A11. School to Enroll in: *
Your answer
A12. School ID: *
Your answer
A13. School Address to enroll in: *
Your answer
B1. PSA Birth Certificate Number (if applicable upon enrolment) *
Your answer
B2. Learner's Reference Number (LRN): *
Your answer
B3. Last Name: *
Your answer
B4. First Name: *
Your answer
B5. Middle Name:
Your answer
B6. Extension Name e.g. Jr., I, II, III (if applicable)
Your answer
B7. Date of Birth (Month/Day/Year) *
Your answer
B8. Age:
Your answer
B9. S*x
Female
Male
B10. Belonging to Indigenous Peoples Community/Indigenous Cultural Community
Yes
No
B11. If Yes, please specify:
Your answer
B12. Mother Tongue:
Your answer
B13. Religion:
Your answer
B14. Does the learner have special education needs?
Yes
No
B15. If Yes, please specify
Your answer
B16. Do you have any assistive technology devices available at home? e.g. screen reader, Braille, DAISY)
Yes
No
B17. If Yes, please specify
Your answer
B18. Address (House Number & Street, Barangay, City or Municipality, Province, Region) *
Your answer
C1. Father' Full Name (Surname, First Name, Middle Name)
Your answer
C2. Father' Highest Educational Attainment
Elementary Graduate
High School Graduate
College Graduate
Vocational
Master's/Doctorate Degree
Did not attend school
C3. Father' Employment Status
Full time
Part time
Self-employed
Unemployed due to ECQ
Not working
C4. Working from Home due to ECQ
Yes
No
C5. Father' Contact Number (Cellphone/Telephone)
Your answer
C6. Mother's Full Name (Surname, First Name, Middle Name)
Your answer
C7. Mother's Highest Educational Attainment:
Elementary Graduate
High School Graduate
College Graduate
Vocational
Master's/Doctorate Degree
Did not attend school
C8. Mother' Employment Status
Full time
Part time
Self-employed
Unemployed due to ECQ
Not working
C9. Working from Home due to ECQ
Yes
No
C10. Mother's Contact Number
Your answer
C11. Guardian' Full Name
Your answer
C12. Guardian's Contact Number
Your answer
D1. How does your child go to school? Choose all that applies.
Walking
Public commute (land/water)
Family-owned vehicle
School service
D2. How many of your household members (including the enrollee) are studying in School Year 2020-2021? Please specify each.
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Other:
D3. Who among the household members can provide instructional support to the child's learning? Choose all that applies.
Parents/Guardians
Elder siblings
Grandparents
Extended members of the family
Others (tutor, house helper)
None
Able to do independent learning
D4. What devices are available at home that the learner can use for learning? Check all that applies. *
Cable TV
Non-cable TV
Basic cellphone
Smartphone
Tablet
Radio
Desktop computer
Laptop
None
Other:
D5. Do you have a way to connect to the internet?
Yes
No (If No, proceed to D7)
D6. How do you connect to the internet? Choose all that applies.
Own mobile data
Own broadband internet (DSL, wireless fiber, satellite)
Computer shop
Other places outside the home with internet connection (library, barangay/municipal hall, neighbor, relatives)
None
D7. What distance learning modality/ies do you prefer for your child? Choose all that applies. *
Online learning
Television
Radio
Modular learning
Combination of Face to Face with other modalities
Other:
D8. What are the challenges that may affect your child's learning process through distance education? Choose all that applies.
Lack of available gadgets/equipment
Insufficient load/data allowance
Unstable mobile/internet connection
Existing health conditions
Difficulty in independent learning
Conflict with other activities (house chores)
High electrical consumption
Distractions (social media, noise from community/neighbors)
Other:
I hereby certify that the above informations given are true and correct to the best of my knowledge and I allow the Department of Eduacation to use my child's details to create and/or update his/her learner profile in the Learner Information System. The information herein shall be treated as confidential in compliance with the Data Privacy Act of 2012. *
Agree
Disagree
Date of Filing:
Date
Submit
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