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Wilfredo Enrollment Form

This document contains a learner enrollment form for Wilfredo Mosendo Jr. for the 2020-2021 school year at Antonio V. Fruto Sr. National High School. It provides personal details about Wilfredo such as his birthdate, address, parents' names and contact information. It also notes that he will be in Grade 12 and lists the devices and internet access available to support his distance learning.

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Jeazel Mosendo
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0% found this document useful (0 votes)
37 views27 pages

Wilfredo Enrollment Form

This document contains a learner enrollment form for Wilfredo Mosendo Jr. for the 2020-2021 school year at Antonio V. Fruto Sr. National High School. It provides personal details about Wilfredo such as his birthdate, address, parents' names and contact information. It also notes that he will be in Grade 12 and lists the devices and internet access available to support his distance learning.

Uploaded by

Jeazel Mosendo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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A 1.

School Year Check the appropriate boxes only: Grade Level to Enroll:
2020-2021 With LRN Grade 12
Last Grade Level completed Last School Year completed:
Grade 11 2019-2020
Last School Attended: School ID
ANTONIO V. FRUTO SR. NATIONL HIGH SCHOOL 304221
School Address: School Type:
ANTONIO V. FRUTO SR. NATIONAL HIGH SCHOOL Public
School to enroll in: School ID:
ANTONIO V. FRUTO SR NATIONAL HIGH SCHOOL 304221
School Address: Semester: Track: Strand (if any):
CABAYANGAN BRAULIO E.DUJALI DAVAO DEL NORTE 1ST TVL SMAW
PSA Birth Certificate No.(if available upon enrollment) Learner Reference Number (LRN):
128625070025
Last Name: First Name: Middle Name: Extension Name e.g. Jr. III (if applicable) Date of Birth:
MOSENDO WILFREDO LIBOON JR. 9/9/1999
Age: Sex: Belonging to Indigenous People (IP) Community/Indigenous Cultural Community
20 MALE No
If yes, please specify: Mother Tongue: Religion:
ILONGGO ROMAN CATHOLIC
Does the learner have Special Education Needs/Disabilities? If yes, please specify:
No
Do you have any assistive technology devices available at home? (For learners with special needs/disabilities i.e. screen reade
If yes, please specify: Address (House Number & Street,Barangay,City/Municipality,Province)
PUROK-1 ANIBONGAN, CARMEN,DAVAO DEL NORTE
Father's Full Name: Highest Educational Attainment Employment Status
WILFREDO ESTOBO MOSENDO ELEMENTARY NOT EMPLOYED
Working from home due to ECQ? Contact Number(s): Mother's Full Name:
No ELSA SAMINIAN LIBOON
Highest Educational Attainment Employment Status Working from home due to ECQ?
HIGHSCHOOL GRADUATE NOT EMPLOYED No
Contact Number(s) Guardian's Full Name: Highest Educational Attainment Employment Status
JIMMY ESTOBO MOSENDO HIGH SCHOOL GRADUATE NOT EMPLOYED
Working from home due to ECQ? Contact Number(s): Is a recipient of the 4Ps?
No No
How does your child go to school? Choose all that applies. Kinder Grade 1 Grade 2 Grade 3
Family-owned vehicle 0 0 0 0
Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12
0 0 0 0 0 1 0 0 2
Others: (in college, vocational, etc.)
0
Who among the household members can provide instructional support to the child's distance learning? Choose all that applies
parents/guardians;elder siblings;extended members of the family
What devices are available at home that the learner can use for learning? Check all that applies.
smartphone;desktop computer
Do you have a way to connect to the internet?
Yes
How do you connect to the internet? (Choose all that applies)
PLDT fiber
What distance learning modality/modalities do you prefer for your child? Choose all that applies.
online learning;modular learning;
What are the challenges that may affect your child's learning process through distance education? Choose all that applies.

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