Everyone is eligible to fill the Learner Enrollment Survey Form.
Grade Level to enroll
Last grade level completed
Last school year completed
Birth Certificate No
Learner Reference Number
Date of Birth
Does the learner have special education needs? (i.e. physical, mental, developmental disability, medical condition, giftedness, among others)
PARENT/ GUARDIAN INFORMATION
Highest Educational Attainment
How does your child go to school? Choose all that applies
What devices are available at home that the learner can use for learning? Check all that applies.
Do you have a way to connect to the internet?
How do you connect to the internet? Choose all that applies
What distance learning modality/ies do you prefer for your child? Choose all that applies
What are the challenges that may affect your child’s learning process through distance education? Choose all that applies
I hereby certify that the above information given are true and correct to the best of my knowledge and I allow the Department of Education to use my child’s details to create and/or update his/her learner profile in the Learner Information System