ALS Form 2-Enrollment Form
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This document is an enrollment form collecting personal information from a learner enrolling in an Alternative Learning System (ALS) program. It requests information such as name, address, birthdate, civil status, religion, ethnicity, highest level of education completed, reason for dropping out of school, prior ALS attendance, distance and travel time to the learning center, and available times for classes. The form is signed by both the learner and facilitating teacher.
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ALS Form 2-Enrollment Form
- 1. Date : : Last Name • Address: Barangay Province • Birthdate (mm/dd/yyyy): _____/_____/________ Place of Birth (Municipality/City) • Civil Status: • Religion: ____________• IP (Specify ethnic group) : ______________ • Mother Tongue : _______________ PWD: □Yes □No • Name of Father/Legal Guardian Last Name • Mother's Maiden Name Last Name Elementary : Secondary : □G-7 □G-8 □G-9 □G-10 • Why did you drop out of school? (For OSY only) □No school in Barangay □School too far from home □Needed to help family □Unable to pay for miscellaneous and other expenses Others: • Have you attended ALS learning sessions before? □YES □NO If Yes: Name of the Program: _____________________________________________ Level of Literacy: □Basic □Elem. □Sec. □InfEd Year Attended: ___________ Have you completed the Program? (Yes/No) _______ If NO, state the reason: • How far is it from your home to your Learning Center? • How do you get from your home to your Learning Center? • When can you attend your Learning Session? _______________________________________ _____________________________ Facilitator: Signature and Date Learner: Signature and Date What specific time can you be at your Learning Center? Monday Tuesday Wednesday Thursday Friday Saturday Sunday House No./Street/Sitio in kms in hours and mins. □K □G-1 □G-2 □G-3 □G-4 □G-5 □G-6 Accessibility and Availability (Part III) Educational information (Part II) □Single □Married □Widow/er □Separated □Solo Parent• Sex: □Male □Female • Last grade level completed Occupation Municipality/City First Name Middle Name Occupation First Name Middle Name Republic of the Philippines Department of Education ALTERNATIVE LEARNING SYSTEM First Name Middle Name Name Extension LRN (if available) Personal Information (Part I) Learner's Basic Profile ALS ENROLMENT FORM (AF2) □Walking □Motorcycle □Bicycle □Others (Pls. Specify) ___________ AF2
- 2. SFRT 2017