DepEd ALS Registration Form (AF2)

Date Filled
MonthDayYear
1
LRN (if available)
- Last Name
- First Name
- Middle Name
- Name Extension
- Address
  House No./Street/Sitio
  Barangay
  Municipality/CityProvince
  Postal / Zip Code
- Birthdate
  MonthDayYear
  2
- Place of Birth
  Municipality/City
- Sex
- Civil Status
- Religion
- IP
  Specify ethnic group
- Mother Tongue
- PWD
- Name of Father/Legal Guardian
  First NameMiddle NameLast NameSuffix
- Occupation
- Mother's Maiden Name
  First NameMiddle NameLast Name
- Occupation
- Last grade level completed
  Elementary
- 3
  Secondary
- Why did you drop out of school?
- If OTHERS, state why:
- Have you attended ALS learning sessions before?
- If YES, name of the Program
- Year attended:
- Level of Literacy
- Have you completed the program?
- If NO, state the reason:
- How far is it from your home to your Learning Center?
  in kilometers
- 4
  in hours and minutes
- How do you get from your home to your Learning Center?
- If OTHERS, please specify:
- When can you attend your Learning Session? What specific time can you be at your Learning Center?
  (For home-based learners, what time can you work on the ALS modules?)
- MONDAY
- Time Start
  :HourMinutesAM/PM Option
- Time End
  :HourMinutesAM/PM Option
- TUESDAY
- Time Start
  :HourMinutesAM/PM Option
- Time End
  :HourMinutesAM/PM Option
- WEDNESDAY
- Time Start
  :HourMinutesAM/PM Option
- Time End
  :HourMinutesAM/PM Option
- THURSDAY
- Time Start
  :HourMinutesAM/PM Option
- Time End
  :HourMinutesAM/PM Option
- FRIDAY
- Time Start
  :HourMinutesAM/PM Option
- Time End
  :HourMinutesAM/PM Option
- SATURDAY
- Time Start
  :HourMinutesAM/PM Option
- Time End
  :HourMinutesAM/PM Option
- Upload Birth Certificate
  Browse Files
  NSO certified only; 500 KB per fileCancelof
- Upload 2x2 photo
  Browse Files
  white background, with name and signature, 500 KB file sizeCancelof
- Facilitator: Signature and Date (for official use only)
  Clear
- Learner: Signature and Date
  Clear
- Should be Empty: