DepEd ALS Registration Form (AF2)

Personal Information (Part 1)
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*
MaleFemale
Civil Status
Religion
IP
Specify ethnic group
Mother Tongue
PWD
YesNo
Name of Father/Legal Guardian*
First NameMiddle NameLast NameSuffix
Occupation
Mother's Maiden Name*
First NameMiddle NameLast Name
Occupation

Accessibility and Availability (Part 3)
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

Acknowledgement
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: