Schools Division Office
F.G.CALDERON INTEGRATED SCHOOL (HS)
Hermosa St., Tondo, Manila ADVISERS COPY
__________________________________________________________________________________________________
LRN: _______________________________
LEARNER’S INFORMATION SHEET
School Year _____________
Please check: ___Regular Student ___ Dropout ___ Repeater ___ Balik-Aral ___Transferee ( ) Public ( ) Private
Name of Previous School: ____________________________ Division: ____________ Province/Region: ______________
Name of Learner: (Surname, First Name, M.I.) _______________________________Gr. & Section: ____________Adviser:_________________
Age: ______ Date of Birth:___________________ Place of Birth: ________________ Gender: ______________No. of Siblings:________
Current Address:___________________________________ Years in FGCIS:____Nationality:_______________ Religion:__________________
Name of Father: ____________________________________ Occupation:_________________ Contact No.:_____________________________
Highest Educational Attainment: ____________________________Number of Years in present address:____Brgy. No: ______ Zone No.: _____
Name of Mother: ____________________________________ Occupation:________________________ Contact No.:_____________________
Highest Educational Attainment: _____________________________Number of Years in present address:____Brgy. No: ______ Zone No.: _____
Currently living with at least one parent? ( ) Yes ( ) No Dialect used to communicate within the family:________________________________
Name of Guardian (if Guardian is not the Parent): _____________________________Relationship to Guardian:___________________________
Address:__________________________________Occupation:___________________ Contact Number: ________________________________
Recipient of 4Ps’? ( ) Yes ( ) No School Year: _______________ Other Scholarship Grant/Sponsorship: _______________________
_____________________________________ _____________________________________
Name of Learner and Signature Name of Parent/Guardian and Signature
Schools Division Office
F.G.CALDERON INTEGRATED SCHOOL (HS)
Hermosa St., Tondo, Manila GUIDANCE COPY
__________________________________________________________________________________________________
LRN: _______________________________
LEARNER’S INFORMATION SHEET
School Year _____________
Please check: ___Regular Student ___ Dropout ___ Repeater ___ Balik-Aral ___Transferee ( ) Public ( ) Private
Name of Previous School: ____________________________ Division: ____________ Province/Region: ______________
Name of Learner: (Surname, First Name, M.I.) _______________________________Gr. & Section: ____________Adviser:_________
Age: ______ Date of Birth:___________________ Place of Birth: ________________ Gender: ________No. of Siblings:________
Current Address:___________________________________ Years in FGCIS:____Nationality:_______________ Religion:__________
Name of Father: ____________________________________ Occupation:________________ Contact No.:_____________________
Highest Educational Attainment: ____________________Number of Years in present address:____Brgy. No: ______ Zone No.: _____
Name of Mother: ____________________________________ Occupation:________________ Contact No.:_____________________
Highest Educational Attainment: ____________________Number of Years in present address:____Brgy. No: ______ Zone No.: _____
Currently living with at least one parent? ( ) Yes ( ) No Dialect used to communicate within the family:____________________
Name of Guardian (if Guardian is not the Parent): _____________________________Relationship to Guardian:__________________
Address:__________________________________Occupation:___________________ Contact Number: _______________________
Recipient of 4Ps’? ( ) Yes ( ) No School Year: _______________ Other Scholarship Grant/Sponsorship: ___________________
_____________________________________ _____________________________________
Name of Learner and Signature Name of Parent/Guardian and Signature
Schools Division Office
F.G.CALDERON INTEGRATED SCHOOL (HS)
Hermosa St., Tondo, Manila OFFICE COPY
__________________________________________________________________________________________________
LRN: _______________________________
LEARNER’S INFORMATION SHEET
School Year _____________
Please check: ___Regular Student ___ Dropout ___ Repeater ___ Balik-Aral ___Transferee ( ) Public ( ) Private
Name of Previous School: ____________________________ Division: ____________ Province/Region: ______________
Name of Learner: (Surname, First Name, M.I.) _______________________________Gr. & Section: ____________Adviser:_________
Age: ______ Date of Birth:___________________ Place of Birth: ________________ Gender: ________No. of Siblings:________
Current Address:___________________________________ Years in FGCIS:____Nationality:_______________ Religion:__________
Name of Father: ____________________________________ Occupation:________________ Contact No.:_____________________
Highest Educational Attainment: ____________________Number of Years in present address:____Brgy. No: ______ Zone No.: _____
Name of Mother: ____________________________________ Occupation:________________ Contact No.:_____________________
Highest Educational Attainment: ____________________Number of Years in present address:____Brgy. No: ______ Zone No.: _____
Currently living with at least one parent? ( ) Yes ( ) No Dialect used to communicate within the family:____________________
Name of Guardian (if Guardian is not the Parent): _____________________________Relationship to Guardian:__________________
Address:__________________________________Occupation:___________________ Contact Number: _______________________
Recipient of 4Ps’? ( ) Yes ( ) No School Year: _______________ Other Scholarship Grant/Sponsorship: ___________________
_____________________________________ _____________________________________
Name of Learner and Signature Name of Parent/Guardian and Signature
