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Screening Form

The document includes a screening form for a learner named Josh Daniel H. Florida to determine his eligibility as a District Learner Government Officer, requiring specific documents and qualifications. It also contains a Parent Consent Form allowing participation in the Learner Government District Level Elections on February 28, 2025. The forms must be completed and verified by the Screening and Validation Committee and the parent/guardian.

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MARIDEN MASAGA
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16 views2 pages

Screening Form

The document includes a screening form for a learner named Josh Daniel H. Florida to determine his eligibility as a District Learner Government Officer, requiring specific documents and qualifications. It also contains a Parent Consent Form allowing participation in the Learner Government District Level Elections on February 28, 2025. The forms must be completed and verified by the Screening and Validation Committee and the parent/guardian.

Uploaded by

MARIDEN MASAGA
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Republic of the Philippines

Department of Education
Region IV-A
SCHOOLS DIVISION OF QUEZON PROVINCE

SCREENING FORM
(Note: This Screening Form shall be accomplished by the Screening and Validation Committee.)

Name of Learner: Josh Daniel H. Florida


Grade Level & Section: Grade IV- Neptune Level: Elementary
/
School: San Miguel Dao I Elementary School Secondary

Direction: Please check the appropriate box to determine if the aspiring candidate possesses
all the qualifications to be elected as a District Learner Government Officer.

DESCRIPTION REMARKS

Required Documents Yes No


1. The learner submits the following documents.
a. School Level Oath of Office
b. Parental Consent Form
Qualifications
1. The learner is enrolled in the current
school year.
2. He/She is an elected School President.
(For districts with less than 7 schools, the
Vice President is also an eligible
candidate.)

With all the required documents submitted by the aspiring candidate, the Learner
Government COMEA hereby declares him/her _____ QUALIFIED _____ NOT QUALIFIED
to run for the elections.

Verified by:
____________________________________________________
Commissioner on Screening and Validation

Date: ___________________

DEPEDQUEZON-TM-SDS-04-025-003

Address: Sitio Fori, Brgy. Talipan, Pagbilao, Quezon


Trunkline #: (042) 784-0366, (042) 784-0164,
(042) 784-0391, (042) 784-0321

DepEdTayoQuezon www.depedquezon.com.ph quezon@deped.gov.ph


Republic of the Philippines
Department of Education
Region IV-A
SCHOOLS DIVISION OF QUEZON PROVINCE

Enclosure 2 to DM No. ______ s. 2025

Parent Consent Form

This form confirms that as parent/guardian, I agree to allow the participation of my


son/daughter in the conduct of the Learner Government District Level Elections on February
28, 2025 at Lopez West Elementary School Bldg. I. This is to confirm that I give full
permission for any activity that may be done during this event and the use of some or all
images/contributions/performances in any publication (including electronic publications such
as film or website) created by or the DepEd – Quezon Learner Formation and to release this
material on DepEd official Platforms.

I hereby confirm that I agree and understand the commitment of my son/daughter to


the learner government program. I also understand and will support my son’s/daughter’s
endeavor by comply with existing rules and regulations for the said event, meet the
expectations as a participant, and fulfill the responsibilities as an officer of the Learner
Government (LG).

____________________________________________

Name and Signature of the Learner

____________________________________________

Name and Signature of the Parent/Guardian

____________________________________________

Date

DEPEDQUEZON-TM-SDS-04-025-003

Address: Sitio Fori, Brgy. Talipan, Pagbilao, Quezon


Trunkline #: (042) 784-0366, (042) 784-0164,
(042) 784-0391, (042) 784-0321

DepEdTayoQuezon www.depedquezon.com.ph quezon@deped.gov.ph

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