Alternative Learning System (ALS) Registration Form

This form collects an applicant's personal, family, and educational background for enrollment in an out-of-school alternative learning program.

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Date Filled

LRN (if available)

Section

Last Name

First Name

Middle Name

Name Extension

Address

Dirección

Ciudad

Estado / Provincia

Código postal

Birthdate

Place of Birth

Sex

Male Female

Civil Status

Religion

Mother Tongue

PWD

Yes No

Name of Father/Legal Guardian

Nombre

Apellido

Occupation

Mother's Maiden Name

Nombre

Apellido

Occupation

Section

Last grade level completed

ALS Level

Why did you drop out of school?

If OTHERS, state why:

Have you attended ALS learning sessions before?

Yes No

If YES, name of the Program

Year attended:

Level of Literacy

Have you completed the program?

Yes No

If NO, state the reason:

Section

How far is it from your home to your Learning Center?

Estimated Travel Time

How do you get from your home to your Learning Center?

If OTHERS, please specify:

Preferred Schedule

Monday

Time Start

Time End

Tuesday

Time Start

Time End

Wednesday

Time Start

Time End

Thursday

Time Start

Time End

Friday

Time Start

Time End

Saturday

Time Start

Time End

Section

Upload Birth Certificate

Max 10 MB per file

Upload 2x2 photo

Max 10 MB per file

Facilitator: Signature and Date (for official use only)

Sign here

Learner: Signature and Date

Sign here

Alternative Learning System (ALS) Registration Form

Section

Section

Section

Section

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