Dauin National High School
Learner's Personal Information
Birthdate
Gender
Select Gender
Male
Female
Belonging to any Indigenous People (IP) Community / Indigenous Cultural Community?
Yes
No
Is your family beneficiary of 4Ps?
Yes
No
Current Address
Permanent Address
Same as Current
Parent's/Guardian's Information
Father
Mother
Guardian
Is the learner under the Special Needs education program?
Yes
No
If Yes, select one:
A1
Attention Deficit Hyperactivity Disorder
Autism Spectrum Disorder
Cerebral Palsy
Emotion-Behavior Disorder
Hearing Impairment
Intellectual Disability
Learning Disability
Multiple Disability
Orthopedic/Physical Handicap
Speech/Language Disorder
Special Health Problem/Chronic Disease
Cancer
Non-Cancer
Visual Impairment
Blind
Low Vision
A2
Difficulty in Applying Knowledge
Difficulty in Communicating
Difficulty in Displaying Interpersonal Behavior
Difficulty in Hearing
Difficulty in Mobility (Walking, Climbing, Grasping)
Difficulty in Performing Adaptive Skills (Self-Care)
Difficulty in Remembering/Concentrating/Paying Attention
Difficulty in Seeing
Does the Learner have a PWD ID?
Yes
No
If the School will implement other distance learning modalities aside from face-to-face instruction, what would you prefer for your child?
(Check all that apply)
Blended (Combination)
Educational Television
Homeschooling
Modular (Digital)
Modular (Print)
Online
Radio-Based Instruction
I hereby certify that the above information given are true and correct to the best of my knowledge and I allow the Department of Education to use my child's details to create and/or update his/her learner profile in the learner Information System.
The Information herein shall be treated as confidential in compliance with the
Data Privacy Act of 2012.
Date
Submit Enrollment Form
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Dauin National High School
by
Dominic Truita