Basic Education Enrollment Form

Annex 1

Revised as of 03/12/2024

Instructions: Print legibly all information required in CAPITAL letters and check all appropriate boxes.

1. School Year:

2. Grade Level to Enroll:

3. Learner’s Personal Information

PSA Birth Certificate No. (If available) Learner Reference No. (LRN) *

Last Name

First Name

Middle Name

Extension (Jr, III)

Birthdate

Age

Sex

M F

Place of Birth

7. For Learner in Senior High School

Semester: 1ST SEM 2ND SEM

Track: ACADEMIC

Strand / Specialization (Write in Full):

Certification & Consent

I hereby certify that the above information is true and correct to the best of my knowledge and I allow the Department of Education to use my child's/my own personal profile for official purposes.

Signature Over Printed Name

05/03/2026

← Change Strand Selection