Scribd
Upload
286 views1 page

Student Profile: Learners Reference Number (LRN)

This document is a student profile form for a high school in Ozamiz City, Philippines. It collects personal information about the student such as name, address, parents' details, health, transfer or repeating status, and whether the student is a beneficiary of a government assistance program. The form is in three parts - part 1 collects basic identity and contact information, part 2 collects health details, and part 3 asks transfer, repeating, and assistance program questions.

Uploaded by

Raymart Diapera
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
286 views1 page

Student Profile: Learners Reference Number (LRN)

This document is a student profile form for a high school in Ozamiz City, Philippines. It collects personal information about the student such as name, address, parents' details, health, transfer or repeating status, and whether the student is a beneficiary of a government assistance program. The form is in three parts - part 1 collects basic identity and contact information, part 2 collects health details, and part 3 asks transfer, repeating, and assistance program questions.

Uploaded by

Raymart Diapera
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

Republic of the Philippines

Department of Education
REGION X – NORTHERN MINDANAO
SCHOOLS DIVISION OF OZAMIZ CITY
OZAMIZ CITY NATIONAL HIGH SCHOOL

STUDENT PROFILE 1X1


Picture
Learners Reference Number (LRN):
PART I
Name Surname First Name Middle Name
Date of Birth Month Day Year

House/Block/Lot Number Street Contact Number


Address Barangay City/Municipality Province

Zip Code Birth Place Religion

Surname First Name Middle Name


Father
Age & Date of Birth Occupation & Status Contact Number

Maiden Surname First Name Maiden Middle Name


Mother
Age & Date of Birth Occupation & Status Contact Number

Surname First Name Middle Name


Guardian
Age & Date of Birth Occupation & Relation to the child Contact Number
PART II
Height Weight Body Mass Index (BMI)
Do you have ailments?
(Attach medical record/certificate) Specify:
PART III

Are you a TRANSFEREE? YES NO


If YES, what school were you from? Section?

Are you a BALIK-ARAL Student? YES NO

If YES, what school were you from?


What year did you stop studying?
What are your reasons for stopping?

Are you a REPEATER? YES NO

If YES, what school were you from?


What subjects did you fail?
What are your reasons for failing?

Are you a 4PS BENEFICIARY? YES NO


If YES, since what year?

Accomplished by: Date of Submission:


(Signature over printed name)

You might also like