1. ICTS - User Support Division
Learner Information System (LIS) and Basic Education Information System (BEIS)
National Helpdesk
Template for Unenrollment of Learner (Request Form 15)
Service Request Type : Unenrolment of Learner
Submit to : Division Planning Officer, Schools Governance and Operations Division
Note : Endorsement of School Head is required (signed and scanned). Please use worksheet/excel format for the matrix.
Present and Correct Enrolment Learner's PersonalInformation UnenroledFrom Reason for Unenrolment
Region Division School School ID Grade Section Date of First LRN First Name Middle Name Last Name Ext Name Date of Gender Region Division School School ID Grade Section School Year
Attendan ce Birth
(MM/D D/Y YY Y (MM/DD/YY
) YY)
STAYING PENDING REQUEST WITHNO APPROVALSINCE IT WAS REQUESTED
I LA UNION DON EULOGIO 300112 11 TVL-ICT ZUCKERBERG 9-15-2021 151002090023REYNALDO LODRIGUITO PATAJO N/A 04/20/2004 MALE I LA UNION DON EULO 300112 11TVL-ICT ZUCKERBERG 2021-2022 TO APPROVED WITH SUPPORTEDDOCUMENTS AND SENT THROUGH LINK
STAYING PENDING REQUEST WITHNO APPROVALSINCE IT WAS REQUESTED
I LA UNION DON EULOGIO 300112 11 TVL-H.E. PIERRE 9-15-2021 100911060034ROGEFRIL MARABE CACDAC N/A 04/14/2001 MALE I LA UNION DON EULO 300112 11TVL-H.E. PIERRE 2021-2022 TO APPROVED WITH SUPPORTEDDOCUMENTS AND SENT THROUGH LINK
STAYING PENDING REQUEST WITHNO APPROVALSINCE IT WAS REQUESTED
I LA UNION DON EULOGIO 300112 11 TVL-CG NIGHTINGALE 9-15-2021 100929100005SHYRA - BAGAMASBAD 06/28/2002 FEMALE I LA UNION DON EULO 300112 11TVL-CG NIGHTINGALE 2021-2022 TO APPROVED WITH SUPPORTEDDOCUMENTS AND SENT THROUGH LINK
Requested By Name Designation Name of School School ID Date Endorsed by Signature
JUBERT L. PADILLA LIS COORDIN AT OR DON EULOGIO DE GUZMANMEMORIAL 300112 18/08/2022 School Head Name EMELYN C. HOBAYAN, PhD.
Endorsed by DO Name Designation Division Date Signature Endorsed by
RO
Name Designation Region Date Signature
Note for school:
1. Fill-up the form correctly and completely
2. Attach this form as Excel file.
3. Attach a scanned copy of the form with School Head signature
4. Attach the following copies:
a. Birth Certificate
b. Form 137 and/or Form 138
Note for Division Planning Officer:
1. Consolidate requests by school byissue
2. Submit to Regional Planning Officer for encoding in the online form
