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Republic of the Philippines
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Department of Education
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ALTERNATIVE LEARNING SYSTEM
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MODIFIED ALS ENROLMENT FORM (AF2)
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Learner's Basic Profile
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Date:LRN (if available) :
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Personal Information (Part I)
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Last Name First Name Middle Name Name Extension
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• Address:
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House No./Street/SitioBarangay Municipality/City
Province
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• Birthdate (mm/dd/yyyy): _____/_____/________ Place of Birth (Municipality/City)
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• Sex: □Male □Female
• Civil Status:
□Single □Married □Widow/er □Separated □Solo Parent
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• Religion: ____________• IP (Specify ethnic group) : ______________ • Mother Tongue : _______________
PWD:
□Yes
□No
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• Contact Number/s: _________________________
4Ps
□Yes
□No
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• Name of Father/Legal Guardian
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Last Name First Name Middle Name Occupation
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• Mother's Maiden Name
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Last Name First Name Middle Name Occupation
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Educational information (Part II)
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• Last grade level completed
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Elementary : □K □G-1 □G-2 □G-3 □G-4 □G-5 □G-6
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Junior High School :
□G-7 □G-8 □G-9 □G-10
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Senior High School :
□G-11
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• Why did you drop out of school? (For OSY only)
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□No school in Barangay
□School too far from home
□Needed to help family
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□Unable to pay for miscellaneous and other expenses
Others:
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• Have you attended ALS learning sessions before?
□YES □NO
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 If Yes:
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Name of the Program: _____________________________________________
Level of Literacy:
□Basic
□Elem.
□JHS
□SHS
□Infed
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Year Attended: ___________
Have you completed the Program? (Yes/No) _______
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If NO, state the reason:
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• What learning Modality/ies do you prefer? Choose all that applies.
□ Online
□Television
□Radio
□Modular Learning
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□Combination of face to face with other modalities
□ Others:
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Accessibility and Availability (Part III)
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• How far is it from your home to your Learning Center?
in kmsin hours and mins.
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• How do you get from your home to your Learning Center?
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• When can you attend your Learning Session?
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What specific time can you be at your Learning Center?Monday Tuesday Wednesday Thursday Friday Saturday Sunday
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_______________________________________ _____________________________
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ALS Teacher/Community ALS Implementor/Learning Facilitator: Signature and Date Learner: Signature and Date
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