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Modified Learner Enrollment and Survey Form

For All Students.

Enrollment for Grade 11 (STEM) has been temporarily suspended.
Select the Grade Level you wish to enroll.
Enter the student LRN (ex. 304260123456).
Enter the first name of the student.
Enter the last name of the student.
Enter the middle name of the student, if applicable.
Enter the name extension of the student, if applicable.
Enter the birth date of the student in YYYY/MM/DD format, or use the date picker.
Select the Sex/Gender of the student.
House No. / Block No. / Lot No. / Street Name
Purok / Subdivision
Barangay
Town / Municipality / City
Province
Enter the name of the father as reflected in the birth certificate.
Select the highest educational attainment of your father.
Enter the name of the mother as reflected in the birth certificate.
Select the highest educational attainment of your mother.
Applicable if not living with parents.
Select the highest educational attainment of your guardian.
Select whether you belong to an IP community or cultural community.
Select whether your family is a 4Ps beneficiary.
Enter your mother tongue.
Enter your religion.
Enter whether the learner have special education needs (i.e. physical, mental, social disability, medical condition, giftedness, among others). Leave BLANK if not applicable.
For Learners with Special Needs Only. Enter any assistive technology devices available at home (i.e. screen reader, Braille, DAISY). Leave BLANK if not applicable.
Enter the name of the last school attended by the student.
Select the type of school where you last attended.
Enter the number of household members studying as Kinder in School Year 2021-2022. Enter 0 (zero) if none.
Enter the number of household members studying as Grade 1 in School Year 2021-2022. Enter 0 (zero) if none.
Enter the number of household members studying as Grade 2 in School Year 2021-2022. Enter 0 (zero) if none.
Enter the number of household members studying as Grade 3 in School Year 2021-2022. Enter 0 (zero) if none.
Enter the number of household members studying as Grade 4 in School Year 2021-2022. Enter 0 (zero) if none.
Enter the number of household members studying as Grade 5 in School Year 2021-2022. Enter 0 (zero) if none.
Enter the number of household members studying as Grade 6 in School Year 2021-2022. Enter 0 (zero) if none.
Enter the number of household members studying as Grade 7 in School Year 2021-2022. Enter 0 (zero) if none.
Enter the number of household members studying as Grade 8 in School Year 2021-2022. Enter 0 (zero) if none.
Enter the number of household members studying as Grade 9 in School Year 2021-2022. Enter 0 (zero) if none.
Enter the number of household members studying as Grade 10 in School Year 2021-2022. Enter 0 (zero) if none.
Enter the number of household members studying as Grade 11 in School Year 2021-2022. Enter 0 (zero) if none.
Enter the number of household members studying as Grade 12 in School Year 2021-2022. Enter 0 (zero) if none.
Enter the number of household members studying as College, Vocational, etc. in School Year 2021-2022. Enter 0 (zero) if none.
Choose all that applies.
Check all that applies.
Choose whether there is an internet signal in your area.
Choose all that applies.
Choose all that applies.
Select if you plan to participate in limited face to face classes.
Choose one.
Note: TCNHS recommends only ONLINE and DIGITAL MODULAR.
Enter a valid and accessible contact number (ex. 09011234567).
Enter a valid and accessible email (ex. admin@tagumcitynhs.ph).
Upload a clear copy of your School Report Card in JPEG format (max. of 3MB).