Online Admission Form

Learner Enrollment and Survey Form

Mga dapat sundin:

Ang enrollment survey na ito ay maaring sagutan ng mag-aaral na edad 18 pataas o magulang/tagapag-alaga ng mag-aaral.

Basahing mabuti ang mga tanong at sagutan ang mga angkop na espasyo at isulat nang maayos sa MALALAKING TITIK ang iyong mga sagot.
Sa mga aytem na hindi angkop, ilagay ang N/A.

Para sa mga katanungan at paglilinaw, humingi ng tulong sa guro/ taong nakatalaga.

Instructions:

This enrollment survey shall be answered by the parent/guardian of the learner.

Please read the questionscarefully and fill in all applicable spaces and write your answers legiblyin CAPITAL letters. For items not applicable, write N/A.

For questions/clarifications, please ask for the assistance of the teacher/person-in-charge.

Data Privacy Consent: Please check the appropriate statement:

I am a student applicant who is 18 or over 18 years old.

I/We are parents or legal guardian of applicant who is a minor(below 18 years old).

* I/We am/are fully aware that Infant Jesus Learning Academy of Malabon, Inc.or its Enrolling Officer is duty bound and obligated under the Data Privacy Act of 2012 to protect all my/our personal and sensitive information upon enrollment which includes any information about my academics or any documents containing my identity. This includes but not limited to the following: LRN, name, address, names of parents or guardians, date of birth, grades and other information necessary for academic purposes. I/We understand that my/our personal information cannot be disclosed without my/our consent. I/We understand that the information that was collected and processed relates to my/our child's enrollment and to be used by Infant Jesus Learning Academy of Malabon, Inc.to pursue its legitimate interests as an educational institution. In this regard, I/we hereby allow Infant Jesus Learning Academy of Malabon, Inc.to collect, process,use and share my child's/our personal data in the pursuit of its legitimate interests as an educational institution. Upon clicking, I/we hereby give my/our consent for the processing, release and retention of personal information.

Grade Level and School Information

Check if Old Student (SY 2019-2020)

Returning? (Balik-Aral)

Grade Level to Enroll *

last grade level completed

last school year completed

Last School Attended

last school attended - school id

last attended school type

last school address

For GRADE 9 Only:

TLE Specialization

For Senior High School Only:

semester

track

strand

PSA Birth Certificate Number (8-Digit Registry No.)

LRN (12-digit No.)

First Name *

Last Name *

Middle Name

Ext Name

Date of Birth *

birth place

Gender *

Belonging to Indigenous Peoples Community / Indigenous Cultural Community

Yes No if yes, please specify

mother tongue

religion

Address

house number and street *

barangay

city

province

region

For Learners with Special Education Needs:

Does the learner have special education needs?

Yes No if yes, please specify

Do you have any assistive technology devices available at home? (i.e. screen reader, Braille, DAISY)

Yes No if yes, please specify

parent/guardian information

Is your family a beneficiary of 4Ps?

Yes No

Father

Father's Full Name (Last name, First name, Middle name)

highest education

employment status

working from home due to ECQ?
Yes No

Father's Phone

Father's Occupation

mother

Mother's Full Maiden Name (Last name, First name, Middle name)

highest education attainment

employment status

working from home due to ECQ
Yes No

Mother's Phone

Mother's Occupation

Student's Guardian *

Father Mother Other

Guardian

Guardian's Name (surname, full name, middle name) *

highest education

employment status

working from home due to ECQ
Yes No

Guardian's Phone *

Guardian's Occupation

Relationship to the Student

Guardian's E-mail

Guardian's Address

household capacity and access to distance learning

How does your child go to school? Choose all that applies.

walking

public commute (land/water)

family-owned vehicle

school service

How many of your household members (including the enrollee) are studying in School Year 2020-2021? Please specify each.

Kinder

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Grade 6

Grade 7

Grade 8

Grade 9

Grade 10

Grade 11

Grade 12

Others

Who among the household members can provide instructional support to the child's distance learning? Choose all that applies.

parents/guardians

elder siblings

grandparents

extended members of the family

others (tutor, house helper)

none

able to do independent learning

What devices are available at home that the learner can use for learning? Check all that applies

cable TV

non-cable TV

basic cellphone

smartphone

tablet

radio

desktop computer

laptop

none

others:

Do you have a way to connect to the internet?

yes

How do you connect to the internet?

own mobile data

own broadband internet (DSL, wireless fiber,satelite))

computer shop

other places outside the home with internet connection (library, barangay/municipal hall, neighbor, relatives)

None

What distance learning modality/ies do you prefer for your child? Choose one only. *

Modular Print

Modular Digital (asynchronous learning via ePNS LMS)

Online (synchronous learning via Google Meet or any online platform)

What are the challenges that may affect your child’s learning process through distance education? Choose all that applies.

lack of available gadgets/ equipment

insufficient load/ data allowance

unstable mobile/ internet connection

existing health condition/s

difficulty in independent learning

conflict with other activities (i.e., house chores)

high electrical consumption

distractions (i.e., social media, noise from community/neighbour

others:

Learner Enrollment and Survey Form

Mga dapat sundin:

Instructions:

Data Privacy Consent: Please check the appropriate statement:

Grade Level and School Information

Student Information

Address

For Learners with Special Education Needs:

parent/guardian information

Father

mother

Student's Guardian *

Guardian

household capacity and access to distance learning