DPLR Form - For LIS Pending Approval at DIVISION LEVEL ONLY PARF 2.
DIVISION OF MASBATE CITY
DIVISION PENDING LIS REQUEST FORM
LIS Change SCHOOL YEAR 2022-2023
CERTIFIED CORRECT:
Request No.: Signature of School Head
CLC/School ID: 302133 or Representative
School Name : CAPITOLINA O. LEGASPI MHS Name of School Head: AIDA R. LEGASPI
Sector: Public Cell Phone Number:
Email Address: 302133@[Link]
I. Profile of Learner with Pending Enrollment or Change Request
LRN: 113679120024 Sex: Male
First Name: JASON Birthdate: 9/12/2006
Middle Name LEONES Contact Person for this Request:
Last Name: TUMBAGA EDISON MARTINEZ TUMBAGA
Grade Level: Grade 10 Cell Phone Number:
Section: DELPHINUS
II. Pending Request Type
Enrolment w/ gap, Enrolment of Ineligible, Correction of Learner Profile, Correction of Grade Level, LRN Approval, Temporary Enrolment, Request for Disapproval
Enrolment w/ gap
III. If applicable, explain or narrate additional details inside the box.
IV. Documentary Requirements for Each Pending Request Type
Pending Request Type Required Supporting Documents
*DPLR Form, *SF9/SF10/Form 137 & 138,ECCD Summary of Rating for Grade 1,
Enrolment w/ gap **RFG, **PEPT, **A&E Rating
*DPLR Form, *SF9/SF10/Form 137 & 138,ECCD Summary of Rating for Grade 1,
Enrolment of Ineligible **RFG, **PEPT, **A&E Rating
*DPLR Form, *SF9/SF10/Form 137 & 138, ECCD Summary of Rating for Kinder, *Birth
Correction of Learner Profile Certificate
Correction of Grade Level *DPLR Form, *SF9/SF10/Form 137 & 138, **RFG, **PEPT, **A&E Rating
*DPLR Form, *SF9/SF10/Form 137 & 138, ECCD Summary of Rating for Grade 1,
LRN Approval **RFG, **PEPT, **A&E Rating, *Birth Certificate, or any Proof of ID
*DPLR Form, *Affidavit of Undertaking, **Other available documents that may add
Temporary Enrolment support to the request
*DPLR Form, *Affidavit of Undertaking, **Other available documents that may add
Request for Disapproval support to the request
*Required, **If Applicable Only.
NOTE: All attached documents must link or reflect learners eligibility to enroll in current grade level of the school year.
If there are DISCREPANCIES Between the Enrollment History in LIS and in Documents, include an explanation to
support the case.
[Link]@[Link]
