FORM 1

DEPARTMENT OF EDUCATION
EARLY REGISTRATION FORM
SCHOOL: ____________________________ REGION: ________________________________
SCHOOL NAME: _______________________ DIVISION: _______________________________
SCHOOL DISTRICT: _______________________

_____________________________________________________________________
KINDER/GRADE/YEAR LEVEL

CATEGORY OF C/Y
WITH DISABILITY**
NAME SEX AGE BIRTHDATE ADDRESS (FOR CHILDREN AND REMARKS*
YOUTH WITH
DISABILITIES ONLY
TOTAL NUMBER OF REGISTRANTS (PER GRADE LEVEL)
MALE ________________
FEMALE ________________
TOTAL ________________
SCHOOL PLAN TO ADDRESS NEEDS FORM 2_ELEM

NAME OF ELEMENTARY SCHOOL:

DIVISION: REGION:
DATE ACCOMPLISHED
PLEASE INDICATE ADDITIONAL INPUTS NEEDED

GRADE LEVEL TENTATIVE ENROLMENT A. ADDITIONAL INPUTS NEEDED (PLEASE INDICATE NUMBER)
MALE FEMALE TOTAL CLASSROOM TEACHERS TEXTBOOKS SEATS
1. KINDER
2. GRADE 1
3. GRADE 2
4. GRADE 3
5. GRADE 4
6. GRADE 5
7. GRADE 6
TOTAL

B. INPUTS NEEDED
LEARNERS UNDER THE ADM'S TENTATIVE ENROLMENT TEACHER-
FACILITATOR MODULES

AGE 9
AGE 10
AGE 11
AGE 12 AND ABOVE
TOTAL

C. INPUTS NEEDED
LEARNERS UNDER THE ALS TENTATIVE ENROLMENT TEACHER-
FACILITATOR MODULES

AGE 9
AGE 10
AGE 11
AGE 12 AND ABOVE
TOTAL

CATEGORIES OF
DISABILITY TENTATIVE ENROLMENT ADDITIONAL INPUTS NEEDED (PLEASE INDICATE NUMBER)
VISUAL IMPAIRMENT MALE FEMALE TOTAL CLASSROOM TEACHERS TEXTBOOKS SEATS

HEARING IMPAIRMENT
INTELLECTUAL
DISABILITY
SPEECH/LANGUAGE
IMPAIRMENT
SERIOUS EMOTIONAL
DISTURBANCE
AUTISM
ORTHOPEDIC
IMPAIRMENT
SPECIAL HEALTH
PROBLEMS

MULTIPLE DISABILITIES
TOTAL

D. PROPOSED DIFFERENTIATED PROGRAM INTERVENTION E. ASSISTANCE NEEDED

1. FORMAL DELIVERY SYSTEM
2. ADMS
3. SPECIAL EDUCATION IN INCLUSIVE SETTING

SUBMITTED BY:

___________________________________________
NAME AND SIGNATURE OF SCHOOL HEAD

___________________________________________
DESIGNATION

MOBILE NUMBER: ______________________________

E-MAIL ADDRESS: _________________________
 SCHOOL PLAN TO ADDRESS NEEDS FORM 2 _ SECONDARY
NAME OF SCHOOL:

DIVISION: REGION:
DATE ACCOMPLISHED
PLEASE INDICATE ADDITIONAL INPUTS NEEDED

GRADE LEVEL TENTATIVE ENROLMENT A. ADDITIONAL INPUTS NEEDED (PLEASE INDICATE NUMBER)
M F TOTAL CLASSROOM TEACHERS TEXTBOOKS SEATS
1. GRADE 7
2. GRADE 8
3. GRADE 9
4. GRADE 10
TOTAL

B. INPUTS NEEDED
LEARNERS UNDER THE ADM'S TENTATIVE ENROLMENT TEACHER-
MODULES
FACILITATOR
AGE 12
AGE 13
AGE 14
AGE 15 AND ABOVE
TOTAL

C. INPUTS NEEDED
LEARNERS UNDER THE ALS TENTATIVE ENROLMENT TEACHER-
MODULES
FACILITATOR
AGE 12
AGE 13
AGE 14
AGE 15 AND ABOVE
TOTAL

CATEGORIES OF
DISABILITY TENTATIVE ENROLMENT ADDITIONAL INPUTS NEEDED (PLEASE INDICATE NUMBER)
M F TOTAL CLASSROOM TEACHERS TEXTBOOKS SEATS

VISUAL IMPAIRMENT

HEARING IMPAIRMENT
INTELLECTUAL
DISABILITY
SPEECH/LANGUAGE
IMPAIRMENT
SERIOUS EMOTIONAL
DISTURBANCE

AUTISM
ORTHOPEDIC
IMPAIRMENT
SPECIAL HEALTH
PROBLEMS

MULTIPLE DISABILITIES
TOTAL

D. PROPOSED DIFFERENTIATED PROGRAM INTERVENTION E. ASSISTANCE NEEDED

1. FORMAL DELIVERY SYSTEM
2. ADMS
3. SPECIAL EDUCATION IN INCLUSIVE SETTING

SUBMITTED BY:
 ___________________________________________
NAME AND SIGNATURE OF SCHOOL HEAD

___________________________________________
DESIGNATION

MOBILE NUMBER: _______________________________

E-MAIL ADDRESS: ____________________________
 SCHOOL PLAN TO ADDRESS NEEDS FORM 2 _ SECONDARY
NAME OF SCHOOL:

DIVISION: REGION:
DATE ACCOMPLISHED
PLEASE INDICATE ADDITIONAL INPUTS NEEDED

GRADE LEVEL TENTATIVE ENROLMENT A. ADDITIONAL INPUTS NEEDED (PLEASE INDICATE NUMBER)
M F TOTAL CLASSROOM TEACHERS TEXTBOOKS SEATS
1. GRADE 11
2. GRADE 12
TOTAL

B. INPUTS NEEDED
LEARNERS UNDER THE ADM'S TENTATIVE ENROLMENT TEACHER-
MODULES
FACILITATOR
AGE 12
AGE 13
AGE 14
AGE 15 AND ABOVE
TOTAL

C. INPUTS NEEDED
LEARNERS UNDER THE ALS TENTATIVE ENROLMENT TEACHER-
MODULES
FACILITATOR
AGE 12
AGE 13
AGE 14
AGE 15 AND ABOVE
TOTAL

CATEGORIES OF
DISABILITY TENTATIVE ENROLMENT ADDITIONAL INPUTS NEEDED (PLEASE INDICATE NUMBER)
M F TOTAL CLASSROOM TEACHERS TEXTBOOKS SEATS

VISUAL IMPAIRMENT

HEARING IMPAIRMENT
INTELLECTUAL
DISABILITY
SPEECH/LANGUAGE
IMPAIRMENT
SERIOUS EMOTIONAL
DISTURBANCE

AUTISM
ORTHOPEDIC
IMPAIRMENT
SPECIAL HEALTH
PROBLEMS

MULTIPLE DISABILITIES
TOTAL

D. PROPOSED DIFFERENTIATED PROGRAM INTERVENTION E. ASSISTANCE NEEDED

1. FORMAL DELIVERY SYSTEM
2. ADMS
3. SPECIAL EDUCATION IN INCLUSIVE SETTING

SUBMITTED BY:

___________________________________________
NAME AND SIGNATURE OF SCHOOL HEAD
 ___________________________________________
DESIGNATION

MOBILE NUMBER: _______________________________

E-MAIL ADDRESS: ____________________________
DISTRICT SCHOOLS OFFICE REPORT ON SCHOOL NEEDS FORM 3_ELEM

SCHOOLS DIVISION OFFICE: ___________________________

DATE ACCOMPLISHED: _______________________________ REGION: _________________________________

______________________________________________________________________________________________________________

I. ELEMENTARY LEVEL
TOTAL NUMBER OF ELEMENTARY SCHOOLS: ________________________________
TOTAL NUMBER OF SCHOOLS WITH INCREASED ENROLMENT: _____________ OR _____________ %
KINDERGARTEN: __________ OR ___________%
ONE: ________ OR ____________
GRADE TWO TO SIX : ________ OR ____________
ADMS: ________ OR ____________
CHILDREN WITH DISABILITIES ___________ OR ____________ %
____________ % INCREASE FROM SY 2013-2014

TOTAL NUMBER OF SCHOOLS WITHOUT INCREASED ENROLMENT:_____________ OR ______________ %

DISTRICT DATA ON TENTATIVE ENROLMENT ON KINDERGARTEN AND GRADES ONE TO SIX AND ADDITIONAL INPUTS NEEDEDD AND PLANS IN
RESPONDING TO NEEDS

GRADE LEVEL NUMBER OF ADDITIONAL INPUTS NEEDED (N) AND PLANS IN RESPONDING TO NEEDS (PR)
TENTATIVE
ENROLMENT CLASSROOM TEACHERS TEXTBOOKS SEATS
N PR N PR N PR N PR
1. KINDER
2. GRADE 1
3. GRADE 2
4. GRADE 3
5. GRADE 4
6. GRADE 5
7. GRADE 6
TOTAL

DISTRICT DATA ON TENTATIVE ENROLMENT OF LEARNERS UNDER THE ADMS

NUMBER OF ADDITIONAL INPUTS NEEDED (N) AND PLANS IN RESPONDING TO NEEDS (PR)

TEACHER- FACILITATOR MODULE/ LEARNING RESOURCES

AGE LEVEL TENTATIVE ENROLMENT N PR N PR

9
10
11
12 AND ABOVE

DISTRICT DATA ON TENTATIVE ENROLMENT OF CHILDREN AND YOUTH WITH DISABILITIES AND ADDITIONAL INPUTS NEEDED AND PLANS IN RESPONDING
TO NEEDS

CATEGORIES OF DISABILITY NUMBER OF ADDITIONAL INPUTS NEEDED (N) AND PLANS IN RESPONDING TO NEEDS (PR)

TENTATIVE
CHILDREN/YOUTH WITH ENROLMENT CLASSROOMS TEACHERS TEXTBOOKS SEATS
TEXTBOOK
N PR CLASSROOM TEACHERS S SEATS
VISUAL IMPAIRMENT

HEARING IMPAIRMENT
INTELLECTUAL
DISABILITY
SPEECH/LANGUAGE
IMPAIRMENT
SERIOUS EMOTIONAL
DISTURBANCE
AUTISM
ORTHOPEDIC
IMPAIRMENT
SPECIAL HEALTH
PROBLEMS

MULTIPLE DISABILITIES
TOTAL

CONSOLIDATED DIFFERENTIATED PROGRAM INTERVENTION ASSISTANCE NEEDED

1
2
3

SUBMITTED BY:

___________________________________________
NAME AND SIGNATURE OF SCHOOL HEAD

___________________________________________
DESIGNATION

MOBILE NUMBER: _______________________________________

E-MAIL ADDRESS: _______________________________________
DISTRICT SCHOOLS OFFICE REPORT ON SCHOOL NEEDS FORM 3 - SECONDARY

SCHOOLS DIVISION OFFICE: ___________________________

DATE ACCOMPLISHED: _______________________________ REGION: _________________________________

II. ELEMENTARY LEVEL

TOTAL NUMBER OF SECONDARY SCHOOLS: ________________________________
TOTAL NUMBER OF SCHOOLS WITH INCREASED ENROLMENT: _____________ OR _____________ %
GRADE 7: __________ OR ___________%
GRADE 8: ________ OR ____________%
GRADE 9 : ________ OR ____________%
GRADE 10 : ________ OR ____________%
ADMS: ________ OR ____________%
CHILDREN WITH DISABILITIES ___________ OR ____________ %
____________ % INCREASE FROM SY 2013-2014

TOTAL NUMBER OF SCHOOLS WITHOUT INCREASED ENROLMENT:_____________ OR ______________ %

DISTRICT DATA ON TENTATIVE ENROLMENT ON KINDERGARTEN AND GRADES ONE TO SIX AND ADDITIONAL INPUTS NEEDEDD AND PLANS IN
RESPONDING TO NEEDS

GRADE LEVEL TENTATIVE NUMBER OF ADDITIONAL INPUTS NEEDED (N) AND PLANS IN RESPONDING TO NEEDS (PR)
ENROLMENT CLASSROOM TEACHERS TEXTBOOKS SEATS
N PR N PR N PR N PR
GRADE 7
GRADE 8
GRADE 9
GRADE 10
TOTAL

DISTRICT DATA ON TENTATIVE ENROLMENT OF LEARNERS UNDER THE ADMS

NUMBER OF ADDITIONAL INPUTS NEEDED (N) AND PLANS IN RESPONDING TO NEEDS (PR)
TEACHER- FACILITATOR MODULE/ LEARNING RESOURCES

AGE LEVEL TENTATIVE ENROLMENT N PR N PR

12
13
14
15 AND ABOVE

DISTRICT DATA ON TENTATIVE ENROLMENT OF CHILDREN AND YOUTH WITH DISABILITIES AND ADDITIONAL INPUTS NEEDED AND PLANS IN RESPONDING
TO NEEDS

CATEGORIES OF DISABILITY NUMBER OF ADDITIONAL INPUTS NEEDED (N) AND PLANS IN RESPONDING TO NEEDS (PR)
TENTATIVE
CHILDREN/YOUTH WITH ENROLMENT CLASSROOMS TEACHERS TEXTBOOKS SEATS
TEXTBOOK
N PR CLASSROOM TEACHERS S SEATS

VISUAL IMPAIRMENT

HEARING IMPAIRMENT
INTELLECTUAL
DISABILITY
SPEECH/LANGUAGE
IMPAIRMENT
SERIOUS EMOTIONAL
DISTURBANCE
AUTISM
ORTHOPEDIC
IMPAIRMENT
SPECIAL HEALTH
PROBLEMS

MULTIPLE DISABILITIES
TOTAL

CONSOLIDATED DIFFERENTIATED PROGRAM INTERVENTION ASSISTANCE NEEDED

1
2
3
SUBMITTED BY:

___________________________________________
NAME AND SIGNATURE OF SCHOOL HEAD

___________________________________________
DESIGNATION
MOBILE NUMBER: _______________________________________
E-MAIL ADDRESS: _______________________________________
DISTRICT SCHOOLS OFFICE REPORT ON SCHOOL NEEDS FORM 3 - SECONDARY

SCHOOLS DIVISION OFFICE: ___________________________

DATE ACCOMPLISHED: _______________________________ REGION: _________________________________

II. ELEMENTARY LEVEL

TOTAL NUMBER OF SECONDARY SCHOOLS: ________________________________
TOTAL NUMBER OF SCHOOLS WITH INCREASED ENROLMENT: _____________ OR _____________ %
GRADE 11: __________ OR ___________%
GRADE 12: ________ OR ____________%
ADMS: ________ OR ____________%
CHILDREN WITH DISABILITIES ___________ OR ____________ %
____________ % INCREASE FROM SY 2013-2014

TOTAL NUMBER OF SCHOOLS WITHOUT INCREASED ENROLMENT:_____________ OR ______________ %

DISTRICT DATA ON TENTATIVE ENROLMENT ON KINDERGARTEN AND GRADES ONE TO SIX AND ADDITIONAL INPUTS NEEDEDD AND PLANS IN
RESPONDING TO NEEDS

GRADE LEVEL TENTATIVE NUMBER OF ADDITIONAL INPUTS NEEDED (N) AND PLANS IN RESPONDING TO NEEDS (PR)
ENROLMENT CLASSROOM TEACHERS TEXTBOOKS SEATS
N PR N PR N PR N PR
GRADE 11
GRADE 12
TOTAL

DISTRICT DATA ON TENTATIVE ENROLMENT OF LEARNERS UNDER THE ADMS

NUMBER OF ADDITIONAL INPUTS NEEDED (N) AND PLANS IN RESPONDING TO NEEDS (PR)
TEACHER- FACILITATOR MODULE/ LEARNING RESOURCES

AGE LEVEL TENTATIVE ENROLMENT N PR N PR

12
13
14
15 AND ABOVE

DISTRICT DATA ON TENTATIVE ENROLMENT OF CHILDREN AND YOUTH WITH DISABILITIES AND ADDITIONAL INPUTS NEEDED AND PLANS IN RESPONDING
TO NEEDS

CATEGORIES OF DISABILITY NUMBER OF ADDITIONAL INPUTS NEEDED (N) AND PLANS IN RESPONDING TO NEEDS (PR)
TENTATIVE
CHILDREN/YOUTH WITH ENROLMENT CLASSROOMS TEACHERS TEXTBOOKS SEATS
TEXTBOOK
N PR CLASSROOM TEACHERS S SEATS

VISUAL IMPAIRMENT

HEARING IMPAIRMENT
INTELLECTUAL
DISABILITY
SPEECH/LANGUAGE
IMPAIRMENT
SERIOUS EMOTIONAL
DISTURBANCE
AUTISM
ORTHOPEDIC
IMPAIRMENT
SPECIAL HEALTH
PROBLEMS

MULTIPLE DISABILITIES
TOTAL

CONSOLIDATED DIFFERENTIATED PROGRAM INTERVENTION ASSISTANCE NEEDED

1
2
3
SUBMITTED BY:

___________________________________________
NAME AND SIGNATURE OF SCHOOL HEAD

___________________________________________
DESIGNATION

MOBILE NUMBER: _______________________________________

E-MAIL ADDRESS: _______________________________________