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ICTS - User Support Division

Learner Information System National Helpdesk


Request Form for Reporting QVRs - Public/SUCs/LUCs (Learner/s who are not tagged with QVR in LIS) - RF 11
Subject: Untagged QVRs - Public/SUCs/LUCs
Send to: icts.usd@deped.gov.ph
CURRENT SCHOOL (PRESENT ENROLLMENT) LEARNER'S INFORMATION CREDENTIALS PRESENTED Contact Details
Personal Information as appeared in Birth Certificate
Status as appeared in Requesting
Date of 1st REMARKS
Grade Track/Program Learner Reference Form 138 or Personnel email address phone number
Region Division School ID School Name Attendance School ID School Name School Year
Level Offering Number First Name Middle Name Last Name Ext Name Date of Birth Gender Equivalent Document
(mm/dd/yyy)
(Please Specify)

REMINDERS:
1. Attach scanned copies of the following documents:
a. Form 137 or Form 138
b. Birth Certificate
2. Submit this properly accomplished form in excel format with the attachment (mentioned above) to icts.usd@deped.gov.ph
3. Subject for this email should be: RF 11 Untagged QVRs - School Name
ICTS - User Sup
Learner Information Syste
Template for Reporting Multiple LRN

Subject: Multiple LRN/Enrollment


Send to: icts.usd@deped.gov.ph
Note: Endorsement of School Head is required (signed and scanned). Please use worksheet/exce

Currently Enrolled (Present enrollment)

LRN
Region Division School School ID Grade Section
(Currently Used)
IV-A Quezon GRABSUM School Inc. 402728 Grade 9 St. Sophiel 402728160025

Reported Teacher/ICT Coordinator Name of School


by GRABSUM School Inc.
Jose Jr. C. De Leon
ICTS - User Support Division
Learner Information System National Helpdesk
te for Reporting Multiple LRN/Enrollment (Request Form 01)

). Please use worksheet/excel format for the matrix.

as appeared in Birth Certificate


Date of 1st
Correct Name Attendance
(MM/DD/YYYY)
First Name Middle Name Last Name Ext Name Date of Birth Gender

IIGO LORICA MENDOZA N/A 8/13/2002 Male 6/13/2017

School ID Division Region Endorsed by


402728 Quezon IV-A School Head
OTHER EXISTING
LRN

402729150184

Jennifer D. Sotelo

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