ENCLOSURE 1

Republic of the Philippines

Department of Education
Region X
Division of Lanao del Norte
KAPATAGAN EAST DISTRICT
CURVADA ELEMENTARY SCHOOL

DEPED REGION X COMMUNITY MAPPING TEMPLATE

Address:
Purok Sitio Street Barangay Municipality Province Survey Street No.

Occupation If IP
Parebt's Guardians Name (Last Name, First Name, Birthday Monthly Check if IP 4Ps (Check)
(Select Only)
(dd/mm/yyyy) Educational Attainment
Religion what
MI,Ext) Income
Government Private Self Employed Yes No tribe? Yes No

Studying? With
Name of Dependents Relationship to the Gender Birthday Civil Grade If Not Studying Kind of Check if
Head of the Family
(Last,Firsrt,Middle,Ex (son,daughter,niece, (Check) School and Distance Disability Religion Check if 4P's
t.) (dd/mm/yyyy) Status Level From Home Disability IP
nephew) M F Why?
Yes No Yes No

NIMFA B. DELA TORRE

Name and Signature of Respondents Name Of Enumerator Name Of Respondents