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Republic of the Philippines

Department of Education
Region 02 (Cagayan Valley)
SCHOOLS DIVISION OFFICE OF ISABELA
Alibagu, City of Ilagan, Isabela 3300

ICTU-TAF-02 ICT EXTERNAL TECHNICAL ASSISTANCE (TA) FORM


CLIENT INFORMATION For DepED Email Password Creation/Reset,
School ID: ____________________________ Pls fill this up: Emp. No.: ________________
School Name: ____________________________________ First Name: ___________________________________________
District: ______________________________ Middle Name: ________________________________________
School Head: _____________________________________ Last Name: ___________________________________________
Contact No.: _________________________ DepED Email (for Reset): _____________________________
ICT Coordinator: __________________________________ Contact No.: ______________________________
Contact No.: _________________________ TIN: _________________ Birthdate: __________________
For DepED LIS/EBEIS User Acct. Mng’t. System: For Internet Connectivity Concern/Issues:
Pls fill this up: Pls fill this up:
Request for Password Reset: Request for TA-Installation:
School Head Username: __________________________ Municipality: __________________________________________
Desired Password: ______________________ Potential Provider: ____________________________________
System Admin Username: __________________________ Request for TA-Existing Subscriber:
Desired Password: ______________________ Status: ( ) Fixed ( ) Portable
Nature: ( ) Postpaid ( ) Prepaid
Request for Change of School Head:
Provider: _______________________________
Name of New School Head: ________________________
Average Spending: ____________________
TIN (New School Head): _____________________
Date of Birth: ______________________ Remarks:
_______________________________________________________
Name of Prev. School Head: ________________________
_______________________________________________________
TIN (Prev. School Head): ____________________
_______________________________________________________
Date of Birth: ______________________
DepED Computerization Program (DCP)
DCP Batch No. ________ Date of Delivery: ______________________
Part Code Hardware Software Network Others
1. Printer 4. Internal 7. OS 10. Installation 13. LAN Configuration
Number: 2. System Unit 5. Peripherals 8. Drivers 11. Update 14. Router/Cables
3. Monitor/Display 6. Connectors/Plugs/Power 9. Malware 12. Files/Data 15. Internet
ITEM DESCRIPTION PROBLEM/ISSUE SERIAL NO.
(Please identify Part Code Number) (Please specify) (Please refer to your Delivery Receipt)
FINDINGS

-----------To be filled up by ICT Unit-----------


STATUS/RECOMMENDATION/REMARKS:

( ) GOOD/RETURNED ( ) CHECK FOR AUTHORIZED SERVICE CENTER ( ) FOR REPLACEMENT ( ) UNSERVICEABLE


OTHER DETAILS:
School Head/Representative: Received/Noted by:

ORLANDO L. NICOLAS, JR.


Signature over Printed Name Information Technology Officer I
Date:_________________________ Date:_________________________

(078) 323-0281 Sdo Isabela Document Code: FM-SDS-ICT-004


(078) 323-2015 https://deped-isabela.com.ph Rev.: 00
isabela@deped.gov.ph As of: 07-02-2018

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