🙋Self-ReferralStudents may ask for guidance support for themselves without needing another referrer.
📣Report a ConcernClassmates, teachers, parents, and school personnel may report a learner concern.
📊Guidance Follow-upSubmissions are organized for review, scheduling, notes, and intervention tracking.
1
Reporter Info
Your role & contact
2
Student Info
Who needs support
3
Concern Details
What & how urgent
4
Review & Submit
Get your ref. no.
🔒Data Privacy Notice: We assure to safeguard your personal information and ensure compliance with the Data Privacy Act of 2012 (R.A. 10173) and DepEd Order No. 40, s. 2012 — Child Protection Policy. All information is strictly confidential.
⏱️ About 5–7 minutes🔑 No login required📄 Receipt provided
Reporter Information
Please identify your role. This QR portal accepts self-referrals and reports from students, parents, teachers, and school personnel.
Role
🎓
Student
📖
Teacher
👤
Parent / Guardian
🏫
School Personnel
Please select your role.
Personal Details
First name is required.
Last name is required.
Reporter school is required.
Format: (0000) 000-0000
Contact number is required.
For follow-up notifications
Privacy Option
Submit Anonymously
Your reporter name will not be saved. Student details are still needed so guidance staff can help the correct learner.
Who Needs Support?
Tell the Guidance Office who this concern is about.
Concerned Person
Please select who needs support.
Date & Time of Concern
Please select a date.
Choose “Not sure” if you do not know the student's previous guidance history.
Concerned Student's Information
Please provide accurate details of the student who needs support.
Student Name
First name is required.
Last name is required.
School is required.
Required.
Track is required for Grade 11 and Grade 12.
Learner Reference Number if known
Urgency Level
Indicate how urgent this referral is so the guidance counselor can prioritize accordingly.
Normal
Routine concern, no immediate risk
Moderate
Needs attention within the week
Urgent
Immediate intervention required — get help now
Please select an urgency level.
🚨Urgent Referral — get help now. For life-threatening situations, do not wait for online processing. Reach out immediately to any of the following:
Your school administration or guidance officeThe National Emergency HotlineSultan Kudarat PDRRMO (Provincial Disaster Risk Reduction & Management Office)The nearest hospital or rural health unitThe nearest PNP / police stationThe Philippine Red Cross
Categories
📚
Academic Development
Nahihirapan ka ba sa'yong pag-aaral?
💛
Personal Development
May pinagdadaanan ka bang problema?
🤝
Social Development / Bullying
Nahihirapan ka bang makitungo sa iba?
🌱
Career Development
Hindi ka pa desidido sa propesyon?
Please select at least one category.
What is/are your concern/s?
Select all concerns that apply within each category.
Additional Details
Please provide any additional context or narrative about the concern.
0 / 500 characters
Supporting Documents (Optional)
📎
Click to attach files or drag and drop
Accepted: JPG, PNG, PDF, DOCX — Max 5MB per file
Review & Submit
Please review all information before submitting. You may go back to correct any details.
⚠️By submitting this form, you confirm that the information provided is truthful and accurate to the best of your knowledge, in accordance with DepEd's Child Protection Policy.
✓
Referral Submitted!
Your referral has been officially recorded. A guidance counselor will review and follow up with the concerned student within the timeframe indicated by the urgency level.
