DIVISION OF BOHOL

M&E FORM 1B
ACTIVITY ATTENDANCE SHEET

Date: September 15, 2018 Title: District-Based Orientation on the Adoptation & Implementation

Duration (days/part-days): Sub-title: of PPST, PPST Modules,RPMS Manuals,Research Development

Component: Location: Mabini Central Elementary Shool

Output: Lead Trainer:
Integrated/combined Type of training Formal training q Workshop q Presentation q
Y / N
participant training activity Meeting q Other q Describe …..……………
Participatory planning: Y / N Office Use only Division Database Event ID

Sex
PRINT School / (check Date: September 15, 2018
No. Grade / appropriate) Signature
Surname AM PM
First Name MI Section Male Female
(Family name) IN OUT IN OUT
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BRIELLENA M. LUEGA
Central School Principal MA. MAYA V. TUMALON, Ph.D
Public Schools District Supervisor
 DIVISION OF BOHOL
M&E FORM 1B
ACTIVITY ATTENDANCE SHEET

Date: September 14, 2018 Title: District-Based Orientation on the Adoptation & Implementation

Duration (days/part-days): Sub-title: of PPST, PPST Modules,RPMS Manuals,Research Development

Component: Location: Mabini Central Elementary Shool

Output: Lead Trainer:
Integrated/combined Type of training Formal training q Workshop q Presentation q
Y / N
participant training activity Meeting q Other q Describe …..……………
Participatory planning: Y / N Office Use only Division Database Event ID

Sex
PRINT School / (check Date: September 14, 2018
No. Grade / appropriate) Signature
Surname AM PM
First Name MI Section Male Female
(Family name) IN OUT IN OUT
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BRIELLENA M. LUEGA
Central School Principal MA. MAYA V. TUMALON, Ph.D
Public Schools District Supervisor
 DIVISION OF BOHOL
M&E FORM 1B
ACTIVITY ATTENDANCE SHEET

Date: September 1, 2018 Title: District-Based Orientation on the Adoptation & Implementation

Duration (days/part-days): Sub-title: of PPST, PPST Modules,RPMS Manuals,Research Development

Component: Location: Mabini Central Elementary Shool

Output: Lead Trainer:
Integrated/combined Type of training Formal training q Workshop q Presentation q
Y / N
participant training activity Meeting q Other q Describe …..……………
Participatory planning: Y / N Office Use only Division Database Event ID

Sex
PRINT School / (check Date: September 1, 2018
No. Grade / appropriate) Signature
Surname AM PM
First Name MI Section Male Female
(Family name) IN OUT IN OUT
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BRIELLENA M. LUEGA
Central School Principal MA. MAYA V. TUMALON, Ph.D
Public Schools District Supervisor
 DIVISION OF BOHOL
M&E FORM 1B
ACTIVITY ATTENDANCE SHEET

Date: August 31, 2018 Title: District-Based Orientation on the Adoptation & Implementation

Duration (days/part-days): Sub-title: of PPST, PPST Modules,RPMS Manuals,Research Development

Component: Location: Mabini Central Elementary Shool

Output: Lead Trainer:
Integrated/combined Type of training Formal training q Workshop q Presentation q
Y / N
participant training activity Meeting q Other q Describe …..……………
Participatory planning: Y / N Office Use only Division Database Event ID

Sex
PRINT School / (check Date: August 31, 2018
No. Grade / appropriate) Signature
Surname AM PM
First Name MI Section Male Female
(Family name) IN OUT IN OUT
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BRIELLENA M. LUEGA
Central School Principal MA. MAYA V. TUMALON, Ph.D
Public Schools District Supervisor
 DIVISION OF BOHOL
M&E FORM 1B
ACTIVITY ATTENDANCE SHEET

Date: August 19, 2018 Title: District-Based Orientation on the Adoptation & Implementation

Duration (days/part-days): Sub-title: of PPST, PPST Modules,RPMS Manuals,Research Development

Component: Location: Mabini Central Elementary Shool

Output: Lead Trainer:
Integrated/combined Type of training Formal training q Workshop q Presentation q
Y / N
participant training activity Meeting q Other q Describe …..……………
Participatory planning: Y / N Office Use only Division Database Event ID

Sex
PRINT School / (check Date: August 17, 2018
No. Grade / appropriate) Signature
Surname AM PM
First Name MI Section Male Female
(Family name) IN OUT IN OUT
1
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BRIELLENA M. LUEGA
Central School Principal MA. MAYA V. TUMALON, Ph.D
Public Schools District Supervisor
 DIVISION OF BOHOL
M&E FORM 1B
ACTIVITY ATTENDANCE SHEET

Date: August 18, 2018 Title: District-Based Orientation on the Adoptation & Implementation

Duration (days/part-days): Sub-title: of PPST, PPST Modules,RPMS Manuals,Research Development

Component: Location: Mabini Central Elementary Shool

Output: Lead Trainer:
Integrated/combined Type of training Formal training q Workshop q Presentation q
Y / N
participant training activity Meeting q Other q Describe …..……………
Participatory planning: Y / N Office Use only Division Database Event ID

Sex
PRINT School / (check Date: August 18, 2018
No. Grade / appropriate) Signature
Surname AM PM
First Name MI Section Male Female
(Family name) IN OUT IN OUT
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BRIELLENA M. LUEGA
Central School Principal MA. MAYA V. TUMALON, Ph.D
Public Schools District Supervisor
 DIVISION OF BOHOL
M&E FORM 1B
ACTIVITY ATTENDANCE SHEET

Date: April 10, 2019 Title: ABACA TEACHERS MEETING

Duration (days/part-days): Sub-title:

Component: Location: ABACA ELEM. SCHOOL

Output: Lead Trainer:
Integrated/combined Type of training Formal training q Workshop q Presentation q
Y / N
participant training activity Meeting q Other q Describe …..……………
Participatory planning: Y / N Office Use only Division Database Event ID

Sex
PRINT School / (check Date: APRIL 10, 2019
No. Grade / appropriate) Signature
Surname AM PM
First Name MI Section Male Female
(Family name) IN OUT IN OUT
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7
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Prepared by:
ESMERALDA N. ELLE
School-In-Charge

Noted by:
THELMA B. FELECIO
Cluster Head
ation q
 DIVISION OF BOHOL
M&E FORM 1B
ACTIVITY ATTENDANCE SHEET

Date: Monday, September 04, 2017 Title: CI Team Meeting

Duration (days/part-days): Sub-title:

Component: Location: Abaca Elementary School

Output: Lead Trainer:
Integrated/combined Type of training Formal training q Workshop q Presentation q
Y / N
participant training activity Meeting q Other q Describe …..……………
Participatory planning: Y / N Office Use only Division Database Event ID

Sex
PRINT School / (check Date: June 18, 2017
No. Grade / appropriate) Signature
Surname AM PM
First Name MI Section Male Female
(Family name) IN OUT IN OUT
1 Glamayo June Gabriel 0 K /
2 Tutor Emmanuel U. K /
3 Labares Silver Faith L K /
4 Mazo Zandralyn O. K /
5 Ladra Jan Edrian S. I-B /
6 Tutor Alexa P I- B /
7 Peligrino Reyner E II-B /
8 Balbadores Maricris L II-B /
9 Terante, Nicole II-B /
10 Jotojot Cristine Mae L II-A /
11 Eroy Rhyll E III-B /
12 Labrador Reymark III-B /
13 Bayron Pauline B III-B /
14 Degamo James B IV-A /
15 Bucio Ella Mae IV-A /
16 Ladra Ma. Sonia E IV-B /
17 Jotojot Trisha Mae C IV_B /
18 Mazo Denmark O. V-A /
19 Bucio Ailen Mae V-A /
20 Jotojot Rudelyn L V-A /
21 Hinautan Charles V-B /
22 Miano Clark Khent V-B /
23 Avelinda Vincent James VI-A /
24 Tutor Manny R VI-A /
25 Ellorimo Daniela V VI-A /
26 Santiago Cirilo S. VI-B /

Prepared by: Noted by:

ESMERALDA N. ELLE THELMA B. FELECIO
Adviser School Head
 DIVISION OF BOHOL
M&E FORM 1B
ACTIVITY ATTENDANCE SHEET

Date: Monday, September 04, 2017 Title: Meeting of SBFP Beneficiaries' Parents

Duration (days/part-days): Sub-title: School-B

Component: Location: Abaca Elementary School

Output: Lead Trainer: Miss Th
Integrated/combined Type of training Formal training q Workshop q Presentation q
Y / N
participant training activity Meeting q Other q Describe …..……………
Participatory planning: Y / N Office Use only Division Database Event ID

Sex
PRINT School / (check Date: June 18, 2017
No. Grade / appropriate) Signature
Surname AM PM
First Name MI Section Male Female
(Family name) IN OUT IN OUT
1 Glamayo June Gabriel 0 K
2 Tutor Emmanuel U. K
3 Labares Silver Faith L K
4 Mazo Zandralyn O. K
5 Ladra Jan Edrian S. I-B
6 Tutor Alexa P I- B
7 Peligrino Reyner E II-B
8 Balbadores Maricris L II-B
9 Terante, Nicole II-B
10 Jotojot Cristine Mae II-A
11 Eroy Rhyll E III-B
12 Labrador Reymark III-B
13 Bayron Pauline B III-B
14 Degamo James B IV-A
15 Bucio Ella Mae IV-A
16 Ladra Ma. Sonia IV-B
17 Jotojot Trisha Mae IV_B
18 Mazo Denmark O. V-A
19 Bucio Ailen Mae V-A
20 Jotojot Rudelyn L V-A
21 Hinautan Charles V-B
22 Miano Clark Khent V-B
23 Avelinda Vincent James VI-A
24 Tutor Manny R VI-A
25 Ellorimo Daniela V VI-A
26 Santiago Cirilo S. VI-B

Prepared by: Noted by:

ESMERALDA N. ELLE THELMA B. FELECIO
Adviser School Head
 DIVISION OF BOHOL
M&E FORM 1B
ACTIVITY ATTENDANCE SHEET

Date: Title:

Duration (days/part-days): Sub-title:

Component: Location:
Output: Lead Trainer:
Integrated/combined Type of training Formal training q Workshop q Presentation q
Y / N
participant training activity Meeting q Other q Describe …..……………
Participatory planning: Y / N Office Use only Division Database Event ID

Sex
PRINT School / (check Date:
No. Grade / appropriate) Signature
Surname AM PM
First Name MI Section Male Female
(Family name) IN OUT IN OUT
1
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Prepared by:
TERESITA T. FELECIO
School Math Coordinator

Noted by:
STEPHEN P. OLAYVAR
Math Coordinator
 DIVISION OF BOHOL
M&E FORM 1B
ACTIVITY ATTENDANCE SHEET

Date: November 10, 2018 Title: LEARNING ACTION CELL (LAC) GRADE V

Duration (days/part-days): Sub-title: Demo-Teaching on MS Word Integration (Englis)

Component: Location: Mabini Central Elementary School, Mabini, Bohol

Output: Lead Trainer: Mr. Teodocio J. Piquero
Integrated/combined Type of training Formal training q Workshop q Presentation q
Y / N
participant training activity Meeting q Other q Describe …..……………
Participatory planning: Y / N Office Use only Division Database Event ID

Sex
PRINT School / (check Date: November 10, 2018
No. Grade / appropriate) Signature
Surname AM PM
First Name MI Section Male Female
(Family name) IN OUT IN OUT
1
2
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Prepared by:
ESMERALDA N. ELLE
Training Manager

Noted by:
TEODUCIO J. PIQUERO
Head Teacher III/District Grade V Coordinator
MN[;BVV
SCHOOL PHYSICAL AND FINANCIAL OUTPUT MONITORING AND EVALUATION for SIP/AIP QUARTER 1 (MONTHS OF JUNE-AUGUST 2016)
SCHOOL: __________________________
S.Y. 2016-2017 __________________________

OUTPUT ACTUAL COST %

OVERALL
Amount & Source OF THE
Target COST
BUDGET
Objectively Verifiable
Programs and Projects Indicators (OVIs)
Means of Verifications (MoVs) Actual 1st OTHERS
Balance % Accomp (Budget (Write the
(Based on Quarter GAA SEF MOOE PTA CANTEEN IGP SSG / SPG SCH.PUB ALUMNI TOTAL (Total Actual
based on NAME of Cost vs Overall
your AIP)
AIP) Stakeholder)
Cost)
PROVISION OF EQUITABLE ACCESS
Fill up school's target projects based on AIP (if there's any)
1. Improved availability of instructional materials and equipment
Secured I-Plans by grade per subject 1 Instructional plans reproduced Inventory Custodian Slip 1 1 0 100% - #DIV/0!

Acquired Teachers Guide by grade per

5 TG acquired 5 4 1 80% - #DIV/0!
subject Inventory Custodian Slip
Acquired Curriculum Guide by Grade per
6 CG acquired 6 6 0 100% - #DIV/0!
subject area Inventory Custodian Slip
Acquired DLP Activity Sheets by grade per
0 activity sheets acquired 0 0 0 #DIV/0! - #DIV/0!
subject
Inventory Custodian Slip
Acquired Learners' Materials by grade per
5 LM acquired 5 4 1 80% - #DIV/0!
subject
Inventory Custodian Slip
Acquired supplementary reference
0 big book acquired 0 0 #DIV/0! - #DIV/0!
materials (ex. big book) Inventory Custodian Slip
Acquired supplementary reference
0 0 0 #DIV/0! - #DIV/0!
materials (ex. review materials) review materials reproduced Inventory Custodian Slip
Acquired supplementary reference
0 0 0 #DIV/0! - #DIV/0!
materials (ex. activity sheets) activity sheets downloaded Inventory Custodian Slip
Acquired supplementary reference
0 0 0 #DIV/0! - #DIV/0!
materials (ex. test materials) test materials reproduced Inventory Custodian Slip
Acquired supplementary reference
0 Strategic Intervention Materials 0 0 #DIV/0! - #DIV/0!
materials (ex. SIM) acquired Inventory Custodian Slip
Acquired learning equipment (ex. Science /
2 2 2 0% - #DIV/0!
Math /TLE equipment / Garden Tools etc) (name of equipment) acquired Inventory Custodian Slip
Acquired health emergency equipment 1 emergency kit acquired Inventory Custodian Slip 1 1 0% - #DIV/0!
Acquired fire emergency equipment 1 fire extinguisher acquired Inventory Custodian Slip 1 1 0% #DIV/0!

Provided supplies for instructional 1 1 1 0% #DIV/0!

materials to teachers teachers provided Requisition and Issuance Slip
(insert rows for more entries) # others, specify Requisition and Issuance Slip # #VALUE! #VALUE! - #DIV/0!
2. Improved physical environment for learning

Repaired classroom ceiling 0 ceiling repaired 0 0 #DIV/0! - #DIV/0!

Program of Work and Official Receipt

Painted _______________________ 1 (name the target scope) painted 1 1 0% - #DIV/0!

Program of Work and Official Receipt

Replaced _____________________ (name the target scope) replaced 0 0 #DIV/0! - #DIV/0!

Program of Work and Official Receipt
(name the target scope)
Constructed ___________________ # # #VALUE! #VALUE! - #DIV/0!
constructed Program of Work and Official Receipt

Installed ______________________ # (name the target scope) installed # #VALUE! #VALUE! - #DIV/0!
Program of Work and Official Receipt
(name the target scope)
Concreted ____________________ # # #VALUE! #VALUE! - #DIV/0!
concreted Program of Work and Official Receipt

Completed ____________________ # (name the target scope) painted # #VALUE! #VALUE! - #DIV/0!
Program of Work and Official Receipt

other maintenance works, specify # (name the target scope) painted # #VALUE! #VALUE! - #DIV/0!
Program of Work and Official Receipt
(insert rows for more entries)
TOTAL 23 15 #VALUE! 65% - - - - - - - - - - - - #DIV/0!
INSTRUCTIONS ON FILLING UP THE TEMPLATE
1. Examine targets in your SIP/AIP for the specified quarter.
2. Plot target quantity by replacing the number (#) sign at the OVI's column. The Target's column will automatically generate the same number
3. Make sure MOVs contain correct date, quantity, specific description of item, amount incurred, source of fund, signature of receiver and school head.
4. Write the number of actual accomplishment under column 'Actual' as reflected in your MOV.
5. Plot amount of your project based on AIP.
6. Under 'Amount and Source' column, plot the actual amount incurred based on OR/RER or ICS/RIS. The total amount incurred automatically generate at the 'TOTAL' column and the percentage at the '% OF THE BUDGET' column.
7. School, Name, Title and Signature of school head and other persons involved in preparing the document (MOVs)
8. All learning materials and equipment can be summarized in one document (ICS/RIS) and served as the school MOV for DsMEA. It is suggested that items follow the sequence in the M&E Template to facilitate validation.
SCHOOL PHYSICAL AND FINANCIAL OUTPUT MONITORING AND EVALUATION for SIP/AIP QUARTER 1 (MONTHS OF JUNE-AUGUST 2016)
SCHOOL:
S.Y. 2016-2017

OUTPUT ACTUAL COST

%
OVERALL Amount & Source
OF THE
Target COST
BUDGET
Objectively Verifiable Means of Verifications
Programs and Projects Indicators (OVIs) (MoVs) OTHERS
Actual Balance % Accomp (Write the
GAA SEF MOOE PTA CANTEEN IGP SSG / SPG SCH.PUB ALUMNI NAME of
TOTAL
(Based on (Budget based (Total Actual
Stakeholder)
your AIP) on AIP) Cost vs Overall
Cost)
QUALITY AND RELEVANCE
Improved subject knowledge, skills and attitudes of teachers
Implemented Continuous Improvement Project re: KSA of teacher/s respondents Attendance Sheet / Certificate
8 0 8 0% - #DIV/0!
Teachers 8 attended of Participation
LAC Documentation Report
LAC Sessions conducted 8 8 0% - #DIV/0!
Conducted monthly LAC Session 8 with attendance sheet
Attendance Sheet / Certificate
teachers participated # #VALUE! #VALUE! - #DIV/0!
Conducted school based training program # of Participation

Participated in district training program approved by teachers participated Certificate of Participation # #VALUE! #VALUE! NMMKK;V - #DIV/0!
DepEd #
Enrolled to Masters and other Higher Education teachers enrolled Enrolment Card /O R # #VALUE! #VALUE! - #DIV/0!
Programs #
Implemented Special Curriculum Programs (i.e Sci Class, Report on Organization of
program implemented # #VALUE! #VALUE! - #DIV/0!
Madrasah etc) selected schools only # classes

program implemented Implementation Status Report # #VALUE! #VALUE! - #DIV/0!

Implemented Dynamic Learning Program (DLP) -Sec only #
(insert rows for other mandated activities)
Improved subject knowledge of pupils
Improved language and reading comprehension skills of pupils

student/pupil Attendance Sheet / Certificate

Implemented Continuous Improvement Project/s ( based # #VALUE! #VALUE! - #DIV/0!
respondents benefited of Participation
on ORVT.EGRA, Phil-IRI SReYA etc if there's any) #

Implemented sustainability Program/s in Reading (ex. student/pupil Attendance Sheet / Certificate

# #VALUE! #VALUE! - #DIV/0!
Remediation/Tutorial Program) # respondents benefited of Participation
pupils/students
Certificate of Participation # #VALUE! #VALUE! - #DIV/0!
Participated Read-A-thon * District Level # participated

Participated ALM: Speech Choir/Sabayang Pagbigkas * pupils/students

Certificate of Participation # #VALUE! #VALUE! - #DIV/0!
District Level # participated
pupils/students
Certificate of Participation # #VALUE! #VALUE! - #DIV/0!
Participated ALM: Spelling Bee * District Level # participated
pupils/students
Participated ALM: Jazz Chants * District Level # Certificate of Participation # #VALUE! #VALUE! - #DIV/0!
participated
Participated Story Writing * District Level # pupils/students participat Certificate of Participation # #VALUE! #VALUE! - #DIV/0!
Participated Press Conference * District Level # pupils/students participat Certificate of Participation # #VALUE! #VALUE! - #DIV/0!
(insert rows for other mandated activities)
Improved mathematical skills of pupils/students

Implemented Continuous Improvement Project in (Title of CI Project)

Minutes of Meetings # #VALUE! #VALUE! - #DIV/0!
Mathematics (if there's any) # implemented

Participated Metrobank-MTAP-DEPED Math Challenge * pupils/students

Certificate of Participation # #VALUE! #VALUE! - #DIV/0!
Distict Level # participated
Participated Super Quiz Bee * District Level # pupils/students participat Certificate of Participation # #VALUE! #VALUE! - #DIV/0!
(insert rows for other mandated activities)
Improved scientific skills of pupils/students

Implemented Continuous Improvement Project in student/pupil

Attendance Sheet # #VALUE! #VALUE! - #DIV/0!
Science (if there's any) # respondents benefited
 pupils/students participat Certificate of Participation # #VALUE! #VALUE! - #DIV/0!
Participated District Level Science Fair #
(insert rows for other mandated activities)
Improved arts and life skills of pupils/students

Implemented Continuous Improvement Project in student/pupil Attendance Sheet/Certificate

# #VALUE! #VALUE! - #DIV/0!
MSEP/MAPEH (if there's any) # respondents benefited of Participation
Participated ALM: Stage Musical * District Level # pupils/students participat Certificate of Participation
pupils/students
Participated Scouting Activities # Certificate of Participation # #VALUE! #VALUE! - #DIV/0!
participated
pupils/students
Certificate of Participation # #VALUE! #VALUE! - #DIV/0!
Participated sports activities * School Level (Intramurals) # participated
pupils/students
Certificate of Participation # #VALUE! #VALUE! - #DIV/0!
Participated sports activities * District level # participated
(insert rows for other mandated activities)
Improved nutritional status of pupils
Implemented Continuous Improvement Project on health student/pupil
Attendance Sheet # #VALUE! #VALUE! - #DIV/0!
and nutrition (if there's any) # respondents benefited
School Based Feeding
beneficiaries served # #VALUE! #VALUE! - #DIV/0!
Conducted feeding program # Program Form 4

pupils participated Implementation Status Report # #VALUE! #VALUE! - #DIV/0!

Implemented Essential Health Care Program #
(insert rows for other mandated activities)
TOTAL 16 0 #VALUE! #VALUE! 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!

INSTRUCTIONS ON FILLING UP THE TEMPLATE

1. Examine targets in your SIP/AIP for the specified quarter.
2. Plot target quantity by replacing the number (#) sign at the OVI's column. The Target's column will automatically generate the same number
3. Make sure MOVs contain correct dates, titles,
4. Write the number of actual accomplishment under column 'Actual' as reflected in your MOV.
5. Plot amount of your project based on AIP.
6. Under 'Amount and Source' column, plot the actual amount incurred based on OR/RER or ICS/RIS. The total amount incurred automatically generate at the 'TOTAL' column and the percentage at the '% OF THE BUDGET' column.
7. School, Name, Title and Signature of school head and other persons involved in preparing the document (MOVs)
8. It is suggested that MOVs are arranged following the sequence in the M&E Template to facilitate validation.
SCHOOL PHYSICAL AND FINANCIAL OUTPUT MONITORING AND EVALUATION for SIP/AIP QUARTER 1 (MONTHS OF JUNE-AUGUST 2016)
SCHOOL:
S.Y. 2016-2017

OUTPUT ACTUAL COST %

OVERALL
Amount & Source OF THE
Target COST
BUDGET
Objectively Verifiable Indicators OTHERS
Programs and Projects (OVIs) Means of Verifications (MoVs)
Actual Balance % Accomp (Write the
(Budget CANTE SSG / SCH.PU
(Based on GAA SEF MOOE PTA IGP ALUMNI NAME of TOTAL (Total Actual
based on EN SPG B Stakeholder
your AIP) Cost vs Overall
AIP) ) Cost)
GOVERNANCE
EDUCATIONAL MANAGEMENT AND ADMINISTRATION
1. Improved school leadership and management
Implemented Continuous Improvement Program on any of School 1 0 1 0% - #DIV/0!
Leadership Management area (if there's any) 1 CI project title implemented Minutes of CI Meetings
Formulated/Adjusted SIP/AIP with stakeholders 1 SIP /AIP formulated/adjusted SIP Acceptance Certificate/Adjusted AIP 1 0 1 0% - #DIV/0!
Institutionalized M&E mechanism 1 SIP/M&E mechanism institutionalized Organizational Structure, Work Plan,Minutes of Meetings 1 0 1 0% - #DIV/0!
Institutionalized Multi-Sectoral Partnership 1 multi-sectoral group institutionalized Organizational Structure, Work Plan,Minutes of Meetings 1 0 1 0% - #DIV/0!
Institutionalized Parents Teachers Association programs & PTA programs & projects 1 1 0 100% - #DIV/0!
projects 1 institutionalized Organizational Structure, Work Plan,Minutes of Meetings
Institutionalized school level rewards system 1 periodic awarding activity institutionalized List of awards and awardees 1 0 1 0% - #DIV/0!
Child Protection mechanism 1 0 1 0% - #DIV/0!
Operationalized Child Protection Mechanism 1 operationalized Organizational Structure, Work Plan,Minutes of Meetings
Operationalized Disaster Risk Reduction Management 1 DRRM operationalized Organizational Structure, Work Plan,Minutes of Meetings 1 0 1 0% - #DIV/0!

Operationalized Results Based Performance Management 1 1 0 100% - #DIV/0!

System 1 RPMS operationalized Organizational Structure, Work Plan,Minutes of Meetings
Operationalized subject area clubs/organizations 1 subject area clubs operationalized Organizational Structure, Work Plan,Minutes of Meetings 1 0 1 0% - #DIV/0!
Operationalized Student/Pupil Government Organization 1 SSSG/SPG operationalized Organizational Structure, Work Plan,Minutes of Meetings 1 1 0 100% - #DIV/0!
coaching on classroom management 1 1 0 100% - #DIV/0!
Conducted coaching to teachers on Classroom Management 1 conducted RPMS Coaching and Monitoring Form
Conducted physical and property inventory of materials and Annual physical and property inventory report 1 1 0 100% - #DIV/0!
facilities 1 inventory of properties conducted (Property Section Format)
Implemented monthly National Greening Program 3 months implemented National Greening Program Report 3 0 3 0% - #DIV/0!
Managed teachers database 1 teachers database managed teachers database 1 0 1 0% - #DIV/0!

Published updated liquidation/financial reports on Transparency 1 1 0 100% - #DIV/0!

Board on all sources of funds 1 Transparency board updated clear picture of posted Financial Statements
Updated EBEIS (BOSY/EOSY) 1 EBEIS updated system generated ebeis copy 1 1 0 100% - #DIV/0!

Updated Learners Information System (LIS) 1 LIS updated system generated LIS copy 1 1 0 100% - #DIV/0!

Updated National School Building Inventory (NSBI) 1 NSBI updated system generated NSBI copy 1 0 1 0% - #DIV/0!
(insert rows for other management activities) - #DIV/0!
2. Strengthened stakeholders participation
Implemented Continuous Improvement Program on any of 1 0 1 0% - #DIV/0!
Stakeholders Participation area (if there's any) 1 (CI project title) implemented Minutes of CI Meetings
Mobilized Adopt-A-School Program 1 Adopt-A-School Program mobilized MOA / Deed of Donation 1 0 1 0% - #DIV/0!

Implemented Amoma Giya Alang sa Kalampusan (AGAK) 1 1 0 100% - #DIV/0!

Program (K-Grade 10) 1 AGAK Program implemented list of beneficiaries
Implemeted LAMPOS PERME (SHS only) LAMPOS PERME Program implemented list of beneficiaries 0 0 0 #DIV/0! - #DIV/0!
Conducted Brigada Eskwela Plus Activities 1 Brigada Eskwela program conducted BE Attendance Form, pictures 1 1 0 100% - #DIV/0!

educational advocacy on (topic) 1 0 1 0% - #DIV/0!

Conducted educational advocacy/forum with school stakeholders 1 conducted Attendance Sheet
resolutions approved / LGU Sessions
Enhanced LGU participation (Brgy/Municipal/Province) attendance, copy of granted resolution 1 0 1 0% - #DIV/0!
1 attended
(insert rows for other management activities) #DIV/0! - #DIV/0!
3. Intensified instructional supervision
Implemented Continuous Improvement Program on any of 1 0 1 0% - #DIV/0!
Instructional Supervision area (if there's any) 1 (CI project title) implemented Minutes of CI Meetings
Conducted classroom observation 45 observations conducted Observation notes 45 42 3 93% - #DIV/0!
Conducted action research based on school problems in Approved Action Research and completion 1 0 1 0% - #DIV/0!
curriculum 1 action research conducted report

8 8 0 100% - #DIV/0!
Conducted coaching on Instructional Delivery 8 teachers / Master Teachers coached Performance Coaching and Monitoring Report
(insert rows for other management activities) - #DIV/0!
4. Intensified resource mobilization/resource generation
Prepared Annual Procurement Program 1 APP prepared Approved APP 1 1 0 100% - #DIV/0!
Implemented Income Generating Projects 1 IGP conducted Financial Report 1 0 1 0% - #DIV/0!
Implemented Food Security Program (Gulayan sa Paaralan, (name of project/s) implemented Financial updates with report on utilization 1 0 1 0% - #DIV/0!
Piggery, Goatery etc) 1

(insert rows for other management activities) - #DIV/0!

GRAND TOTAL 84 84 61 23 #DIV/0! 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!

INSTRUCTIONS ON FILLING UP THE TEMPLATE

1. Examine targets in your SIP/AIP for the specified quarter.
2. Plot target quantity by replacing the number (#) sign at the OVI's column. The Target's column will automatically generate the same number.
3. Make sure MOVs contain correct dates, source of fund
4. Write the number of actual accomplishment under column 'Actual' as reflected in your MOV.
5. Plot amount of your project based on AIP.
6. Under 'Amount and Source' column, plot the actual amount incurred based on OR/RER or ICS/RIS. The total amount incurred automatically generate at the 'TOTAL' column and the percentage at the '% OF THE BUDGET' column.
7. School, Name, Title and Signature of school head and other persons involved in preparing the document (MOVs)
8. It is suggested that MOVs are arranged following the sequence in the M&E Template to facilitate validation.
 INVENTORY CUSTODIAN SLIP

DEPARTMENT OF EDUCATION
(Agency)

School: CARMEN EAST CENTRAL ES ICS No: OO3

District: CARMEN EAST Date: 30-Aug-16

(Below are sample entries. Erase/overwrite for your school's data)

Estimated
Date Property Quanti Source of
Unit Article / Description Subject Grade Cost Useful
Acquired No. ty Fund
Years

17-Aug-16 PO 2016- 50 copy activity sheets MTB 1 50.00 MOOE 1

07-005

17-Aug-16 PO 2016- 250 copy Periodic Test Papers English 5 150.00 MOOE 2
07-003
PO 2016-
18-Aug-16 60 copy activity sheets Filipino 1 50.00 SBM 1
07-006
add rows for more entries
TOTAL 7 250.00

CERTIFICATION

I/We hereby certify to the correctness, validity and accuracy of the above stated data of the school in
support to accomplishment of the SIP/AIP Programs and Projects SY 2016-2017.

Property Custodian Name of Principal

Date Date
 Republic of the Philippines
Department of Education
Region VII, Central Visayas
Division of Bohol
City of Tagbilaran

PROGRAM OF WORK

Project Title:
Component:
Physical Target:
Name of School:
Brgy/Mun/Province:
Total Project Cost:
Project Description:
Project Duration:
Equipment/Tools Needed:

Item No. Scope of Work Total FUND SOURCE

% of Total Qty Unit Unit Price
Amount MOOE Stakeholders
1
2
3
4
5 Sub Total
Breakdown of Cost Estimates MOOE Stakeholders
A. Direct Cost
1. Materials
2. Labor (Manual)
Sub Total
B. Indirect Cost
3. Engg Supervision
4. Contingencies
Sub Total
Grand Total

Prepared by:

Noted:
I.A. Teacher

Principal
 BILL OF MATERIALS AND COST ESTIMATES

Project Title:
School:

Location:
Component:
Materials Cost: P -

Item No. Qty. Unit Particulars Unit Cost Total Cost MOOE STAKEHOLDERS

1
2
3

Sub Total - - -

Item No. Particulars Total Cost MOOE STAKEHOLDERS

1 Materials
2 Labor
Sub Total
3 Eng'g Supervision
4 Contingencies
Sub Total
GRAND TOTAL

Prepared by: Noted:

I.A. Teacher Principal

 REQUISITION AND ISSUANCE SLIP
Department of Education
Region VII, Central Visayas
Division of Bohol
City of Tagbilaran
Agency
Division: BOHOL Resp. Center RIS No. Date:
Office: SAI No. Date: Feb-18
REQUISITION ISSUANCE
Actual
Stock No. Qty. Unit Description APP Price Qty. Price Remarks
1 15 ream bond paper long (8.5x13) 185.00 2775
2 1 pc sign pen my gel blue 60.00 60.00
3 6 pc sign pen g-tec 0.3 black 60.00 360.00
4 1 pc Casio Calculator 12 digit 500.00 500.00
5 2 pc bond paper short (8.5x11) 180.00 360.00
6 12 pc Scotch Tape 2" 28.00 336.00
7 5 pack Vellum Paper 8.5x11 48.00 240.00
8 10 PC Black Cartolina 5.00 50.00
9 20 pc Asstd Cartolina Bright Colors5 5.00 100.00
9 5 pcpc Clear book Long 140.00 700.00
10 6 pc Expanded Folder Green long 11.00 66.00
11 4 pc Green folder Long 9.00 36.00
12 2 box Paper fastener plastic 40.00 80.00
13 3 bot Elmer's Glue 130g 50.00 150.00
14 1 box Maxx Staple Wire #10 35.00 35.00
15 2 pc double sided tape 1" 32.00 64.00
16 2 box Mitsuya Thumbtacks 12.00 24.00
17 1 pc Chalkboard eraser big 40.00 40.00
18 1 jar Elmer's Glue 1010g 450.00 450.00
19 1 pc heavy duty puncher big 165.00 165.00
20 2 pc frame glass 8.5x11 75.00 150.00
21 1 pc Dong-A fine tech 0.3 refill 15.00 15.00
22 6 pack linen paper asst long 35.00 210.00
23 6 rolls ribbons (leis & sashes) 125.00 750.00
24 30 pcs Balloons Asstd colors 15.00 450.00
25 100 pcs Certificate Holder 40.00 4000.00
26
27
28 12166.00
29
30
31
32
33
34
35
36
37
38
39
Purpose: Supplies for instructional materials development
Requested by: Approved by: Issued by: Received by:
Signature:
Printed Name: THELMA S. LADRA ESMERALDA N. ELLE
Designation: Supply Officer School Head Supply Officer End-user
Date: Date:
 REQUISITION AND ISSUANCE SLIP
Department of Education
Region VII, Central Visayas
Division of Bohol
City of Tagbilaran
Agency
Division: BOHOL Resp. Center RIS No. Date:
Office: SAI No. Date:
REQUISITION ISSUANCE
Actual
Stock No. Qty. Unit Description APP Price Qty. Price Remarks
1
2
3
4
5
6
7
8
9
10

Purpose: Supplies for instructional materials development

Requested by: Approved by: Issued by: Received by:
Signature:
Printed Name:
Designation: Supply Officer School Head Supply Officer End-user
Date: Date:
 DIVISION OF BOHOL
M&E FORM 1B
ACTIVITY ATTENDANCE SHEET

Date: Monday, September 10, 2018 Title: SBFP 2ND MEETING

Duration (days/part-days): Sub-title:

Component: Location: Abaca Elementary School

Output: Lead Trainer: ESMERALDA N. ELLE
Integrated/combined Type of training Formal training q Workshop q Presentation q
Y / N
participant training activity Meeting q Other q Describe …..……………
Participatory planning: Y / N Office Use only Division Database Event ID

(check
PRINT Date: September 10, 2018
approp
No. riate) Signature
Surname AM PM
First Name MI
(Family name) CELL NO. IN OUT IN OUT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38

Prepared by: Noted by:

ESMERALDA N. ELLE THELMA B. FELECIO
Feeding Coordinator Cluster Head
 Republic of the Philippines
Department of Education
Region VII, Central Visayas
Division of Bohol
City of Tagbilaran
Agency

LEARNING ACTION CELL (LAC) SESSION

What: (Topic/s of Discussion)

_____________________________________
_____________________________________
_____________________________________

When: (Date of LAC conducted)

_____________________________________

Where: (Venue)
_____________________________________

What: Learnings from the sharing session and discussion

________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________

Next Topic: ________________________________

Venue and Time: _______________________________________

Prepared by: Facilitator:

Secretary School Head

Note:
Attach attendance sheet: M & E Form 1b
 Republic of the Philippines
Department of Education
Region VII, Central Visayas
Division of Bohol
City of Tagbilaran
Agency
School:
District:

DYNAMIC LEARNING PROGRAM

IMPLEMENTATION STATUS REPORT
As of June 13-August 31, 2016

Reasons for the 100%

Grade Required No. of No. of Skills
Section % completed completion / Reasons for the
Level Contact Days Covered
balance

SIGNATURE OVER PRINTED NAME

Designation

SIGNATURE OVER PRINTED NAME

Designation of School Head
 Department of Education
Division of Bohol
SPED/SPECIAL SCIENCE CLASS/MADRASAH
As of _______________

Municipality:________________ Region VII

Division of Bohol

No. of
Annual Enrolment (July 31) Monthly Enrolment No. of Teachers with DepEd Item Teacher Teachers w/
Name of School Program Offered Pupil Ratio non-DepEd
REMARKS
M F T M F T M F T item /local

Total

Verified true & correct:

Prepared by:

Schools District Supervisor

Principal
 Republic of the Philippines
Department of Education
Region VII, Central Visayas
Division of Bohol
City of Tagbilaran
Agency
School:
District:

ESSENTIAL HEALTH CARE PROGRAM

IMPLEMENTATION STATUS REPORT
As of June 13-August 31, 2016

Conducted Daily Conducted Daily

Handwashing Activity Toothbrushing Activity
Grade
Section %. of Children Issues and Concerns
Level %. of children
No. of days who No. of days
participated participated

K
I
II
III

Prepared by:
 Documenter

Noted:

School Head
 Republic of the Philippines
Department of Education
Region VII, Central Visayas
Division of Bohol
City of Tagbilaran
Agency
School: Abaca Eementary School
District: Mabini District

MINUTES OF MEETING

Date of Meeting: February 23, 2018

Venue: Abaca Es Office
No. of Present: 6
No. of Absent: 0
Time Started: 4:08 PM
Presiding Officer: Esmeralda N. Elle

AGENDA: 1 Preparation fo The CI Vadidation

2
3

4 Other Matters
Compose Jingles related to the Project
RESOLUTIONS/AGREEMENTS MADE:
1 Preparation of Fortfolio and MOV's
2 Identifying the Persons needed to be present during Validation
3 ( CI Team, BLGU, Stakeholders, Parents
4
5

AGENDA FOR THE NEXT MEETING:

1 None
2

Time Adjourned: 4:50: PM

Prepared by:
ANALY T. ELLE
SIGNATURE OVER PRINTED NAME
Documenter

Noted:
ESMERALDA N. ELLE
SIGNATURE OVER PRINTED NAME
School Head
Appendix E
BE Form 04
Republic of the Philippines
Department of Education
Region VII
Division: Bohol
School Year: ____________________

BRIGADA ESKWELA
DAILY ATTENDANCE OF VOLUNTEERS
Date: _____________________
Volunteers themselves should personally fill in the details required by this form under the supervision of any of the committee members. *For the
Instructions: last column,
NATURE OF VOLUNTEER
AFTERNOON
MORNING TIME SERVICES RENDERED/ACTIVITY
TIME
TO PARTICIPATE IN
POSITION/ ADDRESS/
CONTACT Total No.

Landscaping/G
NAME DESIGNATIO ORGANIZATION SIGNATURE
NUMBER of Hours

Repainting
Carpentry

plumbing

ardening

Cleaning
/AFFILIATION

Masonry
N

Fencing

etc.
IN OUT IN OUT
Monitored by: Noted:

___________________________ ROSENDO T. LIBRES ESMERALDA N. ELLE

Documenter Brigada Eskwela Coordinator School Head
 DEED OF DONATION
KNOW ALL MEN BY THESE PRESENTS:

WITNESSETH

Details of the Donation School Address

Emergency Kit for pupils

IN WITNESS WHEREOF, the DONOR has hereto subscribed herself/himself this _____ day of ________, 2016.
_________________________
DONOR
(Print Name & Signature)

DEED OF ACCEPTANCE

The DONEE, for and in behalf of the school, hereby accepts and acknowledges the donation from the DONOR and express his most since
appreciation for the benevolence shown by the DONOR.
IN WITNESS WHEREOF, the DONEE has set his hands this ________ day of ________, 2016.

___________________________
DONEE (School Principal)
­_____________________________________________________________________________
Name of School & Address

SIGNED IN THE PRESENCE OF:

____________________________________
Signature over Printed Name

ACKNOWLEDGMENT
REPUBLIC OF THE PHILIPPINES)
_________________________) ss.
 BEFORE ME this (____ ), personally appeared to me with

____________
___________________________

Known to me and to me known to be the same persons who executed the foregoing instrument, and they acknowledged to me that the s
is free and voluntary act and deed, including that of the entities that they represent.

This instrument refers to a Deed of Donation and Certificated of Acceptance that consists of 1 page, including this whereon
acknowledgment is written, and in which is signed by the parties concerned on each and every page thereof.

WITNESS MY HAND AND NOTARIAL SEAL, on the date at the place first written above.

Doc. No.
Page No.

Book No.
Series of
 DEED OF DONATION
THESE PRESENTS:

This Deed of Donation made and executed by the (Name of Company)___________________________ ___
herein represented by ____________________________ with office address at
_______________________________ hereinafter called the DONOR,
________________________________ herein represented by its PRINCIPAL, _________________________
with office address at _________________________________ hereinafter called the DONEE.

That for and in consideration of a desire to contribute a share for the cause of the education of Filipino
learners through the Adopt-a-School Program of the Department of Education, the DONOR has freely and
voluntarily given, transferred and conveyed by way of donation to the DONEE, its successors and assigns free
and clear of any and all liens and encumbrances whatsoever all its rights, interests and title on: ( Title of
Donation) ________________________________

ls of the Donation School Address

_____________________________ ____________________________

OF, the DONOR has hereto subscribed herself/himself this _____ day of ________, 2016.
_________________________
DONOR
(Print Name & Signature)

DEED OF ACCEPTANCE

d in behalf of the school, hereby accepts and acknowledges the donation from the DONOR and express his most sincere
appreciation for the benevolence shown by the DONOR.
OF, the DONEE has set his hands this ________ day of ________, 2016.

___________________________
DONEE (School Principal)
­_____________________________________________________________________________
Name of School & Address

____________________________________
Signature over Printed Name

ACKNOWLEDGMENT

________) ss.
 BEFORE ME this (____ ), personally appeared to me with

CTC# _______________
CTC# _______________

me known to be the same persons who executed the foregoing instrument, and they acknowledged to me that the same
act and deed, including that of the entities that they represent.

ers to a Deed of Donation and Certificated of Acceptance that consists of 1 page, including this whereon this
written, and in which is signed by the parties concerned on each and every page thereof.

AND NOTARIAL SEAL, on the date at the place first written above.

________
________

________
________
NOTARY PUBLIC
 Republic of the Philippines
Department of Education
Region VII, Central Visayas
Division of Bohol
District of _______________
______________________________ SCHOOL

I hereby certify to the correctness, authenticity and veracity of the documents submitted
to the Public Schools District Supervisor to support the school's accomplishment presented for the
SIP/AIP Quarter ________ SY 2016-2017.

That I executed this certificate to attest to the truth of the foregoing statements and my

guide to pursue my commitment and loyalty to the duties and responsibilities attached to my position

SIGNATURE OVER PRINTED NAME OF SCHOOL

DESIGNATION OF SCHOOL HEAD