Schools District: ALICIA NORTH

School: STO. DOMINGO ELEMENTARY SCHOOL___________

General Direction: Fill out the template shown below by ticking (ü) the method/technique utilized during the
conduct of Instructional Supervision to all newlyhired teachers in your school.

Year 1, Quarter 1, Module 1

Instructional Supervision Used

Discussion (FGD)
Peer Teaching /
Date of

Focused-Group
Date Hired

other method
Name of Newlyhired Teacher Formal
Mentoring

(mm/dd/year) Remarks
Coaching

Learning

(specify)
Classroom
Observation

1 MARITESS V. NAPARAN JUNE 9, 2016 / Jun-16

2
3
4
5
6
7
8
9
10
*you may add rows as necessary

Prepared by: Checked by:

EDWIN G. DELA PENA ______SUSANA G. LORENZO

(Signature over printed name of School Head) (Signature over printed name of PSDS)

Recommending Approval: Approved:

________________________________________ MADELYN L. MACALLING, PhD, CESO VI
Asst. Schools Division Superintendent OIC - Office of the Schools Division Superintendent
Schools District: _________________________________________________
School: _________________________________________________________

General Direction: Fill out the template shown below by ticking (ü) the method/technique utilized during the
conduct of Instructional Supervision to all newlyhired teachers in your school.

Year 1, Quarter 1, Module 2

Instructional Supervision Used

Discussion (FGD)
Peer Teaching /
Date of

Focused-Group
Date Hired

other method
Name of Newlyhired Teacher Formal
Mentoring

(mm/dd/year) Remarks
Coaching

Learning

(specify)
Classroom
Observation

1 MARITESS V. NAPARAN JUNE 9, 2016 / Aug-16

2
3
4
5
6
7
8
9
10
*you may add rows as necessary

Prepared by: Checked by:

EDWIN G. DELA PENA ______SUSANA G. LORENZO EDWIN G. DEL

(Signature over printed name of School Head) (Signature over printed name of PSDS)

Recommending Approval: Approved:

________________________________________ MADELYN L. MACALLING, PhD, CESO VI
Asst. Schools Division Superintendent OIC - Office of the Schools Division Superintendent
 Schools District: _________________________________________________
School: _________________________________________________________

General Direction: Fill out the template shown below by ticking (ü) the method/technique utilized during the
conduct of Instructional Supervision to all newlyhired teachers in your school.

Year 1, Quarter 2, Module 3

Instructional Supervision Used

Discussion (FGD)
Peer Teaching /
Date of

Focused-Group
Date Hired

other method
Name of Newlyhired Teacher Formal
Mentoring

(mm/dd/year) Remarks
Coaching

Learning

(specify)
Classroom
Observation

1 MARITESS V. NAPARAN JUNE 9, 2016 STAR Oct-16

2
3
4
5
6
7
8
9
10
*you may add rows as necessary

Prepared by: Checked by:

WIN G. DELA PENA ______________SUSANA G. LORENZO

(Signature over printed name of School Head) (Signature over printed name of PSDS)

Recommending Approval: Approved:

________________________________________ MADELYN L. MACALLING, PhD, CESO VI
Asst. Schools Division Superintendent OIC - Office of the Schools Division Superintendent
Schools District: _________________________________________________ Schools
School: _________________________________________________________ School:

General Direction: Fill out the template shown below by ticking (ü) the method/technique utilized during the General
conduct of Instructional Supervision to all newlyhired teachers in your school. conduct

Year 1, Quarter 2, Module 4

Instructional Supervision Used

Discussion (FGD)
Peer Teaching /

Focused-Group
Date Hired

other method
Name of Newlyhired Teacher Date of Formal Na
Mentoring

(mm/dd/year) Remarks
Coaching

Classroom
Learning

(specify)
Observation

1 MARITESS V. NAPARAN JUNE 9, 2016 / Dec-16 1

2 2
3 3
4 4
5 5
6 6
7 7
8 8
9 9
10 10
*you may add rows as necessary *you ma

Prepared by: Checked by: Prepared

EDWIN G. DELA PENA _____ SUSANA G. LORENZO

(Signature over printed name of School Head) (Signature over printed name of PSDS) (Signatur

Recommending Approval: Approved: Recomm

________________________________________ MADELYN L. MACALLING, PhD, CESO VI _______
Asst. Schools Division Superintendent OIC - Office of the Schools Division Superintendent Asst. Sch
Schools District: _________________________________________________ Schools D
School: _________________________________________________________ School: __

General Direction: Fill out the template shown below by ticking (ü) the method/technique utilized during the General D
conduct of Instructional Supervision to all newlyhired teachers in your school. conduct o

Year 1, Quarter 3, Module 5

Instructional Supervision Used

Discussion (FGD)
Peer Teaching /

Date Hired Focused-Group

other method
Name of Newlyhired Teacher Date of Formal Name
Mentoring

(mm/dd/year) Remarks
Coaching

Classroom
Learning

(specify)
Observation

MARITESS V. NAPARAN JUNE 9, 2016 STAR Jan-17 1

2
3
4
5
6
7
8
9
10
*you may add rows as necessary *you may a

Prepared by: Checked by: Prepared b

EDWIN G. DELA PENA ______SUSANA G. LORENZO EDWIN G. DELA PEN

(Signature over printed name of School Head) (Signature over printed name of PSDS) (Signature o

Recommending Approval: Approved: Recommen

________________________________________ MADELYN L. MACALLING, PhD, CESO VI _________
Asst. Schools Division Superintendent OIC - Office of the Schools Division Superintendent Asst. Schoo
 Schools District: _________________________________________________ Schools D
School: _________________________________________________________ School: __

General Direction: Fill out the template shown below by ticking (ü) the method/technique utilized during the General D
conduct of Instructional Supervision to all newlyhired teachers in your school. conduct o

Year 1, Quarter 3, Module 6

Instructional Supervision Used

Discussion (FGD)
Peer Teaching /

Date Hired Focused-Group

other method
Name of Newlyhired Teacher Date of Formal Name
Mentoring

(mm/dd/year) Remarks
Coaching

Classroom
Learning

(specify)
Observation

MARITESS V. NAPARAN JUNE 9, 2016 / Feb-17 1

2
3
4
5
6
7
8
9
10
*you may add rows as necessary *you may

Prepared by: Checked by: Prepared b

G. DELA PENA _______________SUSANA G. LORENZO EDWIN G. DELA PEN

Signature over printed name of School Head) (Signature over printed name of PSDS) (Signature o

Recommending Approval: Approved: Recommen

________________________________________ MADELYN L. MACALLING, PhD, CESO VI _________
Asst. Schools Division Superintendent OIC - Office of the Schools Division Superintendent Asst. Schoo
 Schools District: _________________________________________________
School: _________________________________________________________

General Direction: Fill out the template shown below by ticking (ü) the method/technique utilized during the
conduct of Instructional Supervision to all newlyhired teachers in your school.

Year 1, Quarter 4

Instructional Supervision Used

Discussion (FGD)
Peer Teaching /

Date Hired Focused-Group

other method
Name of Newlyhired Teacher Date of Formal
Mentoring

(mm/dd/year) Remarks
Coaching

Classroom
Learning

(specify)
Observation

MARITESS V. NAPARAN JUNE 9, 2016 / Mar-17

*you may add rows as necessary

Prepared by: Checked by:

G. DELA PENA _______________SUSANA G. LORENZO

Signature over printed name of School Head) (Signature over printed name of PSDS)

Recommending Approval: Approved:

________________________________________ MADELYN L. MACALLING, PhD, CESO VI
Asst. Schools Division Superintendent OIC - Office of the Schools Division Superintendent
 Schools District: _________________________________________________ Schools
School: _________________________________________________________ School: _

General Direction: Fill out the template shown below by ticking (ü) the method/technique utilized during the General
conduct of Instructional Supervision to all newlyhired teachers in your school. conduct

Year 2, Quarter 1
Instructional Supervision Used

Discussion (FGD)
Peer Teaching /

Focused-Group

other method
Date Hired Date of
Mentoring

Coaching

Name of Newlyhired Teacher Na

Learning

(specify)
(mm/dd/year) Formal
Classroom Remarks
Observation

1 1
2 2
3 3
4 4
5 5
6 6
7 7
8 8
9 9
10 10
*you may add rows as necessary *you may

Prepared by: Checked by: Prepared

___________________________________________ ____________________________________ __________
(Signature over printed name of School Head) (Signature over printed name of PSDS) (Signatur

Recommending Approval: Approved: Recomm

________________________________________ MADELYN L. MACALLING, PhD, CESO VI ________

Asst. Schools Division Superintendent OIC - Office of the Schools Division Superintendent Asst. Sch
Schools District: _________________________________________________ Schools D
School: _________________________________________________________ School: _

General Direction: Fill out the template shown below by ticking (ü) the method/technique utilized during the General D
conduct of Instructional Supervision to all newlyhired teachers in your school. conduct o

Year 2, Quarter 2
Instructional Supervision Used

Discussion (FGD)
Peer Teaching /

Focused-Group

other method
Date Hired Date of
Mentoring

Coaching

Name of Newlyhired Teacher Nam

(mm/dd/year) Learning Formal
Remarks
Classroom
Observation

1
2
3
4
5
6
7
8
9
10
*you may add rows as necessary *you may

Prepared by: Checked by: Prepared

_________________________________________ ____________________________________ ___________
(Signature over printed name of School Head) (Signature over printed name of PSDS) (Signatur

Recommending Approval: Approved: Recomme

________________________________________ MADELYN L. MACALLING, PhD, CESO VI ________

Asst. Schools Division Superintendent OIC - Office of the Schools Division Superintendent Asst. Scho
Schools District: _________________________________________________ Schools Di
School: _________________________________________________________ School: __

General Direction: Fill out the template shown below by ticking (ü) the method/technique utilized during the General D
conduct of Instructional Supervision to all newlyhired teachers in your school. conduct of

Year 2, Quarter 3
Instructional Supervision Used

Discussion (FGD)
Peer Teaching /

Focused-Group

other method
Date Hired Date of
Mentoring

Coaching

Name of Newlyhired Teacher (mm/dd/year) Learning Formal Nam

Classroom Remarks
Observation

1
2
3
4
5
6
7
8
9
10
*you may add rows as necessary *you may a

Prepared by: Checked by: Prepared b

_________________________________________ ____________________________________ ____________
(Signature over printed name of School Head) (Signature over printed name of PSDS) (Signature

Recommending Approval: Approved: Recommen

________________________________________ MADELYN L. MACALLING, PhD, CESO VI _________

Asst. Schools Division Superintendent OIC - Office of the Schools Division Superintendent Asst. Schoo
Schools District: _________________________________________________
School: _________________________________________________________

General Direction: Fill out the template shown below by ticking (ü) the method/technique utilized during the
conduct of Instructional Supervision to all newlyhired teachers in your school.

Year 2, Quarter 4
Instructional Supervision Used

Discussion (FGD)
Peer Teaching /

Focused-Group

other method
Date Hired
Mentoring

Date of Formal
Coaching

Name of Newlyhired Teacher (mm/dd/year)

Learning
Classroom Remarks
Observation

*you may add rows as necessary

Prepared by: Checked by:

_________________________________________ ____________________________________
(Signature over printed name of School Head) (Signature over printed name of PSDS)

Recommending Approval: Approved:

________________________________________ MADELYN L. MACALLING, PhD, CESO VI

Asst. Schools Division Superintendent OIC - Office of the Schools Division Superintendent
Schools District: _________________________________________________
School: _________________________________________________________

General Direction: Fill out the template shown below by ticking (ü) the method/technique utilized during the
conduct of Instructional Supervision to all newlyhired teachers in your school.

Year 3, Quarter 1
Instructional Supervision Used

Discussion (FGD)
Peer Teaching /

Focused-Group
Date Hired Date of
Mentoring

other method
Coaching

Name of Newlyhired Teacher Learning Formal

(mm/dd/year) Remarks
Classroom
Observation

1 (specify)
2
3
4
5
6
7
8
9
10
*you may add rows as necessary

Prepared by: Checked by:

___________________________________________ _______________________________
(Signature over printed name of School Head) (Signature over printed name of PSDS)

Recommending Approval: Approved:

________________________________________ MADELYN L. MACALLING, PhD, CESO VI

Asst. Schools Division Superintendent OIC - Office of the Schools Division Superintendent
Schools District: _________________________________________________
School: _________________________________________________________

General Direction: Fill out the template shown below by ticking (ü) the method/technique utilized during the
conduct of Instructional Supervision to all newlyhired teachers in your school.

Year 3, Quarter 1
Instructional Supervision Used

Discussion (FGD)
Peer Teaching /

Focused-Group
Date Hired Date of
Mentoring

other method
Coaching

Name of Newlyhired Teacher (mm/dd/year) Learning Formal

Classroom Remarks
Observation

(specify)
1
2
3
4
5
6
7
8
9
10
*you may add rows as necessary

Prepared by: Checked by:

___________________________________________ _______________________________ ______

(Signature over printed name of School Head) (Signature over printed name of PSDS)

Recommending Approval: Approved:

________________________________________ MADELYN L. MACALLING, PhD, CESO VI

Asst. Schools Division Superintendent OIC - Office of the Schools Division Superintendent
Schools District: _________________________________________________
School: _________________________________________________________

Direction: Write the date of completion of the Teacher Induction Program per teacher.

Year 3, Quarter 3

Date Hired
Name of Newlyhired Teacher
(mm/dd/year) Date of Completion of Remarks
the Program

1
2
3
4
5
6
7
8
9
10
*you may add rows as necessary

Prepared by: Checked by:

________________________________________ __________________________________
(Signature over printed name of School Head) (Signature over printed name of the PSDS)

Recommending Approval: Approved:

________________________________________ MADELYN L. MACALLING, PhD, CESO VI

Asst. Schools Division Superintendent OIC - Office of the Schools Division Superintendent