FORM 2: LAC Facilitator Information Sheet

This form should be accomplished by the designated LAC Facilitator on or before the first LAC
session.

Region:

Division:

NAME: Male/Female: Date of Birth: Age:

Contact details: Email: Mobile Number: Facebook Name:

Preferred contact (Indicate all: email, phone, Skype, Viber, WhatsApp, Zoom,
mode: Googlemeet, FB, Messenger, etc.)