Republic of the Philippines

Department of Education
Region VIII
Schools Division of Leyte

BATO NATIONAL HIGH SCHOOL

Bato, Leyte
FORM 1: LAC PROFILE
This form should be accomplished by the LAC Facilitator and its members at the first LAC
session.

REGION: VIII

LAC ID (name or number): Number of LAC members:

Name of LAC Facilitator: PAZ S. DELEN Designation/Position: Master Teacher II

LAC Members
Male/ DESIGNATION/ DIVISION/S Contact details Preferred contact
NAME Female POSITION (email, mobile mode (email, phone,
number) Skype, Zoom, Google
Meet, Viber, FB)

Republic of the Philippines

Department of Education
Region VIII
A. Ma b ini St. Brg y. Ba g o n g b a ya n , Ba Schools
to , Le yte Division of Leyte
Te l. No . 053-568-0204 I b nh s_b a to @ya h o o .c o m
BATO NATIONAL HIGH SCHOOL
Yo u r Fu ture … O u r Fo c us…
Bato, Leyte
 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 mode: (Indicate all: email, phone, Skype, Viber, WhatsApp, Zoom, Googlemeet, FB,
Messenger, etc.)

A. Ma b in i St. Brg y. Ba g o ng b a ya n, Ba to , Le yte

Te l. No . 053-568-0204 I b nh s_b a to @ya h o o .c o m

Yo u r Futu re … O ur Fo c u s…

Republic of the Philippines

Department of Education
Region VIII
Schools Division of Leyte
A. Ma b ini St. Brg y. Ba g o n g b a ya n , Ba to , Le yte
Te l. No . 053-568-0204 I b nh s_b a to @ya h o o .c o m
BATO NATIONAL HIGH SCHOOL
Yo u r Fu ture … O u r Fo c us…
Bato, Leyte
 FORM 3: LAC Session Report
This form should be accomplished by the LAC Facilitator at the end of every LAC session.

LAC ID: REGION

LAC FACILITATOR: LAC SESSION NO.:

DATE AND TIME OF SESSION: VENUE/PLATFORM OF SESSION:

Number of members present (attach attendance document):

Materials and resources:

___ Self-Learning Module

___ Activity sheets
___ Digital resources
___ Online resources
___ Smartphone
___ PC
___ LAC session guide
___ Others. Please specify:
_______________________________________

Part A
Please indicate the extent to which you agree with each of the following statements by ticking the
appropriate box.

(SD = Strongly Disagree; D = Disagree; N = Neutral; A = Agree; SA = Strongly agree)

Comments / Remarks
(For example, if you disagree or strongly
SD D N A SA disagree, please indicate why.)

MEMBER PARTICIPATION

1. All of the members came

prepared for the LAC
session

2. All of the members had an

opportunity to share and
discuss their assignment,
insights, and ideas

3. Members listened to each

other’s insights and ideas.

4. The members’ assignments

showed an understanding
of the lessons in the SLM.

5. The members
demonstrated
engagement in and/or
enthusiasm for the learning
tasks during the session
 (including providing
feedback
on each other’s
assignment).

FACILITATION

6. I managed the sharing and

discussion during the LAC
session by keeping the
discussion focused on the
lesson or topic.

7. I encouraged all the

members to actively
participate in the LAC
session (i.e., for the
teachers to share their work
and ideas/ insights).

8. I provided useful feedback

on the teachers’
assignments.

Part B
Please provide the information requested.

1. The best part of the session (i.e. what went well):

2. Problems or challenges encountered and how they were resolved:

3. Other topics discussed apart from the recommended topics, if any:

4. Recommendations/Plans for next LAC session:

A. Ma b ini St. Brg y. Ba g o n g b a ya n, Ba to , Le yte

Te l. No . 053-568-0204 I b nh s_b a to @ya h o o .c o m

Yo u r Fu ture … O ur Fo c us…

Republic of the Philippines

Department of Education
Region VIII
A. Ma b in i St. Brg y. Ba g o ng b a ya n, Ba to , Le yte
Schools
Te l. No . 053-568-0204 I b nh s_b a to @ya Division
h o o .c oof
m Leyte
A. Ma b in i St. Brg y. Ba g o ng b a ya n, Ba to , Le yte
Te l. No . 053-568-0204 I b nh s_b a to @ya h o o .c o m
Yo u r Futu re … O ur Fo cBATO
u s… NATIONAL HIGH SCHOOL
Yo u r Futu re … O ur Fo c u s… Bato, Leyte
 FORM 4: LAC ENGAGEMENT REPORT
This form should be accomplished by each LAC Member at the end of every LAC session.

NAME OF MEMBER: LAC SESSION ID.:

REGION: DATE OF LAC SESSION:

DIVISION: NUMBER OF LAC SESSION:

Part A
Please indicate the extent to which you agree with each of the following statements by ticking
the appropriate box. (SD = Strongly Disagree; D = Disagree; N = Neutral; A = Agree; SA =
Strongly agree)

Comments / Remarks (For example, if

you disagree or strongly disagree, please
SD D N A SA indicate why.)

THE LAC SESSION

1. I learned a lot from my

colleagues in this LAC session.

2. The LAC session deepened

my understanding of the SLM
content.

3. My perspective on the topic/s

covered has changed as a
result of the LAC session.

4. I participated actively in the

LAC session by sharing my
assignment and insights,
asking questions, and giving
feedback on what colleagues
shared.

5. I interacted with different

people during the LAC
session.

ACTION PLAN

6. I feel motivated to apply in

my region/division/district
what I have learned in this
lesson.

7. I intend to apply what I have

learned from the lesson in my
region/division/district

Part B
Please provide the information requested.
1. I need further clarification and/or resources on the following topics:

2. I encountered the following problems or challenges:

3. Other comments/suggestions:

A. Ma b ini St. Brg y. Ba g o n g b a ya n, Ba to , Le yte

Te l. No . 053-568-0204 I b nh s_b a to @ya h o o .c o m

Yo u r Fu ture … O ur Fo c us…