Department of Education

Region V
Division of Camarines Sur
Pili West District
SCHOOL OF THE FUTURE
San Jose, Pili, Camarines Sur

CHECKLIST FOR DISTRIBUTION AND RETRIEVAL OF MODULES/LAS

Name of Pupil: Grade &
1-Burgos
Section:
Learning Areas: (Indicate the number of Modules/ LAS received & returned in all Subjects) Signature over Printed Name of
Week 1 Parent/Representative
Math MTB Aral. Pan ESP Music Arts P.E Health

Module
Received
Date:___________________ LAS

Module
Returned
Date:___________________ LAS

Learning Areas: (Indicate the number of Modules/ LAS received & returned in all Subjects) Signature over Printed Name of
Week 2 Parent/Representative
Math MTB Aral. Pan ESP Music Arts P.E Health

Module
Received
Date:___________________ LAS

Module
Returned
Date:___________________ LAS

Department of Education
Region V
 Division of Camarines Sur
Pili West District
SCHOOL OF THE FUTURE
San Jose, Pili, Camarines Sur

CHECKLIST FOR DISTRIBUTION AND RETRIEVAL OF MODULES/LAS

Name of Pupil: Grade &
1-Burgos
Section:
Learning Areas: (Indicate the number of Modules/ LAS received & returned in all Subjects) Signature over Printed Name of
Week 3 Parent/Representative
Math MTB Aral. Pan ESP Music Arts P.E Health

Module
Received
Date:___________________ LAS

Module
Returned
Date:___________________ LAS

Learning Areas: (Indicate the number of Modules/ LAS received & returned in all Subjects) Signature over Printed Name of
Week 4 Parent/Representative
Math MTB Aral. Pan ESP Music Arts P.E Health

Module
Received
Date:___________________ LAS

Module
Returned
Date:___________________ LAS