FORM 2: LAC Facilitator Information Sheet

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

Region:X

Division: Misamis Oriental

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

Ginalyn B. Rosal FEMALE 12-30-69 50

Contact details: Email Mobile Number: Facebook Name:

ginalyn.rosal@deped 09155629045 Gumisad Lasoranab
.gov.ph

Preferred contact (Indicate all: email, phone, Skype, Viber, WhatsApp, Zoom,
mode: Googlemeet, FB, Messenger, etc.)
MESSENGER AND CP
NUMBER
MESSENGER- Gumisad Lasoranab
Gmail – ginalyn.rosal@deped.gov.ph