LEARNERS’ QUERY SHEET and FEEDBACK FORM

S.Y. 2020-2021

Name of Student: ________________________________ Grade and Section: __________________________

Date: __________________________________________ Teacher’s Name: ____________________________

I. Write at least 1-2 learnings you have gained this week.

1._______________________________________________________________________________________________
2. ______________________________________________________________________________________________
II. Rate your understanding of the reading activities this week. (Encircle the corresponding number: 1- lowest,
10 – highest)
1 2 3 4 5 6 7 8 9 10
III. List down 1 or 2 things that you have not understood properly.
1. __________________________________________________________________________________________________________
2. _______________________________________________________________________________________________________
IV. For the parent/guardian:
Write down your questions/concerns/suggestions below. Thank you very much!

___________________________________________________________________________
Parent’s/Guardian’s Signature over printed name