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DEPARTMENT OF EDUCATION
REGION XI
SCHOOLS DIVISION OF DAVAO OCCIDENTAL
Malita West District
MOTE ELEMENTARY SCHOOL
Name: ____________________________________________
LAC Session Title: ___________________________________
Date: _____________________________________________
Name of the Facilitator: _____________________________
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.)
ACTION PLAN
Part B
3. Other comments/suggestions:
___________________________________
Signature Over Printed Name