FORM 1: LAC PROFILE

This form should be accomplished by the LAC Facilitator and its members at the first LAC
session.

REGION: I

LAC ID (name or number): DO NO. 35 S. 2016 Number of LAC members: 43

Name of LAC Facilitator: Designation/Position:

JOHN-REY B. MANZANO TEACHER III

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

PUZON, FEMALE TEACHER III SDO1 FB

PELITA Q. PANGASINAN 09261352091

CASTRO, FE P. FEMALE TEACHER III SDO1 FB

PANGASINAN 09478743814

CORTEZ, FEMALE TEACHER III SDO1 FB

NENITA M. PANGASINAN 09096735957

LANTORIA, FEMALE TEACHER III SDO1 FB

CRISANTA L. PANGASINAN 09183005254

TESORO, FEMALE TEACHER III SDO1 FB

JENELYN M. PANGASINAN 09458394406

RACRAQUIN, MALE TEACHER III SDO1 FB

NOEL G. PANGASINAN 09157971288

RACRAQUIN, MALE TEACHER III SDO1 FB

JEREMIAS N. PANGASINAN 09260251459

RACRAQUIN, FEMALE TEACHER III SDO1 FB

KHAIZEL M. PANGASINAN 09951439100

CASTRO, FEMALE TEACHER III SDO1 FB

RISAN R. PANGASINAN 09458463989

BAUTISTA, FEMALE TEACHER II SDO1 09103688994 FB

JESSABEL PANGASINAN
CARLA L.

CASTRO, FEMALE TEACHER II SDO1 FB

AMELITA E. PANGASINAN 09204324082

BUTIAL, FEMALE TEACHER II SDO1 FB

JANICE B. PANGASINAN 09174809066

ALCAUSIN, FEMALE TEACHER II SDO1 FB

ANGELYN PANGASINAN
GRACE M. 09096489288

AMLA, FEMALE TEACHER II SDO1 FB

SIENNA PANGASINAN
LARISSA N. 09562963856

OBINQUE, FEMALE TEACHER II SDO1 FB

DORGIE V. PANGASINAN 09958535451

GUTIERREZ, MALE TEACHER II SDO1 FB

ERNESTO L. PANGASINAN 09393605086

CASIPIT, FEMALE TEACHER II SDO1 FB

MARIA PANGASINAN
INGRID
ALISON P. 09271714250

RACRAQUIN, FEMALE TEACHER II SDO1 FB

ALLAN C. PANGASINAN 09953282825

RAMOS, FEMALE TEACHER II SDO1 FB

ROWENA P. PANGASINAN 09568976664

CAPITLE, MALE TEACHER I SDO1 FB

MARLON C. PANGASINAN 09203424140

YANGA, MARY FEMALE TEACHER I SDO1 FB

JANE C. PANGASINAN 09205127839

RIÑO, FEMALE TEACHER I SDO1 FB

CONSUELO A. PANGASINAN 09954494338

PERALTA, MALE TEACHER I SDO1 FB

RIZALDY F. PANGASINAN 09460943389

AQUINO, FEMALE TEACHER I SDO1 09328729509 FB

RUBEZA PANGASINAN

DE GUZMAN, FEMALE TEACHER I SDO1 FB

ANGELICA V. PANGASINAN 09153258645

RACRAQUIN, FEMALE TEACHER I SDO1 FB

MARVIN B. PANGASINAN 09120334067

ROMASOC, FEMALE TEACHER I SDO1 FB

JOY E. PANGASINAN 09303881926

SAGUN, KEVIN MALE TEACHER I SDO1 FB

JHUN B. PANGASINAN 09163284139

BALBAS, FEMALE TEACHER I SDO1 FB

MADILYN J. PANGASINAN 09125368908

ORODIO, FEMALE TEACHER I SDO1 FB

KAREN MAY PANGASINAN
C. 09491252022

VELASCO, FEMALE TEACHER I SDO1 FB

MARIA PANGASINAN
LORENA E. 09454950489

URPILLA, FEMALE TEACHER I SDO1 FB

OLEVIA D. PANGASINAN 09079657834

BANTING, MALE TEACHER I SDO1 FB

RICHIE A. PANGASINAN 09770582776

ORTALEZA, FEMALE TEACHER I SDO1 FB

VANESSA O. PANGASINAN 09950782189

PAREL, JAYCEL FEMALE TEACHER I SDO1 FB

U. PANGASINAN 09667633116

ALCAUSIN, MALE TEACHER I SDO1 FB

KING JASON PANGASINAN 09503717477

FLORES, MALE TEACHER I SDO1 FB

ROBERT V. PANGASINAN 0946259974

DELA ROSA, FEMALE TEACHER I SDO1 FB

AILYN B. PANGASINAN 09076364332

ATIENZA, MALE TEACHER I SDO1 09175079279 FB

ROMMEL PANGASINAN
JOHN G.

RAMOS, FEMALE TEACHER I SDO1 FB

BARBARA LEE PANGASINAN
B. 09159337700

DUPAGAN, FEMALE TEACHER I SDO1 FB

ANA PATRICIA PANGASINAN
C. 09207992838

ARIOLA, FEMALE TEACHER I SDO1 FB

GEANNE F. PANGASINAN 09480664484

FORM 2: LAC Facilitator Information Sheet

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

Region: I

Division: SDO1 PANGASINAN

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

JOHN-REY B. 12-29-1986 33
MANZANO

Contact details: Email: Mobile Number: Facebook Name:

09094433933 strikerjohn24@gmail. 09094433933 JOHN-REY BALLESCA
com MANZANO

Preferred contact (Indicate all: email, phone, Skype, Viber, WhatsApp, Zoom,
mode: Googlemeet, FB, Messenger, etc.)

FB, email strikerjohn24@gmail.com

jrmstriker24@gmail.com

FORM 3: LAC Session Report

This form should be accomplished by the LAC Facilitator at the end of every LAC session.
LAC ID: DO NO. 35 S. 2016 REGION I

LAC FACILITATOR: JOHN-REY B. MANZANO LAC SESSION NO.: 1

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

FEBRUARY TAGUDIN NATIONAL HIGH SCHOOL

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 disagree, please indicate
SD D N A SA 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):

Sharing of ideas regarding on the most important factors in successful implementation of
distance learning

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

NONE

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

NONE

4. Recommendations/Plans for next LAC session:

NONE

FORM 4: LAC ENGAGEMENT REPORT

This form should be accomplished by each LAC Member at the end of every LAC session.
NAME OF MEMBER: FE P. CASTRO LAC SESSION ID.: DO NO. 35 S. 2016

REGION: I DATE OF LAC SESSION: FEB. 28, 2020

DIVISION: PANGASINAN I NUMBER OF LAC SESSION: 1

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:

NONE

2. I encountered the following problems or challenges:

NONE

3. Other comments/suggestions:
NONE