FORM 2: LAC Facilitator Information Sheet

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

Region: XIII-CARAGA

Division: BISLIG CITY

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

CLIMFEL MARIES T. FEMALE APRIL 20,1991 29
DATOON

Contact details: Email: Mobile Number: Facebook Name:

09639069499 Climfelmaries.datoon 09163103694 CLIMFEL MARIZ
@deped.gov.ph DATOON

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

ALL

Prepared by: Noted by: Checked by:

CLIMFEL MARIES T. RICKY S. CABIL FLAVIANO L.

DATOON YPARRAGUIRRE
TEACHER -I SSHT-I/School Head Instructional Coach