Lac Forms Sy2021 22

Republic of the Philippines
Department of Education
Region IX-Zamboanga Peninsula
SCHOOLS DIVISION OF ZAMBOANGA DEL SUR
MARIA CLARA LOBREGAT NATIONAL HIGH SCHOOL
Tickwas, Dumalinao, Zamboanga del Sur
FORM 1: LAC PROFILE

This form should be accomplished by the LAC Facilitator and its members at the first LAC session.
REGION: IX-ZAMBOANGA PENINSULA
LAC ID: MCLNHS-001 Number of LAC members: 15
Name of LAC Facilitator: Designation/Position:

REYMUNDO B. PENIALA SECONDARY SCHOOL TEACHER-I
LAC Members
NAME Male/ POSITION DIVISION Contact details Preferred contact

Female (email, mobile mode (email, phone,
number) Skype, Zoom,
Google Meet,
Viber, FB)
1. JOANNE C. FEMALE SST-I ZAMBOANGA 09488626934 email, phone,

ROSALES DEL SUR joanne.rosales@dep Skype, Zoom,
ed.gov.ph Google Meet,
Viber, FB
2. MARK LESTER A. MALE SHST-II ZAMBOANGA 09569387877 email, phone,

ROSALES DEL SUR marklester.rosales Skype, Zoom,
@deped.gov.ph Google Meet,
Viber, FB
3. REYMUNDO B. MALE SST-1 ZAMBOANGA 09214312411/ email, phone,

PENIALA DEL SUR 09606663702 Google Meet, FB
reymundo.peniala
@deped.gov.ph
4. SHENA MAE J. FEMALE SST-1 ZAMBOANGA 09076191910/ email, phone,

PENIALA DEL SUR 09606663703 Google Meet, FB
shenamae.peniala@
deped.gov.ph
5. RACHELLE J. FEMALE SST-1 ZAMBOANGA 09099247651/ email, phone,

BONGCAWEL DEL SUR 09606663705 Google Meet, FB
rachelle.bongcawel
@deped.gov.ph
6. JUNJIE P. MALE SHST-2 ZAMBOANGA 09567748965 email, phone,

PANGALAY DEL SUR junjie.pangalay001 Google Meet, FB
@deped.gov.ph
7. JEICEL C. FEMALE SST-1 ZAMBOANGA 09667489192/0909 email, phone,

BAHANDIA-NON DEL SUR 8387700/ Google Meet, FB
09606663710
jeicel.bahandianon
@deped.gov.ph
8. GRACE LYN L. FEMALE SST-1 ZAMBOANGA 09300529894 email, phone,

REPOLLIDO DEL SUR gracelyn.repollido Google Meet, FB
@deped.gov.ph
9. MARY JOY D. FEMALE SST-3 ZAMBOANGA 09297144233/0907 email, phone,

GABULE DEL SUR 1443924 Google Meet, FB
maryjoy.gabule@d
eped.gov.ph
10. ALBERTO A. MALE SST-3 ZAMBOANGA 09187075202 email, phone,

REPOLLIDO JR. DEL SUR repollido001@depe Google Meet, FB
d.gov.ph
11. HAZEL S. FEMALE SHST-1 ZAMBOANGA 09551837892 email, phone,

OLONGAYO DEL SUR hazel.olongayo@de Google Meet, FB
ped.gov.ph
12. CHRISTIANA W. FEMALE SHST-1 ZAMBOANGA 09186029192/0905 email, phone,

BANA DEL SUR 2190868 Google Meet, FB
christiana.bana@de
ped.gov.ph
13. FE D. SUPERALES FEMALE SHST-1 ZAMBOANGA 09304418404/ email, phone,

DEL SUR 09606663709 Google Meet, fb
fe.superales@deped
.gov.ph
14. GABRIEL R. EBINA MALE SHST-1 ZAMBOANGA 09505885888/ email, phone,

DEL SUR 09606663711 Google Meet, fb
gabriel.ebina@dep
ed.gov.ph
15. ALFREDO ACASIO MALE SST-1 ZAMBOANGA 09075651360/0927 email, phone,

JR. DEL SUR 0010608 Google Meet, fb
alfredo.acasio@de
ped.gov.ph
FORM 2: LAC Facilitator Information Sheet
This form should be accomplished by the designated LAC Facilitator on or before the first LAC session.
Region: IX-ZAMBOANGA PENINSULA
Division: ZAMBOANGA DEL SUR

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

REYMUNDO B. MALE JULY 22, 1989 32
PENIALA
Contact details: Email: Mobile: Facebook Name:

reymundo.peniala@deped.g 09214312411 Reymundo Peniala
ov.ph
Preferred contact mode: (Indicate all: email, phone, Skype, Viber, WhatsApp, Zoom, Googlemeet, FB,
Call, email, messenger, fb Messenger, etc.)
FB: Reymundo Peniala
Messenger: Reymundo Peniala
Email: reymundo.peniala@deped.gov.ph
Contact No. 09214312411
FORM 3: LAC Session Report
This form should be accomplished by the LAC Facilitator at the end of every LAC session.
LAC ID: MCLNHS-001 REGION: IX-Zamboanga Peninsula
LAC FACILITATOR: LAC SESSION NO.: 01

REYMUNDO B. PENIALA
DATE AND TIME OF SESSION: VENUE/PLATFORM OF SESSION:

September 24, 2021/9:00am Maria Clara Lobregat NHS/Synchronous
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
SD D N A SA indicate why.)
MEMBER PARTICIPATION ✔
All of the members came prepared for the

LAC session ✔
All of the members had an opportunity to

share and discuss their assignment, insights,
and ideas ✔
Members listened to each other’s insights and ✔

ideas.
The members’ assignments showed an ✔

understanding of the lessons in the SLM.
The members demonstrated

engagement in and/or
enthusiasm for the learning tasks during the ✔
session (including providing feedback
on each other’s assignment).
FACILITATION
I managed the sharing and discussion during

the LAC session by keeping the discussion
focused on the lesson or topic. ✔
I encouraged all the members to actively

participate in the LAC session (i.e., for the
teachers to share their work and ideas/ ✔
insights).
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):
 The best part of the session when everyone was given the chance to share their insights, ideas, opinion, thoughts,
and showed interest in the discussion.
2. Problems or challenges encountered and how they were resolved:
 So far, the session went well since everybody was very active and participative in the discussions which created
a positive environment wherein no idle moments were then observed.
3. Other topics discussed apart from the recommended topics, if any:
 We focused our discussions on the Appendix D of DepEd Memorandum DM-Cl-2020-00162 which is all about
creating a Weekly Home Learning Plan and Individual Monitoring Pan while adopting the Modular Distance
Learning Modality during this pandemic time.
4. Recommendations/Plans for next LAC session:
 Our LAC Leader recommended that all teachers shall have to prepare Weekly Home Learning Plan and
Individual Monitoring Plan for those struggling learners using the unified template being agreed during the LAC
Session.
LAC SESSION ATTENDANCE SHEET
LAC FACILITATOR: REYMUNDO B. PENIALA, SST-1
TOPIC: APPENDIX D OF DEPED MEMORANDUM DM-CI-2020-00162
NAME POSITION PRESENT ABSENT/ SIGNATURE

ON LEAVE
1. JOANNE C. ROSALES SHST-2

2. MARK LESTER A. ROSALES SHST-2
3. SHENA MAE J. PENIALA SST-1
4. RACHELLE J. BONGCAWEL SST-1
5. JUNJIE P. PANGALAY SHST-1

6. JEICEL C. BAHANDIA-NON SST-1
7. GRACE LYN L. REPOLLIDO SST-1
8. MARY JOY D. GABULE SST-3
9. ALBERTO A. REPOLLIDO JR. SST-3
10. FE D. SUPERALES SHST-1
11. CHRISTIANA W. BANA SHST-1
12. HAZEL S. OLONGAYO SHST-1
13. GABRIEL R. EBINA SHST-1
14. ALFREDO A. ACASIO SST-1
15. REYMUNDO B. PENIALA SST-1
NOTED:
RANDY BUTCH G. GAMBOA

School Principal 2/LAC Leader
FORM 4: LAC ENGAGEMENT REPORT
This form should be accomplished by each LAC Member at the end of every LAC session.
NAME OF MEMBER: LAC SESSION ID.: MCLNHS-001

JOANNE C. ROSALES
REGION: IX-ZAMBOANGA PENINSULA DATE OF LAC SESSION: SEPTEMBER 24, 2021
DIVISION: ZAMBOANGA DEL SUR NUMBER OF LAC SESSION: 01
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)
SD D N A SA Comments / Remarks (For

example, if you disagree or

strongly disagree, please
indicate why.)
THE LAC SESSION
I learned a lot from my colleagues in this LAC

session.
The LAC session deepened my understanding of

the SLM content.
My perspective on the topic/s covered has

changed as a result of the LAC session.
I participated actively in the LAC session by

sharing my assignment and insights, asking
questions, and giving
feedback on what colleagues shared.
I interacted with different

people during the LAC
session.
ACTION PLAN
I feel motivated to apply in my

region/division/district what I have learned in
this lesson.
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:


2. I encountered the following problems or challenges:


3. Other comments/suggestions:

LAC SESSION GUIDE
LAC Components Activity Suggested Period

1. Getting Started The LAC Facilitator leads the
preliminaries
a. Prayer
b. National Anthem 10 minutes
c. Checking of Attendance
d. House Rules
2. Presentation/Discussion of the The LAC Facilitator discusses and
Topic presents the WHLP (Weekly
Home Learning Plan) Guide and
Sample Template based on the 45 minutes
DepEd Memorandum DM-Cl-2020-
00162
3. Plenary Synthesis The LAC Facilitator asks for 2-3
volunteers to share their thoughts, 60 minutes
ideas on the topic discussed.
The LAC members shall make a
Weekly Home Learning Plan of

all the subjects they are teaching
using the presented template as
their guide.
4. Presentation of Outputs The LAC Facilitator asks
representatives to present their
output. 15 minutes
The LAC members take down
notes on the important ideas of the
presentation.
TOTAL 130 minutes
PREPARED BY: Noted:
REYMUNDO B. PENIALA, SST-1 RANDY BUTCH G. GAMBOA, P-2

LAC Facilitator LAC Lead

Lac Forms Sy2021 22

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Republic of the Philippines

FORM 1: LAC PROFILE

LAC ID: MCLNHS-001 Number of LAC members: 15

Name of LAC Facilitator: Designation/Position:

NAME Male/ POSITION DIVISION Contact details Preferred contact

1. JOANNE C. FEMALE SST-I ZAMBOANGA 09488626934 email, phone,

2. MARK LESTER A. MALE SHST-II ZAMBOANGA 09569387877 email, phone,

3. REYMUNDO B. MALE SST-1 ZAMBOANGA 09214312411/ email, phone,

4. SHENA MAE J. FEMALE SST-1 ZAMBOANGA 09076191910/ email, phone,

5. RACHELLE J. FEMALE SST-1 ZAMBOANGA 09099247651/ email, phone,

6. JUNJIE P. MALE SHST-2 ZAMBOANGA 09567748965 email, phone,

7. JEICEL C. FEMALE SST-1 ZAMBOANGA 09667489192/0909 email, phone,

8. GRACE LYN L. FEMALE SST-1 ZAMBOANGA 09300529894 email, phone,

9. MARY JOY D. FEMALE SST-3 ZAMBOANGA 09297144233/0907 email, phone,

10. ALBERTO A. MALE SST-3 ZAMBOANGA 09187075202 email, phone,

11. HAZEL S. FEMALE SHST-1 ZAMBOANGA 09551837892 email, phone,

12. CHRISTIANA W. FEMALE SHST-1 ZAMBOANGA 09186029192/0905 email, phone,

13. FE D. SUPERALES FEMALE SHST-1 ZAMBOANGA 09304418404/ email, phone,

14. GABRIEL R. EBINA MALE SHST-1 ZAMBOANGA 09505885888/ email, phone,

15. ALFREDO ACASIO MALE SST-1 ZAMBOANGA 09075651360/0927 email, phone,

Region: IX-ZAMBOANGA PENINSULA

Division: ZAMBOANGA DEL SUR

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

Contact details: Email: Mobile: Facebook Name:

FORM 3: LAC Session Report

LAC ID: MCLNHS-001 REGION: IX-Zamboanga Peninsula

LAC FACILITATOR: LAC SESSION NO.: 01

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

Number of members present (attach attendance document):

Materials and resources:

All of the members came prepared for the

All of the members had an opportunity to

Members listened to each other’s insights and ✔

The members’ assignments showed an ✔

The members demonstrated

I managed the sharing and discussion during

I encouraged all the members to actively

I provided useful feedback on the teachers’ ✔

LAC SESSION ATTENDANCE SHEET

LAC FACILITATOR: REYMUNDO B. PENIALA, SST-1

TOPIC: APPENDIX D OF DEPED MEMORANDUM DM-CI-2020-00162

NAME POSITION PRESENT ABSENT/ SIGNATURE

1. JOANNE C. ROSALES SHST-2

5. JUNJIE P. PANGALAY SHST-1

RANDY BUTCH G. GAMBOA

FORM 4: LAC ENGAGEMENT REPORT

NAME OF MEMBER: LAC SESSION ID.: MCLNHS-001

REGION: IX-ZAMBOANGA PENINSULA DATE OF LAC SESSION: SEPTEMBER 24, 2021

DIVISION: ZAMBOANGA DEL SUR NUMBER OF LAC SESSION: 01

SD D N A SA Comments / Remarks (For

example, if you disagree or

THE LAC SESSION

I learned a lot from my colleagues in this LAC

The LAC session deepened my understanding of

My perspective on the topic/s covered has

I participated actively in the LAC session by

I interacted with different

I feel motivated to apply in my

I intend to apply what I have learned from the

1. I need further clarification and/or resources on the following topics:

2. I encountered the following problems or challenges:

LAC SESSION GUIDE

LAC Components Activity Suggested Period

Weekly Home Learning Plan of