FORM 4:しAC ENGAGEMENT REPORT

This form 5hou!d be accomplished by each LAC Memberat the end ofeve「y LAC ses5ion,

NAMEOFMEMBER‥ 高畑鳴し 〇・ J"AぬT LACSESS10NiD∴ 件. L^しけ

REGION:体的○Å DATE OF LAC5E5S10N‥ SEPr. M7妙O

DiVIS10N: NUMBER OF LACSE5510N:

初心外山 pれ 幼く

Plea5e indicate the extent to which you ag「ee with ea⊂h ofthe fo=owing 5tatementS by

ti⊂king

the app「op「iate box" (SD =Stron呂母Disagree; D = Di5agree; N = Neut「al; A = Ag「ee; SA =

与t「ong!Y亀g「朋〉

SD D N A SA Comments/Remarks (Fo「exampie言fyoudisagree o「筑rongIγdi掘g「ee,PI印§e indicatewhY.)

THELACSESSION

1" =eamedalotfrommy /
COIleaguesinthisLACse5Sion.

2.TheLACse5Siondeepened /
myunde「standingoftheSLM

COntent.

3" Myperspectiveonthetopic/s /

COVe「edhaschangeda5a

resu看toftheLAC5eSSion,

4・ipa面cipatedactive寒yinthe /

LAC5e5Si。nbysha「ingmy
assignmentandinsights,
askingquestion5,andgiving
feedbackonwhatcolleagues
Sha「ed.

5.=nteractedwithdiffe「ent /

PeOPledu「ingtheLAC
与eSS看On.
 ACT10NPLAN
ヽ・ 6"南elmotivatedtoap両in ●ヽ・● ●r    ￣ う / ●二● ●l ヽ●喜パヽ 章●I、ヽ

上申持region/division/dist「ict
Whatlhaveleamedinthi5
lesson,

了・=ntendtoapplywha=have /
1ea「nedfromthelessoninmy

「egion/division/dist「i⊂t

PartB
Pl朗se p「ovide the information reque5ted.

1’l need furthe「 cIarification and/or re5Ou「CeS On the fol看owing topics:

2" l encountered the fo看!owing probiem5 Or⊂h訓enge5:

3. Othe「 comments/suggestion5:
FORM 4:しAC ENGAGEMENT REPORT

Thi5 fo「m should be a⊂COmP畦hed by each LAC Memberat the end ofeve「y LAC 5eSSion.

NAME OF MEMBER‥ Jtや唯しら・ J人跡OaT LACSESS10NID": P(●■しAしr}

REGiON‥ a食卓久e青 DA丁E OF LACSESSiON‥拘rr.叫h坤

DIVIS10N: NUMBEROF LACSESS10N:

畑的山 鳩l.負々

Pa「章A
Piea5e indicate the extent to which you ag「ee with ea⊂h of the foi!owing statements by

ticking
the appr。Priate box" (SD =S亡「on富ly Disagree; D = Disagree; N = Neut「ai; A = Agree; SA=

Strongly ag「ee)

SD D N A SA Comments/Rema「ks (Forexample膏youdisagree OrStrOngIYdisagree,Please indjcate間h再

THELAC5ESS10N

1,=ea「nedaI。tfrommy /
⊂O帖aguesinthisLACsession.

2,丁heLACsessiondeepened /
myunderstandingoftheSLM
COntent,

3.Mype「5PeCtiveonthetopic/5 ′

COVeredhas⊂hangeda.sa

re5ultoftheLACsession.

4.巾a「ti⊂ipateda仁tivelyinthe /

LACsessionbysha「ingmy

assignmentandinsight5,
askingquestions,andgiving
feedbackonwhatcolieagues
Sha「ed,

5〇 日nte「a⊂tedwithdifferent /

PeOPIeduringtheLAC
S巳SSiOn.
 ACT10NPLAN

富清さl壷で油ed亡O坤回れ ●●∴∴∴. ヽ.● ・ ’ヽI / I.∴. .i●l言丁 i_′●、ヽ′￣

.†.,叩.「egion/division/di5trict

Whatlhavelearnedinthis
I

7・=ntendtoapp!ywhatIhave / ′ /?

!ea「nedfromtheIes50ninmy

「egion/divi5ion/di5trict

Pa「tB
PIease p「ovide the information requested。

1. 1 need further仁ia「ification and/o「 re50u「Ce5 Cm the foilowing topi⊂S:

2" l en⊂Ountered the foiIowing p「obIem5 0rCh訓enges:

3" Othe「 comments/suggestions:

FORM 4: LAC ENGAGEMENT REPORT
This form shou!d be accomplished by eachしAC Member at the end of every LAC session.

NAMEOFMEMB駅:竜抑 LACSESSIONID・: n”膿C.け

ら・ Jふ日直の費†

REG看ON: c▲m DATE OF LAC SESSION: t#Pr.

田園四囲
DIVIS10N: NUMBER OF LAC SESSION:
具咽 oみ 抑農

PIease indicate the extent to which you agree with each ofthe following statements by
ticking
the app「opriate box. (SD = StrongIy Disagree; D = Disagree川= Neutraly A = Agree; SA =

Strongly agree)

「 音    SD D N A Comments/Remarks (Forexampie,ifyoudisagree O「StrOngiydisag「ee,Please SAindicatewhy.)

THEUICSESSION

1.11earnedaIotfrommy /      、1● ′

CO=eaguesinthisLACsession.

2.TheLACsessiondeepened /
myunderstandingoftheSしM
COntent.

3.Myperspectiveonthetopic/s /
COVeredhaschangedasa
resu!toftheしACsession.

4.1pa巾Cipatedactivelyinthe /

LACsessionbysharingmy
assignmentandinsights,
askingquestions,andgiving
feedbackonwhatcoileagues
Shared.

5.Iinteractedwithd群erent /

PeOP!eduringtheLAC
SeSSion.
 ACTIONPしAN

6-1fe鉦nbtivatedtoappIyin .ヽ1’I● ●  ノ ∴) / l 、ヽ●.∴∴“ヽ

.∴甲yregion/division/dist「ict
1W晴t'ihaveIearnedinthis

lesson.

7.1intendtoapplywhatlhave / ..書

ieamedfromthelessoninmy
region/division/dist「ict

pa轟B
P!ease provide the information requested.

1. 1 need fu軸er clarificatio= and/or resources on the fol-owing topics:

2. 1 encountered the foI!owing problems or cha-lenges:

l●

●ゆI血1近 寄肌尋軸

3. Othe「 comments/suggestions:
FORM 4: LACたNGAGたMENT REPORT
This form should be accompIished by each LAC Member at the end of every LAC session.

NAMEOF MEMBER:鳴寄晦し 〇・ J旬^。di丁 いCSESSIONID・:ぐ小隊しけ

REGiON: Cふ鱗ム∽ DATE OFしAC SESS10N: 締れめI拘れ

DIVISiON: NUMBER OF LAC SESS10N:
`叫畑 暗霊・寝

PIease indicate the extent to which you agree with each ofthe fol-owing statements by
ticking
the appropriate box. (SD = Strongly Disagree; D = Disagree川= NeutraIt A = Agree; SA =

Strongly agree)

SD D N A SA Comments/Remarks (Fo「exampIe,ifγOudisagree O「St「OngIγdisag「ee,PIease indicatewhy.)

THEしACSESSION ,◆   ・ " l  I’細 ●

1・=earnedaIotfrommy /
COlleaguesinthisしACsession,

2.TheLACsessiondeepened ′
myunderstandingoftheSしM
COntent.

3.Myperspectiveonthetopic/s ノ
COVeredhaschangedasa
「esultoftheしAC§eSSion.

4.Ipa面Cipatedactiveiyinthe ′

しACsessionbysharingmγ
assignmentandinsights,
askingquestions.andgiving
feedbackonwhatcoIleagues
Shared.

5.Iinteractedwithd肝erent /

PeOPleduringtheしAC
SeSSion.
 ACT10NPしAN
∴●∴ 6.￨fe観inotifatedtoapplyin ↑  ● 二、、●・● / ●I ■●-..∴1.l 1“

+ 申y[紳On/division/dist幅
.whatlhaveIearnedinthis

lesson.

7.=ntendtoappIywhatlhave /
leamedfromthelessoninmy
region/division/district

pa鴫寄
PIease provide the information requested.

1. 1 need fu直her cIarification and/or resources on the faliowing topics:

2. 1 encountered the foi!owing problems or cha!Ienges:

・心立山巾 の峨叫の…

3. Other comments/suggestions:
FORM 4:しAC ENGAGEMENT REPORT
This form shouId be accomplished by each LAC Member at the end of every LAC session.

NAMEOFMEMBER: J再説L O.心lLD巾drr LACSESSIONID・: P[′- LAl竹

DATEOF LACSESSION:鱗PT. iちわめ

DIVISION: NUMBER OFしAC SESSION:

れ明記 0機 知鴫

P尋鴫A
PIease indicate the extent to which you agree with each ofthe fo=owing statement§ by

ticking
the appropriate box. (SD = Strongly Disagree; D = Disag「ee; N = NeutraL; A = Agree; SA =

Strongiy agree)

SD D N A SA Comments/Remarks (Forexample,ifyoudisag「ee OrStrOngIydisagree,Please indicatewhy.)

THEしACSESS!ON .-  ;●

1.=eamedalotfrommy /
CO=eaguesinthisLACsession.

2.TheLACsessiondeepened /
myunderstandingoftheSしM
COntent.

3.Mype「spectiveonthetopic/s /
COVeredhaschangedasa
resultoftheしACsession.

4.Ipa面Cipatedactivelyinthe /

LACsessionbysharingmy
assignmentandinsights,
askingquestions,andgiving
feedbackonwhatco=eagues
Shared.

5.=nteractedwithdifferent ′

PeOPleduringtheLAC
SeSS○○n.
 ACTIONPしAN

6.Ife朗motivatedtoapp!yin 1- ヽ● } / ●●. 「∴∴子子 l音、し

言㌦:叩yregion/division/dist幅
what宜aveieamedinthis
iesson.

7.=ntendtoappiywhat!have ●l /
iearnedfromthelessoninmy
region/division/district

Pa巾B
Piease provide the information requested.

1. 1 need fu刷er cIarification and/o「 resources on the fo=owing topics:

2. I encountered the fo=owing problems or chaiienges:

●調郎h切t 困り竜 山“h巾

3. Othe「 comments/suggestions: