Enclosure No. 1: Revised Learning Action Cell Form – June 2021 v.

Republic of the Philippines

Department of Education
Region I
SCHOOLS DIVISION OFFICE II OF PANGASINAN
Canarvacanan, Binalonan

LEARNING ACTION CELL PROPOSAL

PART I: SCHOOL INFORMATION

Date of Submission
Indicative Dates of
Implementation
Title of LAC
Name of School School ID
District / Municipality
Name of School Head
(LAC Leader)
LAC Facilitator
LAC Documenter
LAC Resource Persons 1.
2.
LAC Members 1.
2.
LAC Modality (Specify if Face To Face; Online, Blended )
Budgetary Requirement
Funding Source
Name of HRD Coordinator Mobile Number

1|P age
Enclosure No. 1: Revised Learning Action Cell Form – June 2021 v.2

PART II: LAC DETAILS

LAC TITLE:
TERMINAL OBJECTIVE: 1.
ENABLING OBJECTIVES: 1.
2.
NUMBER OF HOURS
TARGET PARTICIPANTS Career Stage:
(Career Stage, Grade/Year level, Grade / Year Level:
Learning Area) Learning Area:
PROFESSIONAL DEVELOPMENT PHILIPPINE PROFESSIONAL STANDARDS FOR TEACHERS
PRIORITIES DOMAIN: __________
- Professional Standards Covered - Strands: ________
- PPST, PPSSH, PPSS - Indicators: ______
- Domains, Strands, Indicators
DOMAIN: __________
- Strands: ________
- Indicators: ______

DOMAIN: __________
- Strands: ________
- Indicators: ______
NUMBER OF HOURS
MODULES AND LEARNING
RESOURCES TO BE USED (1) Session Guides of Resource Speakers
The following requirements must be (2) Powerpoint Presentations to be used by Resource Speakers
attached in the submission of the LAC
Proposal: (3) Activity Worksheets
1. Session Guides (4) Other references
2. Powerpoint Presentation of Resource
Speakers
3. Activity Worksheets
4. Other References

2|P age
Enclosure No. 1: Revised Learning Action Cell Form – June 2021 v.2

PHASE ACTIVITIES PERSONS TIME RESOURCES SUCCESS INDICATORS

(Write the details of all the activities INVOLVED FRAME FUND FUND SOURCE (Specify the success indicators
to be done in every phase) in details in every phase)

Planning

Implementation

Evaluation

PART III. LAC DESIGN

LAC TITLE:
(Write the specific title of the LAC Session)

Duration Topic/s Session Methodology Assessment Outputs Resource Person/s

Objectives Strategies

60 min Topic 1: TITLE Obj. 1 (Sample only) (Sample only) (Sample only) (Sample only)
Obj. 2
The session shall start with Specify assessment Specify what JUAN CRUZ, EdD
the review of DO 35, s. 2016 strategies outputs will be PSDS
(Conduct of Learning Acton required or
Cells). The methodology expected
follows the four phases:
Activity, Analysis, Abstraction
and Application

Reference:

3|P age
Enclosure No. 1: Revised Learning Action Cell Form – June 2021 v.2

PART IV. MONITORING AND EVALUATION PLAN

(Note: This is a sample M and E Plan following the Kirkpatrick Evaluation Model)
Level of M & E Indicators Methods and Tools Data Schedule of Persons Responsible
Sources M&E
Results Improved Performance of IPCRF IPCRF Form At the end of School Year QAME in-charge
participants by at least 2% from the (School Head, PSDS, HRD)
baseline performance
Behavior 90-95% of the total number of Analysis of data generated Self- After 1 year of QAME in-charge
participants applied their learnings from self-assessment form Assessment implementation (School Head, PSDS, HRD)
effectively and efficiently Tool
Learning At least 75% and above mastery Comparative analysis of Pretest & Post Before and after the QAME in-charge
level in all the topics discussed pretest and post test Test conduct of the webinar (School Head, PSDS, HRD)
results before and after
the webinar
Reaction At least 90-95% of the participants Daily analysis of the data QAME Tool Every day after the end of QAME in-charge
responded, “strongly agree” on the gathered from the QAME the day’s session (School Head, PSDS, HRD)
indicators included in the QAME tool
during the conduct of the webinar

SUBMITTED BY: NOTED:

Name of School Head Public Schools District Supervisor NOTE: Requirements when submitting LAC Proposals:
1. Cover Letter
2. Enclosure No. 1: Revised Learning Action Cell
CHECKED & RECORDED:
Form – v.2 June 2021
3. CV of Resource Speakers
MARIA LUISA C. CATALAN, PhD 4. Session Guides
Senior Education Program Specialist - HRD 5. Copy of Powerpoint Presentation of Speakers
6. Activity Worksheets to be used

RECOMMENDING APPROVAL:
CORNELIO R. AQUINO, EdD
Chief, Curriculum Implementation Division
APPROVED FOR THE SCHOOLS DIVISION SUPERINTENDENT:
__________________________________________________________
Assistant Schools Division Superintendent

4|P age