MODULAR DISTANCE LEARNING (MDL) MODALITY

SELF-LEARNING MODULE AND SUMMATIVE TEST ACCOMPLISHMENT FEEDBACK FORM

To Parent/Guardian:
This is to provide you with the Evaluation Result of your child’s accomplished self-learning module. This is being done for you to
know the status of his/her performance.
Please feel free to communicate with the undersigned if you have queries on the given feedback.
Thank you.
Learning Area: SCIENCE 7 Quarter: 1ST Week: ______ Module No.: 1-6
Name of Learner: _______________________________________________________________ Grade & Section: ___________________________
Date Accomplished: ______________________________ School Year: 2021-2022
Parts of the Module &
Status of Accomplishment Summative Test
(C/INC)
Module Average Rating/Descriptive
PRE - POST- Module Value (Total No. of Score/
ACTIVITIES Action/Remarks
TEST TEST Score Total No. Summative Test
Item)
1
1-2
2 Provide LAS
3 Dialogue with parents
3-4 Include in intervention
4
5 Communicate with the learner
5
Conduct Home Visitation
6 6 No further intervention needed
Legend:
C – Complete O – Outstanding (91-100) S – Satisfactory (75-79)
INC – Incomplete VS – Very Satisfactory (80-90) NR – Needs Remediation (74 & below)

Evaluated by:
HAZEL P. RECAÑA Conformed:
Subject Teacher
Hazel Padernal Recaña ___________________________________________
Parent’s Signature over printed name
Noted: CP No./Messenger Account: __________________________
ESTER R. SANTILLAN
Principal I

MODULAR DISTANCE LEARNING (MDL) MODALITY

SELF-LEARNING MODULE AND SUMMATIVE TEST ACCOMPLISHMENT FEEDBACK FORM

To Parent/Guardian:
This is to provide you with the Evaluation Result of your child’s accomplished self-learning module. This is being done for you to
know the status of his/her performance.
Please feel free to communicate with the undersigned if you have queries on the given feedback.
Thank you.
Learning Area: SCIENCE 7 Quarter: 1ST Week: ______ Module No.: 1-6

Name of Learner: _______________________________________________________________ Grade & Section: ___________________________

Date Accomplished: ______________________________ School Year: 2021-2022
Parts of the Module &
Status of Accomplishment Summative Test
(C/INC)
Module Average Rating/Descriptive
PRE - POST- Module Value (Total No. of Score/
ACTIVITIES Action/Remarks
TEST TEST Score Total No. Summative Test
Item)
1
1-2
2 Provide LAS
3 Dialogue with parents
3-4 Include in intervention
4
5 Communicate with the learner
5
Conduct Home Visitation
6 6 No further intervention needed
Legend:
C – Complete O – Outstanding (91-100) S – Satisfactory (75-79)
INC – Incomplete VS – Very Satisfactory (80-90) NR – Needs Remediation (74 & below)

Evaluated by:
HAZEL P. RECAÑA Conformed:
Subject Teacher
Hazel Padernal Recaña ___________________________________________
Parent’s Signature over printed name
Noted: CP No./Messenger Account: __________________________
ESTER R. SANTILLAN
Principal I