Republic of the Philippines
Department of Education
Region IV-A CALABARZON
Santa Cruz
SBM ASSESSMENT FORM
NAME OF SCHOOL: ___________________________________
SCHOOL HEAD: ______________________________________
SBM ASSESSMENT ON FOUR PRINCIPLES (40%)
LEADERSHIP AND GOVERNANCE (30%)
RATING
0 NO EVIDENCE
EVIDENCE OF COMPLIANCE
OF COMPLIANCE (NON-COMPLIANCE)
INDICATES EARLY OR PRELIMINARY STAGE (LESS
1 COMPLIANCE)
EVIDENCE OF COMPLIANCE INDICATES THE IMPLEMENTATION STAGE (MODERATE
2 COMPLIANCE)
3 EVIDENCE OF COMPLIANCE INDICATES COMPLETENESS (HIGH COMPLIANCE)
Performance
Indicators
Artifacts 0 1 2 3 SCORE
A. Vision , 1. Statements displayed
Mission and Goal a. DepEd Order # 36,s.2013 (file or copy of DepEd
(VMG) Vision, Mission & Core Values) 3 3
b. Vision , Mission, Goals ( displayed in conspicuous 3 3
area )
B. Stakeholders'
Participation 1. Documents to show the participation of
stakeholders to SIP/AIP
a. Barangay Development Plan in Education 2 2
b. Minutes of meeting 3 3
c. School Report Card (showing 3 3
stakeholders'participation)
C. Organizational 1. Organizational Chart
Structure for
Education a. School Profile 3 3
Governance b. School Organizational Chart 3 3
c. List of Homeroom Officers 3 3
1. School Head Annual Report 3 3
2. School Address of the SH / State of School
Address( SOSA) 1 1
3. School Head /Department Heads Professional
Development Plan 3 3
4. Office Order /Job Description 2 2
5. Personnel Evaluation System /Performance
Rating/IPCRF 3 3
D. Governance
Practices 6. Documents on School Budget Allocation 3 3
7. Staff and Students Handbooks 1 1
D. Governance
Practices
8. Report on Accomplishment of pupils /students
Government 1 1
9. School Incentive /Reward System for Staff
/Students , School Community 3 3
10. Reports on Accomplishment of Homeroom and
General PTA 3 3
TOTAL SCORE 2.56
Assessed by:
______________________________ ___________________________
Member, In-charge of Data Management ___
Member, Leadership and Governance
______________________________ ______________________________
Member, Continuous Improvement and Accountability Member, Management of Resources
______________________________
Team Leader, Curriculum and Learning
1
1
1
1
1
1
1
1
1
1
1
1
1
1
18
Republic of the Philippines
Department of Education
Region IV-A CALABARZON
Santa Cruz
SBM ASSESSMENT FORM
NAME OF SCHOOL: ___________________________________
SCHOOL HEAD: ______________________________________
SBM ASSESSMENT ON FOUR PRINCIPLES (40%)
CURRICULUM AND LEARNING (30%)
RATING
0 NO EVIDENCE OF COMPLIANCE (NON-COMPLIANCE)
EVIDENCE OF COMPLIANCE INDICATES EARLY OR PRELIMINARY STAGE (LESS
1 COMPLIANCE)
EVIDENCE OF COMPLIANCE INDICATES THE IMPLEMENTATION STAGE (MODERATE
2 COMPLIANCE)
3 EVIDENCE OF COMPLIANCE INDICATES COMPLETENESS (HIGH COMPLIANCE)
Performance
Indicators
Artifacts 0 1 2 3 SCORE
1. Curricular Programs of Core Subject Areas
a. CG/TG/LM/ Budget of Work 3 3
b. Lesson Plans/ Lesson Logs w/ Integrations Suited to the
Community or with Contextualized Materials 2 2
2. EPP/Tech.Voc. Program
a. CG/TG/LM/ Budget of Work/Syllabus 2 2
b. Lesson Plans/ Lesson Logs w/ Integrations Suited to the
Community or with Contextualized Materials 3 3
3. SPED Program
a. Individualized Education Program (IEP) 2 2
b. CG/TG/LM/ Budget of Work/Syllabus 2 2
c. Lesson Plans/ Lesson Logs w/ Integrations Suited to the
A. Flexibility of Community or with Contextualized Materials 3 3
Curricular 4. ALS Program*
Programs for the
Development a. Learning Modules 3 3
Needs of all b. CG/TG/LM/ Budget of Work/Syllabus 3 3
Types of
Learners c. Session Guides/ Lesson Logs w/ Integrations Suited to
the Community or with Contextualized Materials 3 3
5. Multigrade Education Program*
a. CG/TG/LM/ Budget of Work/Syllabus 3 3
b. Lesson Plans/ Lesson Logs w/ Integrations Suited to the
Community or with Contextualized Materials 3 3
6. MADRASAH/ALIVE/IPED*
a. CG/TG/LM/ Budget of Work/Syllabus 2 2
b. Lesson Plans/ Lesson Logs w/ Integrations Suited to the
Community or with Contextualized Materials 2 2
7. School Sports Program
a. Calendar of Activities 3 3
8. BSP/GSP / Red Cross Program*
a. Report on Approved Activities 1 1
B. Learning 1. Consolidated Learner's Portfolio
Systems and a. Portfolio Quizzes
their
Appropriate - Result of Summative Tests 3 3
Tools
- Result of District/ School Periodical Tests 3 3
-Result of Diagnostic &Achievement Tests 3 3
b. Record of Homeroom PTA Meeting
-Attendance Sheets 2 2
-Minutes of Meetings 2 2
-Resolutions 2 2
c. Students' Learning Plan (Classroom Improvement Plan) 2 2
2. Modified SFs / F 137/138/ Class Record* 3 3
3. Phil-IRI Results 3 3
4. EGRA/EGMA Results 3 3
1. School Head and Teachers' Portfolio
C. Nurturing a. Attendance of Civic/ School Activities 1
Values and 1
Environment b. Letter of Invitations (sent & received) 2 2
c. Photo Documentation 2 2
d. Certificates of Appreciation/ Recognition/ Participation
2 2
e. Professional Development Program 2 2
2. School Action Plan (per subject area) 2 2
3. Drop-out Reduction Program 3 3
4. Other Remedial/ Intervention Programs per Subject
Area 3 3
5. EGRA/EGMA/ Reading Program 3 3
6. Reports of Science & Math Programs 3 3
7. Reports of English & Filipino Programs
a. Journalism Programs 2 2
b. School Paper Adviser (SPA) Program 2 2
8. Health Program
a. Health/Dental Examination of Learners 3 3
b. Annual Physical Examination of School Personnel 3 3
c. Baseline/Endline Nutritional Status Report 3 3
d. Deworming Report 3 3
D. School-based 1. Teachers' Observation Record (STAR) 3 3
Monitoring & 2. Supervisory Plan
Evaluation 3 3
3. Supervisory Checklist 3 3
4. Memoranda/Orders 3 3
5. Report on Results
a. Continuous Improvement Programs 3 3
b. Action Research 3 3
c. Mentoring & Coaching Program 3 3
TOTAL SCORE 2.57
Assessed by:
______________________________ ______________________
Member, In-charge of Data Management ________
Member, Leadership and
Governance
______________________________ ______________________________
Member, Continuous Improvement and Member, Management of Resources
Accountability
______________________________
Team Leader, Curriculum and Learning
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
49
Republic of the Philippines
Department of Education
Region IV-A CALABARZON
Santa Cruz
SBM ASSESSMENT FORM
NAME OF SCHOOL: ___________________________________
SCHOOL HEAD: ______________________________________
SBM ASSESSMENT ON FOUR PRINCIPLES (40%)
CURRICULUM AND LEARNING (30%)
RATING
0 NO EVIDENCE OF COMPLIANCE (NON-COMPLIANCE)
EVIDENCE OF COMPLIANCE INDICATES EARLY OR PRELIMINARY STAGE (LESS
1 COMPLIANCE)
EVIDENCE OF COMPLIANCE INDICATES THE IMPLEMENTATION STAGE (MODERATE
2 COMPLIANCE)
3 EVIDENCE OF COMPLIANCE INDICATES COMPLETENESS (HIGH COMPLIANCE)
Performance
Indicators
Artifacts 0 1 2 3 SCORE
1. Curricular Programs of Core Subject Areas
a. CG/TG/LM/ Budget of Work 3 3
b. Lesson Plans/ Lesson Logs w/ Integrations Suited to the
Community or with Contextualized Materials 2 2
2. EPP/Tech.Voc. Program
a. CG/TG/LM/ Budget of Work/Syllabus 2 2
b. Lesson Plans/ Lesson Logs w/ Integrations Suited to the
Community or with Contextualized Materials 3 3
3. SPED Program
a. Individualized Education Program (IEP) 2 2
b. CG/TG/LM/ Budget of Work/Syllabus 2 2
c. Lesson Plans/ Lesson Logs w/ Integrations Suited to the
A. Flexibility of Community or with Contextualized Materials 3 3
Curricular 4. ALS Program*
Programs for the
Development a. Learning Modules 3 3
Needs of all b. CG/TG/LM/ Budget of Work/Syllabus 3 3
Types of
Learners c. Session Guides/ Lesson Logs w/ Integrations Suited to
the Community or with Contextualized Materials 3 3
5. Multigrade Education Program*
a. CG/TG/LM/ Budget of Work/Syllabus 3 3
b. Lesson Plans/ Lesson Logs w/ Integrations Suited to the
Community or with Contextualized Materials 3 3
6. MADRASAH/ALIVE/IPED*
a. CG/TG/LM/ Budget of Work/Syllabus 2 2
b. Lesson Plans/ Lesson Logs w/ Integrations Suited to the
Community or with Contextualized Materials 2 2
7. School Sports Program
a. Calendar of Activities 3 3
8. BSP/GSP / Red Cross Program*
a. Report on Approved Activities 1 1
B. Learning 1. Consolidated Learner's Portfolio
Systems and a. Portfolio Quizzes
their
Appropriate - Result of Summative Tests 3 3
Tools
- Result of District/ School Periodical Tests 3 3
-Result of Diagnostic &Achievement Tests 3 3
b. Record of Homeroom PTA Meeting
-Attendance Sheets 2 2
-Minutes of Meetings 2 2
-Resolutions 2 2
c. Students' Learning Plan (Classroom Improvement Plan) 2 2
2. Modified SFs / F 137/138/ Class Record* 3 3
3. Phil-IRI Results 3 3
4. EGRA/EGMA Results 3 3
1. School Head and Teachers' Portfolio
C. Nurturing a. Attendance of Civic/ School Activities 1
Values and 1
Environment b. Letter of Invitations (sent & received) 2 2
c. Photo Documentation 2 2
d. Certificates of Appreciation/ Recognition/ Participation
2 2
e. Professional Development Program 2 2
2. School Action Plan (per subject area) 2 2
3. Drop-out Reduction Program 3 3
4. Other Remedial/ Intervention Programs per Subject
Area 3 3
5. EGRA/EGMA/ Reading Program 3 3
6. Reports of Science & Math Programs 3 3
7. Reports of English & Filipino Programs
a. Journalism Programs 2 2
b. School Paper Adviser (SPA) Program 2 2
8. Health Program
a. Health/Dental Examination of Learners 3 3
b. Annual Physical Examination of School Personnel 3 3
c. Baseline/Endline Nutritional Status Report 3 3
d. Deworming Report 3 3
D. School-based 1. Teachers' Observation Record (STAR) 3 3
Monitoring & 2. Supervisory Plan
Evaluation 3 3
3. Supervisory Checklist 3 3
4. Memoranda/Orders 3 3
5. Report on Results
a. Continuous Improvement Programs 3 3
b. Action Research 3 3
c. Mentoring & Coaching Program 3 3
TOTAL SCORE 2.57
Assessed by:
______________________________ ______________________
Member, In-charge of Data Management ________
Member, Leadership and
Governance
______________________________ ______________________________
Member, Continuous Improvement and Member, Management of Resources
Accountability
______________________________
Team Leader, Curriculum and Learning
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
49
Republic of the Philippines
Department of Education
Region IV-A CALABARZON
Santa Cruz
SBM ASSESSMENT FORM
NAME OF SCHOOL: ___________________________________
SCHOOL HEAD: ______________________________________
SBM ASSESSMENT ON FOUR PRINCIPLES (40%)
ACCOUNTABILTY AND CONTINUOUS IMPROVEMENT (25%)
RATING
0 NO EVIDENCE
EVIDENCE OF COMPLIANCE
OF COMPLIANCE (NON-COMPLIANCE)
INDICATES EARLY OR PRELIMINARY STAGE (LESS
1 COMPLIANCE)
EVIDENCE OF COMPLIANCE INDICATES THE IMPLEMENTATION STAGE (MODERATE
2 COMPLIANCE)
3 EVIDENCE OF COMPLIANCE INDICATES COMPLETENESS (HIGH COMPLIANCE)
Performance
Indicators Artifacts 0 1 2 3 SCORE
1. NAT Result (last three years) 3 3
2. NAT Review schedule (if any) Folder enhancement 3 3
A. Academic 3. District Achievement Test Results Folder (school based)
3 3
4. Display of Awards 3 3
1. Compiled TSNA 3 3
2. Compilation of IPPD 3 3
B. NCBTS 3. CIP documentation 3 3
4. Completed Action Researches / Studies 3 3
5. CB-PAST / PASSA / RPMS (OPCRF/ IPCRF) 3 3
1. Records of School MOOE and SBM (if applicable) 3 3
2. Approved Work and Financial Plan 3 3
3. Validated and signed Liquidation reports 3 3
4. Records of Financial transaction 3 3
5. Records of Donations in Cash and in kind 3 3
6. Written Appointment of the School Canteen Manager and
C. Financial Assistant Canteen Manager
Management 3 3
7. Canteen Financial Reports (audited and signed) 3 3
8. Reports on shared funds from School Canteen (logbook and
flow of transaction) 3 3
9. PTA Records of Annual programs and projects with
corresponding audited financial reports 3 3
10. Organization/Club Financial Report 3 3
1. Approved Request Form/ Matrix 3 3
2. INSET and its schedule and reports 3 3
D. School-based
Teachers 3. Coaching and Mentoring schedule and reports 3 3
Development 4. GAD Implementation Plan
3 3
5. GAD Reports 3 3
E. Crises Management Plan (DRRM) 1 1
F. School Building and Facilities built / improved by LGUs, NGOs and other
partners (last 3 years) 1 1
G. Records and Pictures of events/ activities held spearheaded by stakeholders
and school
H. Monitoring 1. Observation and Supervisory Plan 1 1
and Evaluation 2. Report on Results of M&E 1 1
3. School Notice/ Memorandum 1 1
TOTAL SCORE 2.66
Assessed by:
______________________________ ____________________
Member, In-charge of Data Management __________
Member, Leadership and
Governance
______________________________ ______________________________
Member, Continuous Improvement and Member, Management of Resources
Accountability
______________________________
Team Leader, Curriculum and Learning
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
29
Republic of the Philippines
Department of Education
Region IV-A CALABARZON
Santa Cruz
SBM ASSESSMENT FORM
NAME OF SCHOOL: ___________________________________
SCHOOL HEAD: ______________________________________
SBM ASSESSMENT ON FOUR PRINCIPLES (40%)
MANAGEMENT OF RESOURCES (15%)
RATING
0 NO EVIDENCE OF COMPLIANCE (NON-COMPLIANCE)
1 EVIDENCE OF COMPLIANCE INDICATES EARLY OR PRELIMINARY STAGE (LESS COMPLIANCE)
EVIDENCE OF COMPLIANCE INDICATES THE IMPLEMENTATION STAGE (MODERATE
2 COMPLIANCE)
3 EVIDENCE OF COMPLIANCE INDICATES COMPLETENESS (HIGH COMPLIANCE)
Performance
Indicators
Artifacts 0 1 2 3 SCORE
1. EBEIS (On Line Updated EBEIS to be checked during validation)
3 3
2. Report on Brigada Eskwela
a. Form 1 and 1.1 3 3
b. Scrap Book 3 3
A. Regular c. Deed of Donations and Acceptance 3 3
Resource
Inventory d. Memorandum of Agreement /Understanding 3 3
3. Adopt-A-School Report
a. Infrastructure 2 2
b. Non-Infrastucture 2 2
c. Last Mile Projects 3 3
d. Senior High School Partnership Program 2 2
1. Enhanced SIP Project Proposals 2 2
B. Resource
Programming 2. Approved APP 2 2
3. Income Resource Generating Projects 2 2
1. Fidelity Bond Document 1 1
2. Plantilla / SREAT / HRIS 1 1
C. Resource 3. School Feeding Program 1 1
Management 4. School Layout 1 1
System
5. School Site Title (proof of ownership-Tax Dec., ) 1 1
6. Inventory of Physical Facilities (Learning resources-LRMDS)
1 1
1. Feeding Beneficiaries
a. SBFP 1 1
D. Regular
Monitoring,
Evaluation and
Reporting
Process
b. School Canteen Feeding 1 1
c. Other stakeholders feeding program 1 1
D. Regular
Monitoring, 2. Other stakeholders financial support for school programs and
Evaluation and projects 1 1
Reporting 3. Regular Resource Inventory
Process 1 1
4. Annual Implementation Plan Revision/ Adjusted 1 1
5. Memorandum of Agreement 1 1
6.Awards and Recognition Program for Stakeholders (School Level)
1 1
TOTAL SCORE 1.69
Assessed by:
______________________________ _____________________
Member, In-charge of Data Management _________
Member, Leadership and
Governance
______________________________ ______________________________
Member, Continuous Improvement and Member, Management of Resources
Accountability
______________________________
Team Leader, Curriculum and Learning
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
26
Republic of the Philippines
Department of Education
Region IV-A CALABARZON
Santa Cruz
SBM ASSESSMENT FORM
NAME OF SCHOOL: ___________________________________
SCHOOL HEAD: ______________________________________
SBM ASSESSMENT SCORES ON FOUR PRINCIPLES (40%)
AREAS TOTAL SCORE WEIGHT RESULTS
Leadership and Governance 2.56 30% 0.77
Curriculum and Learning 2.57 30% 0.77
Accountability and Continuous
2.66 25% 0.66
Improvement
Management of Resources 1.69 15% 0.25
SUB - TOTAL 2.46
INTERPRETATION BETTER
INTERPRETATION:
Numerical Rating Scale Description
0.50 - 1.49 Good
1.50 - 2.49 Better
2.50 - 3.00 Best
Assessed by:
______________________________ ______________________________
Member, In-charge of Data Management Member, Leadership and Governance
______________________________ ______________________________
Member, Continuous Improvement and Member, Management of Resources
Accountability
______________________________
Team Leader, Curriculum and Learning
0 GOOD
1.5 BETTER
2.5 BEST
