Republic of the Philippines

Department of Education
Region I
Schools Division of Pangasinan I

Dalanguiring Integrated School

DALANGUIRING, URBIZTONDO, PANGASINAN

MONITORING AND EVALUATION TOOL ON THE IMPLEMENTATION OF

PRINTED MODULAR DISTANCE LEARNING DELIVERY MODALITY

School: DALANGUIRING INTEGRATED SCHOOL

District: URBIZTONDO
School Head: CHODELYN P. DE GUZMAN, ED.D.
PSDS: LONGINO D. FERRER, ED.D.

Name of Learner Name of Parent/Guardian

Grade and Section Inclusive Date/s of Monitoring

and Evaluation

A. FOR THE LEARNER: YES NO

1. Did you receive your self-learning modules on time?

2. Were your self-learning modules meaningful, age-appropriate, credible
and readable?

If NO, what errors did you see with the self-learning modules?

Typographical error/s Blurred or pixelated

graphics or pictures
Faulty grammar or Lack of localized or
construction contextualized content
Plagiarized content with Unknown references or
copyright issues author/publisher
Poor lay-out/design Others pls. specify:

2. Did you had a hard time studying and answering self-learning modules?

If YES, which subject/s did you find difficult to learn and answer?

FILIPNO ARAL. PAN.

ENGLISH TLE
MATH MAPEH
SCIENCE ESP
3. Did you answer your self-learning module by yourself?

If NO, who helped or guided you?

Mother Sibling/s
Father Others pls. specify
Guardian
YES NO

Address: Dalanguiring, Urbiztondo, Pangasinan Document Code: P1URB1-FR-002

Telephone No.: 633-28-43 Revision No.: 00
Email: resquirdalanguiringhs@gmail.com Page No.: Page 1 of 4
Website: www.dalanguiringintegratedschool.com Effectivity Date: 01-23-2020
 Republic of the Philippines
Department of Education
Region I
Schools Division of Pangasinan I

Dalanguiring Integrated School

DALANGUIRING, URBIZTONDO, PANGASINAN

4. Did your teachers answer your questions and clarifications concerning

the self-learning modules?

If YES, which means of communication did you use?

Social Media (FB, Call/ Video

Messenger etc. Conferencing

Texts Messaging Face-to-Face through

Home Visitation
Others Pls. specify:

5. Did you finish accomplishing your self-learning modules on time?

If NO, what were your reason/s?

Lack of time Lack of interest

Bulk of modules or Did not get module

subjects to be learned on time

Others pls. specify

Other comment/s, suggestion/s or recommendation/s:

B. FOR THE PARENT/GUARDIAN: YES NO

1. Did you get your child’s self-learning modules from the teachers
and submit them on time?
If NO, what is/are the reason/s:

Lack of time due to busy No interest/

work schedule willingness at all

No means of transportation Others pls. specify

going to school

Financial difficulty

Address: Dalanguiring, Urbiztondo, Pangasinan Document Code: P1URB1-FR-002

Telephone No.: 633-28-43 Revision No.: 00
Email: resquirdalanguiringhs@gmail.com Page No.: Page 2 of 4
Website: www.dalanguiringintegratedschool.com Effectivity Date: 01-23-2020
 Republic of the Philippines
Department of Education
Region I
Schools Division of Pangasinan I

Dalanguiring Integrated School

DALANGUIRING, URBIZTONDO, PANGASINAN

YES NO

2. Did you help or guide your child/ren in learning and answering their
modules?

If NO, what is/are the reason/s?

Lack of time due to busy work Lack of

schedule knowledge/skill
No interest or willingness Others pls. specify
Other comment/s, suggestion/s or recommendation/s:

C. FOR THE TEACHER: YES NO

1. Did you prepare corrected, edited, readable and streamlined

self-learning modules?

2. Did you distribute and retrieve self-learning modules on time?

3. Did you implement minimum health protocols during the course

of module retrieval and distribution?

4. Did you help or guide your leaners in learning and answering

their modules using various communication platforms?

5. Did you provide technical assistance to parents or guardians

who serve as learning facilitators for leaners?

6. Did you prepare weekly learning plan, individual monitoring plan,

assessment tool for leaners, etc. to track leaners’ progress?

7. Did you report learners’ progress to parents or guardians?

8. Did you experience any difficulty in planning, implementing,

monitoring and assessing the status of printed modular distance
learning delivery modality?

If YES, write them below:

Address: Dalanguiring, Urbiztondo, Pangasinan Document Code: P1URB1-FR-002

Telephone No.: 633-28-43 Revision No.: 00
Email: resquirdalanguiringhs@gmail.com Page No.: Page 3 of 4
Website: www.dalanguiringintegratedschool.com Effectivity Date: 01-23-2020
 Republic of the Philippines
Department of Education
Region I
Schools Division of Pangasinan I

Dalanguiring Integrated School

DALANGUIRING, URBIZTONDO, PANGASINAN

With the difficult you encountered, what intervention or course of action are you willing to undertake?

Other comment/s, suggestion/s, recommendation/s and reflection:

___________________________________
Signature of Teacher over Printed Name

D. FOR THE SCHOOL HEAD OR PSDS:

Comments, Suggestions, Recommendations for Mentoring and Provision of Technical Assistance

___________________________________
Signature of School Head/PSDS over Printed Name

Address: Dalanguiring, Urbiztondo, Pangasinan Document Code: P1URB1-FR-002

Telephone No.: 633-28-43 Revision No.: 00
Email: resquirdalanguiringhs@gmail.com Page No.: Page 4 of 4
Website: www.dalanguiringintegratedschool.com Effectivity Date: 01-23-2020