Republic of the Philippines

Department of Education
REGION III- CENTRAL LUZON
SCHOOLS DIVISION OFFICE OF PAMPANGA
(NAME OF SCHOOL)
(SCHOOL ADDRESS)

V. ADMINISTRATIVE
CONCERNS

1. Documentation of learners and parents’ orientation (e.g. attendance sheet, photos etc.)

School Address:
School
School ID:
Logo
Email Address :
Contact Number of the School:
 Republic of the Philippines
Department of Education
REGION III- CENTRAL LUZON
SCHOOLS DIVISION OFFICE OF PAMPANGA
(NAME OF SCHOOL)
(SCHOOL ADDRESS)

(SAME WITH 1. Documentation of learner’s orientation about the learning objectives and
evaluation of their development ) PLEASE SEE III. Evaluation of Learner’s Development

2. Approved budget vs Financial Report of HG (e.g materials, training expenses etc.)

- Ask from your School Head;

School Address:
School
School ID:
Logo
Email Address :
Contact Number of the School:
 Republic of the Philippines
Department of Education
REGION III- CENTRAL LUZON
SCHOOLS DIVISION OFFICE OF PAMPANGA
(NAME OF SCHOOL)
(SCHOOL ADDRESS)

-See Table for other option

School - School Address:

School Head - School ID:
District - Division:
Guidance Counselor/ Designate :

Donors/Sponsors/Other Resource Items Quantity

Prepared and submitted by:

____________________
Counselor/ Designate

Noted:

____________________
School Head

3. Inventory of supplies and materials vs reports of utilization

-NOTE: PER SCHOOL via LINK
Name of School:
School Address:
District SECTOR:
School Head:
School Address:
Counselor/Designate:
School
School ID:
Logo REPORT ON PRINTING AND UTILIZATION OF HOMEROOM GUIDANCE PROGRAM FOR QUARTERS 1&2 (MODULES)
Email Address : (as per Memorandum DM-CI-2020-00155)
GRADE LEVEL TITLE OF MODULES TARGET NUMBER ACTUAL NUMBER TITLE OF MODULES TARGET NUMBER ACTUAL NUMBER REMARKS/ISSUES/CONCERNS
Contact
QUARTER 1 Number of the DISTRIBUTED
OF MODULES School: QUARTER 2 OF MODULES DISTRIBUTED
KINDER Quarter 1: Week 1 - I am Unique Quarter 2: Week 1 to 2 – Let’s Make It Work
Quarter 1: Week 2 to 6 – Family is Love Quarter 2: Weeks 3 to 4 – I Do, I Feel!
Quarter 2: Week 5 – People in the Community

GRADE 1 Quarter 1 – Module 1: Quarter 2 – Module 3:

 I Belong...We Belong Make Good Choices
Quarter 2 – Module 5:
You and I: We Connect Towards Success

GRADE 2 Quarter 1 – Module 1: Quarter 2 – Module 4:

I am Responsible Making it Proper, Making it Great
Quarter 1 – Module 2: Quarter 2 – Module 5:
My Roots When Choosing is Tough
Quarter 1 – Module 3: Quarter 2 – Module 6: My Guiding Stars
It’s Okay to be Different

GRADE 3 Quarter 1 – Module 1: Quarter 2 – Module 5:

I Love The Way I Am
Quarter 1 – Module 2:
RepublicLearning
of Around
the MePhilippines
Quarter 2 – Module 6:
Thank You, My Family
Quarter 1 – Module 3:
Department
For Success, of Education
Choose the Best!
Quarter 2 – Module 7:
Me, From My Family REGION III- CENTRAL
Get Loaded: Time for Choice LUZON

GRADE 4 Quarter 1 – Module 1:

SCHOOLS DIVISION OFFICE OF PAMPANGA
Quarter 2 – Module 4:
The Real Me (NAME
I Get It!OF SCHOOL)
Quarter 1 – Module 2: Quarter 2 – Module 5:
Let’s E.A.R.N R.E.S.P.E.C.T
(SCHOOL ADDRESS)
Achieving Success in School
Quarter 1 – Module 3: Ready, Set, Go! Quarter 2 – Module 6: C
Career Outlook: Connecting to the Future

GRADE 5 Quarter 1 – Module 1: Quarter 2 – Module 4:

“I” is for IDEAL Good Decision, Better Community
Quarter 1 – Module 2: Quarter 2 – Module 5: My Learning, My Share
Connecting with Others

GRADE 6 Quarter 1 – Module 1: Quarter 2 – Module 4:

Embracing the Best in Me My Responsible Decisions
Quarter 1 – Module 2: Quarter 2 – Module 5:
I Can Relate My Journey to Success

ACCOMPLISHED BY:

NOTED BY:

4. Number of learners in each learning modality (TO BE CONSOLIDATED BY GUIDANCE

DESIGNATE EVERY QUARTER)

______QUARTER
School Address:
School
School ID:
Logo
Email Address :
Contact Number of the School:
 Republic of the Philippines
Department of Education
REGION III- CENTRAL LUZON
SCHOOLS DIVISION OFFICE OF PAMPANGA
(NAME OF SCHOOL)
(SCHOOL ADDRESS)

NUMBER OF LEARNERS IN EACH LEARNING MODALITY

(QUARTER REPORT)
Name of Class Advisers Grade Level/ Section MODULAR ONLINE BLENDED

Prepared and submitted by:

_________________________
Designated Guidance Counselor

Noted:

_________________________
School Head

5. Documentation of orientation for the personnel and teachers

(SAME WITH THE PREVIOUS DOCUMENTATIONS DURING THE
ORIENTATION/INSET/LAC/MEETINGS)

School Address:
School
School ID:
Logo
Email Address :
Contact Number of the School:
 Republic of the Philippines
Department of Education
REGION III- CENTRAL LUZON
SCHOOLS DIVISION OFFICE OF PAMPANGA
(NAME OF SCHOOL)
(SCHOOL ADDRESS)

6. Mid-year and year-end reports by the school

School Address:
School
School ID:
Logo
Email Address :
Contact Number of the School:
 Republic of the Philippines
Department of Education
REGION III- CENTRAL LUZON
SCHOOLS DIVISION OFFICE OF PAMPANGA
(NAME OF SCHOOL)
(SCHOOL ADDRESS)

7. Matrix of issues and concerns from the reports and actions taken (per school)

REGION: DIVISION:

NAME OF SCHOOL:

CLUSTER/ DISTRICT/MUNICIPALITY: NAME OF SCHOOL HEAD:

GUIDANCE COUNSELOR/DESIGNATE: LEVEL: ____GRADE SCHOOL

Please check
____ JUNIOR HIGH SCHOOL
School Address:
School
School ID:
Logo
Email Address :
Contact Number of the School:
 Republic of the Philippines
Department of Education
REGION III- CENTRAL LUZON
SCHOOLS DIVISION OFFICE OF PAMPANGA
(NAME OF SCHOOL)
(SCHOOL ADDRESS)

____SENIOR HIGH SCHOOL

Instructions: Indicate your rating for the following items below by putting a check ( ) in the box
corresponding to your answer. SDA stands for Strongly Disagree, DA stands for Disagree, N for
Neutral, A for Agree, and SA for Strongly Agree.

I. LEARNING OBJECTIVES

ITEMS SDA DA N A SA NA
1. The Objectives/MELCS of
the modules were clearly
understood.
2. The Objectives/MELCS of
the modules were specific,
achievable and relevant.
3. The expected results of the
module were well-described
4. The objectives/MELCS of
the modules delivered were
all achieved at the end of the
session.
II. LEARNING CONTENT

ITEMS SDA DA N A SA NA
1. The Learning Content of the
Module is aligned with the
Objectives/MELCS
2. The learning content of the
module is suited to the
needs of the learners.
3. The learning content of the
module is suited to the level
of understanding of the
learners.
4. The assignment given and
complement the objectives
of the module.
5. The activities accommodate
individual differences
III. ORGANIZATION

ITEMS SDA DA N A SA NA
1. The module is well-
organized in terms of
content and flow.
2. The activities in the module
are sequenced in a logical
manner.
3. The time given conducting
the module is appropriate
IV. LEARNING EXPERIENCE

School Address:
School
School ID:
Logo
Email Address :
Contact Number of the School:
 Republic of the Philippines
Department of Education
REGION III- CENTRAL LUZON
SCHOOLS DIVISION OFFICE OF PAMPANGA
(NAME OF SCHOOL)
(SCHOOL ADDRESS)

ITEMS SDA DA N A SA NA
1. The activities match the
level of appreciation of the
learners.
2. The activities are
challenging yet stimulating
for the learners
3. The activities are
completely aligned to the
objectives.
4. The activities are essential
to the needs of the learners .
5. The activities are easy to
conduct but very
meaningful.
6. The learning materials
needed in the module are
easy to provide

Comments/Suggestions/Recommendations
Instructions: In 3-5 sentences, answer the given questions below. Write your answers on the blank
provided.

1. What were the best features of the content of the module? Why?

2. What were the features of the content of the module which need further improvement? How could
we improve them?

3. Other comments and suggestions.

School Address:
School
School ID:
Logo
Email Address :
Contact Number of the School: