Republic of the Philippines

Department of Education
Region IV – A CALABARZON
SCHOOLS DIVISION OF ___________

FORM 4: LAC ENGAGEMENT REPORT

This form should be accomplished by each LAC Member at the end of every LAC session.

NAME OF MEMBER: LAC SESSION ID.:

REGION: DATE OF LAC SESSION:

DIVISION: NUMBER OF LAC SESSION:

Part A
Please indicate the extent to which you agree with each of the following statements by ticking
the appropriate box. (SD = Strongly Disagree; D = Disagree; N = Neutral; A = Agree; SA =
Strongly agree)

Comments / Remarks
(For example, if you
disagree or strongly
disagree, please
SD D N A SA indicate why.)

THE LAC SESSION

1. I learned a lot from my SA

colleagues in this LAC
session.

2. The LAC session deepened SA

my understanding of the
_____________________.

3. My perspective on the topic/s SA

covered has changed as a
result of the LAC session.

4. I participated actively in the SA

LAC session by sharing my
assignment and insights,
asking questions, and giving
feedback on what colleagues shared.

5. I interacted with different SA

people during the LAC
session.
 Republic of the Philippines
Department of Education
Region IV – A CALABARZON
SCHOOLS DIVISION OF ___________

ACTION PLAN SA

6. I feel motivated to apply in my SA

region/division/district/school
what I have learned in this
SLAC.

Part B
Please provide the information requested.

1. I need further clarification and/or resources on the following topics:

2. I encountered the following problems or challenges:

3. Other comments/suggestions: