FORM 4: LAC ENGAGEMENT REPORT

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

NAME OF MEMBER: NAME HERE LAC SESSION TITLE:

SCHOOL: DATE OF LAC SESSION:

DIVISION:URDANETA CITY NUMBER OF LAC SESSION: 4

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

colleagues in this LAC session.

2. The LAC session deepened my

understanding of the topic
presented.

3. My perspective on the topic/s

covered has changed as a result
of the LAC session.

4. I participated actively in the LAC

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

5. I interacted with different

people during the LAC
session.
 ACTION PLAN

6. I feel motivated to apply in my

region/division/district what I
have learned in this LAC session.

7. I intend to apply what I have

learned from this LAC Session in
my
region/division/district/school

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:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
______________________________________________________________________________

Name of Participant with E-signature

Position