Republic of the Philippines

Department of Education
Region III
Division of Mabalacat City
Doña Asuncion Lee Integrated School

REFLECTION NOTES FORM

SY 2022-2023
NAME OF TEACHER JUAN P. DELA CRUZ
POSITION Teacher I
GRADE LEVEL 1
ACTIVITY Indicate here what type of activity (LAC session /
Focus Group Discussion (FGD) / Meeting / Collegial
Discussion)
DATE QUARTER □1 □ 2 □3 □4
VENUE
NAME OF FACILITATOR/
SPEAKER/MENTOR/
COACH/COLLEAGUE

PPST INDICATOR ADDRESSED

Teacher and learner feedback to enrich teaching practice (PPST 4.4.2)

TOPIC
Sample: Strategies on how to address learners with behavioral problems

INSIGHTS/ REALIZATIONS/LESSONS LEARNED:

You may include the following here:
 Significant learning
 Insights or realizations gained from the facilitator, mentor, or coach
regarding new concepts learned and known concepts that were more
understood
 Lessons learned based on personal situation/experience
 Easy and challenging points in the application of the concepts learned
Easy points (what was easy to learn or apply to learners and why)
Challenging points (what difficult to learn or apply to learners and why)

Address: Xevera, Tabun, Mabalacat City, Pampanga

Email address: dalis@depedmabalacat.org
Website: www.dalisdeped.com
 Republic of the Philippines
Department of Education
Region III
Division of Mabalacat City
Doña Asuncion Lee Integrated School

NEXT COURSE OF ACTION

You may include the following here:
 Plans for the application of the new strategies learned
 Plans for addressing issue/challenges encountered
 Plans to materialize the impact of what you have learned to your work as a
teacher

Prepared by:

JUAN P. DELA CRUZ

Ratee/Teacher I

Noted:

NONNAANN L. GUTIERREZ
Rater/Master Teacher I

Address: Xevera, Tabun, Mabalacat City, Pampanga

Email address: dalis@depedmabalacat.org
Website: www.dalisdeped.com
 Republic of the Philippines
Department of Education
Region III
Division of Mabalacat City
Doña Asuncion Lee Integrated School

PHOTO DOCUMENTATION OF THE CONDUCTED

ACTIVITY

Address: Xevera, Tabun, Mabalacat City, Pampanga

Email address: dalis@depedmabalacat.org
Website: www.dalisdeped.com
 Republic of the Philippines
Department of Education
Region III
Division of Mabalacat City
Doña Asuncion Lee Integrated School

CERTIFICATE AS PROOF OF ATTENDANCE

Include this if the activity is a LAC session, training, FGD with Certificate

Address: Xevera, Tabun, Mabalacat City, Pampanga

Email address: dalis@depedmabalacat.org
Website: www.dalisdeped.com
 Republic of the Philippines
Department of Education
Region III
Division of Mabalacat City
Doña Asuncion Lee Integrated School

ATTENDANCE SHEET

Address: Xevera, Tabun, Mabalacat City, Pampanga

Email address: dalis@depedmabalacat.org
Website: www.dalisdeped.com