REQUEST SLIP

Agreement on the use of the two (2) hours Teaching Related Loads
to be under taken Outside the School Campus
(CSC Resolution No. 080096, DepEd Memorandum 291, s. 2008 and DepEd Order No. 16, s. 2009)

Name:____________________________________ Contact No.:____________________________

Please fill and check the day/s and activity/ies:

Schedule Date/s: From:_______________________ To:_______________________

Tuesday
Monday Wednesday Thursday Friday

1. Preparation of DLL/DLP 7. Structuring of Classroom

8. Guidance and Counseling for students willl

2. Preparation of IMs
special needs

3. LAC with Co-Teachers 9. Conference with Parents of students

4. Checking of Students Outputs 10. Coaching/Training for ECA

5. Computation of Grades 11. Doing Community Linkages

6. Remedial sessions for students need 12. Other task, please

improvement specify :_____________________________________

Approved: ___________________________ Disapproved:_____________________________

Justification/s:__________________________________________________________________

This is to acknowledge that the undersigned teacher and principal agree that the activity/ies
marked (/) shall be carried out on the date indicated.

This agreement likewise serves as the authority for the teacher to be allowed to leave the
campus after rendering 6-hours of actual classroom teaching and spend the 2-hours outside the
school campus.

RENIA G. BAÑEZ__ ____________________________

School Head Signature of the Teacher