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Survey Form

This document is a survey form from Calatagan High School in Catanduanes, Philippines for a pilot implementation of blended learning. It collects information on students' vaccination status, address, access to private transportation, parental consent and whether they have special needs. The form lists the name of 22 students along with their responses. It is prepared by their class adviser Jobelle P. Alintana and provides her contact information.

Uploaded by

Alintana Jobelle
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd

Topics covered

  • Health and Safety,
  • Learning Modalities,
  • ID Number,
  • Educational Framework,
  • Student Engagement,
  • Learning Outcomes,
  • Public Health,
  • Community Health,
  • Calatagan High School,
  • Bicol Region
98 views5 pages

Survey Form

This document is a survey form from Calatagan High School in Catanduanes, Philippines for a pilot implementation of blended learning. It collects information on students' vaccination status, address, access to private transportation, parental consent and whether they have special needs. The form lists the name of 22 students along with their responses. It is prepared by their class adviser Jobelle P. Alintana and provides her contact information.

Uploaded by

Alintana Jobelle
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd

Topics covered

  • Health and Safety,
  • Learning Modalities,
  • ID Number,
  • Educational Framework,
  • Student Engagement,
  • Learning Outcomes,
  • Public Health,
  • Community Health,
  • Calatagan High School,
  • Bicol Region

Republic of the Philippines

Department of Education
Region V (Bicol)
Schools Division office of Catanduanes
CALATAGAN HIGH SCHOOL

SURVEY FORM FOR PILOT IMPLEMENTATION ON THE BLENDED LEARNING


MODALITY

GRADE AND SECTION:


BARANGAY COVERED:
CLASS ADVISER:
Address Within Parental With Private
Vaccinated LSEN
Name Virac Consent Vehicle
Yes No Yes No Yes No Yes No Yes No
1 Angelo O. Borja √ √
2 Mac Daryl Angeles √ √
3 Jerico T. Cardo √ √
4 Erwin M. Valeza √ √
5 Ervin L. Ternida √ √
6 Peter Luise Manlangit √ √
7 Erwin C. Incilla √ √
8 John Patrick D. Mirasol √ √
9 Jerome Tabuzo √ √
10 April Don Crispino √ √
11 Roselle Vargas √ √
12 Ranzel Kaye Borja √ √
13 Celine Pajarillo √ √
14 Bea V. Veloria √ √
15 Catherine Joy Basister √ √
16 Carla S.J. Cajuday √ √
17 Jean Jasmin R. Delluza √ √
18 Jennylen T. Gomez √ √
19 Shanly Mae Magdahong √ √
20 Jeraldine Malavega √ √
21 Shayne Lee San Juan √ √
22 Salve T. San Andres √ √

Prepared by:

JOBELLE P. ALINTANA
Adviser

Address : Calatagan, Virac, Catanduanes


Email Address : 302084@deped.gov.ph
ID Number : 302084
Address : Calatagan, Virac, Catanduanes
Email Address : 302084@deped.gov.ph
ID Number : 302084
Republic of the Philippines
Department of Education
Region V (Bicol)
Schools Division office of Catanduanes
CALATAGAN HIGH SCHOOL

SURVEY FORM FOR PILOT IMPLEMENTATION ON THE BLENDED LEARNING


MODALITY

GRADE AND SECTION:


BARANGAY COVERED:
CLASS ADVISER:
Address Within Parental With Private
LSEN
Name Vaccinated Virac Consent Vehicle
Yes No Yes No Yes No Yes No Yes No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

Prepared by:

LIBERTY B. LIM
Class Adviser

Address : Calatagan, Virac, Catanduanes


Email Address : 302084@deped.gov.ph
ID Number : 302084
Republic of the Philippines
Department of Education
Region V (Bicol)
Schools Division office of Catanduanes
CALATAGAN HIGH SCHOOL

SURVEY FORM FOR PILOT IMPLEMENTATION ON THE BLENDED LEARNING


MODALITY

GRADE AND SECTION:


BARANGAY COVERED:
CLASS ADVISER:
Address Within Parental With Private
Vaccinated LSEN
Name Virac Consent Vehicle
Yes No Yes No Yes No Yes No Yes No
1 Renofloro Gianan √ √
2 Brian Joseph R. Lumbao √ √
3 John Mark O. Beo √ √
4 Christopher Sto. Tomas √ √
5 John Mark Tañon √ √
6 Edwin M. Asuncion √ √
7 Janxent Magtangob √ √
8 Mark S. Matienzo √ √
9 Mark Ryan B. Torreja √ √
10 Jerome B. Tabuzo √ √
11 Clarissa Lie S. Lopez √ √
12 Mia S. Romano √ √
13 Charmaine B. Tablizo √ √
14 Mariah Agunday √ √
15 Angie B. Matienzo √ √
16 Reena May Ogalesco √ √
17 Jenny Camacho √ √
18 Geann S. Arcilla √ √
19 Marielle C. Del Rosario √ √
20 Mica Cajuday √ √
21 May C. Gallora √ √
22 Bernadeth Villafuerte √ √

Prepared by:

JOBELLE P. ALINTANA
Adviser

Address : Calatagan, Virac, Catanduanes


Email Address : 302084@deped.gov.ph
ID Number : 302084
Address : Calatagan, Virac, Catanduanes
Email Address : 302084@deped.gov.ph
ID Number : 302084

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