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Republic of the Philippines

Department of Education
Region X – Northern Mindanao
Division of Iligan City
North I District

____________________________________________________
School ID: _________

FORM 1: LAC Profile


REGION: Date of Session:

LAC ID (name or number): Number of LAC members:

Name of LAC Facilitator: Designation/Position:

LAC Members

NAME Male/ DESIGNATION/ DIVISION/S Contact Preferred


Female POSITION details contact mode
(email, (email,
mobile phone,
number) Skype, Zoom,
Google Meet,
Viber, FB)

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