Republic of the Philippines

Department of Education
Region VIII (Eastern Visayas)
Division of LEYTE
JUAN VILLABLANCA MEMORIAL HIGH SCHOOL
Pastrana, Leyte

SCHOOL CHECKING OF FORMS CHECKLIST

Name of Teacher: _____________________________________ Name of School: _______________________________

District: _________________ Grade and Section:
_____________________________

Name of Learner SF1 SF2 SF5 SF9 SF10 Remarks / Comments

 Republic of the Philippines
Department of Education
Region VIII (Eastern Visayas)
Division of LEYTE
JUAN VILLABLANCA MEMORIAL HIGH SCHOOL
Pastrana, Leyte

Prepared by:

___________________
Class Adviser

DISTRICT CHECKING COMMITTEE

JOSE MARIE B. HINLO ERLEENE I. HOMERES JENNYLIND G. MARTILLO

Member Member Member

DENNIS P. DAGAMI NICOLAS V. CABIDOG J.D. NIDA A. BERTOS

Member Member Member
 Republic of the Philippines
Department of Education
Region VIII (Eastern Visayas)
Division of LEYTE
JUAN VILLABLANCA MEMORIAL HIGH SCHOOL
Pastrana, Leyte

JOEL B. RANES
Chairman/PIC, Pastrana District

Noted by:

DIVISION CHECKING COMMITTEE

EPSvr ARLITA V. LABACLADO EPSvr GINA P. DILOY

Chairperson Vice-Chairperson

Members:

JOEL B. RANES ROLANDO P. SUSAYA

PIC, Pastrana District PIC, Tunga District

RUBY DE VEYRA MA. KRISTINA TABERNERO

PRS ESPA