Republic of the Philippines

Department of Education
Cordillera Administrative Region

Instructional Plan
S.Y. 2020-21

LEARNERS’/PARENTS INFORMATION MEETING INFORMATION

Learner’s Name: Jane N. Basitan DATE OF MEETING: ________

Sex: Female DATE OF LAST IP: ________
Birthdate: 06/01/1978 PURPOSE OF MEETING:
Grade: One ____First IP
LRN: 13607200001 ____Second IP
Learner’s Primary Language: Iloko ____Third IP
Address: Liwan West, Rizal, Kalinga ____Revision of IP Date: ______
Learner’s Home Address: Liwan West, Rizal, Kalinga ____IP Revision without a Meeting:
Parents: Juan Basitan/Maria Basitan At the request of ____ Parent
Parent Phone: 09360000001
Work: Farming/Housekeeping Anticipated Duration of Intervention:
Mobile Phone/Email: 093600000001/jbasitan@gmail.com _______________
Language Spoken at Home: Iloko, Idallak
Emergency Contact/Phone Number: 09360000001 IP Review Date: ___________
Current School: Liwan East Elementary School COMMENTS:
District: Rizal _____________________________________

IP PARTICIPATION

Parent/Guardian: Juan Basitan

Learner’s Name: Jane N. Basitan
School Head: Marivic A. Domingo
Special Education Teacher: None
Regular Education Teacher: Miriam P. Lasegan
Guidance Counselor/Guidance Designate: Mayflor S. Turales
 Republic of the Philippines
Department of Education
Cordillera Administrative Region

PROCEDURAL SAFEGUARDS
________ I was provided with information relative to the Instructional Plan. The process, intervention, and
benefits were clearly explained in my primary language. I will help and give the basic information needed in
this plan.
Parent Signature: _____________________________________
 Republic of the Philippines
Department of Education
Cordillera Administrative Region

STRENGHTS, CONCERNS, INTERESTS AND PREFERENCES

STATEMENT OF THE LEARNER’S STRENGHTS:

Ex. The learner is very good in self-help skills. She can manage to zip her pants,
unbutton her blouse, tie shoe lace, combing hair etc…. (My Daily Routine)

Ex. The learner has a good fine motor skills. She can draw shapes correctly, color
artworks completely etc. (Fine motor Skills)

STATEMENT OF PARENTS’ EDUCATIONAL CONCERNS:

Ex. I want my child to identify letter names and sounds.

STATEMENT OF LEARNER’S PREFERENCES AND INTERESTS

Ex. The learner is observed to be playful, she often plays with her classmates even
class hours.

CONSIDERATIONS OF SPECIAL FACTORS

IP GOALS, INCLUDING ACADEMIC AND FUNCTIONAL GOALS AND

BENCHMARKS OR SHORT-TERM OBJECTIVES
MEASURABLE GOAL: PROGRESS REPORT
1. Satisfactory Progress being made (Continue)
2. Unsatisfactory Progress being made (need to
review/revise)
3. Goal Met (Note date)

Date Date Date Date

BENCHMARK OR SHORT-TERM OBJECTIVES

FIRST SEMESTER:

SECOND SEMESTER:
 Republic of the Philippines
Department of Education
Cordillera Administrative Region