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LAC FORM 1 4 Template

This document contains templates for Lac related forms including: 1. A Lac profile form to record basic Lac details and member information. 2. A Lac facilitator information sheet to collect contact details. 3. A Lac session report form for the facilitator to provide feedback after each session. 4. A Lac engagement report for members to provide their feedback and action plans after sessions. The forms are to be used at various stages including initial Lac setup, sessions, and evaluation to support effective Lac coordination and activities.

Uploaded by

Catleah Zamora
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
3K views9 pages

LAC FORM 1 4 Template

This document contains templates for Lac related forms including: 1. A Lac profile form to record basic Lac details and member information. 2. A Lac facilitator information sheet to collect contact details. 3. A Lac session report form for the facilitator to provide feedback after each session. 4. A Lac engagement report for members to provide their feedback and action plans after sessions. The forms are to be used at various stages including initial Lac setup, sessions, and evaluation to support effective Lac coordination and activities.

Uploaded by

Catleah Zamora
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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FORM 1: LAC PROFILE

This form should be accomplished by the LAC Facilitator and its members at the first LAC session.

REGION:

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

Name of LAC Facilitator: Designation/Position:

LAC Members
NAME Male/Female DESIGNATION/ DIVISION/S Contact details Preferred
POSITION (email, mobile contact mode
number) (email, phone,
Skype, Zoom,
Google Meet,
Viber, FB)
FORM 2: LAC Facilitator Information Sheet
This form should be accomplished by the designated LAC Facilitator on or before the first LAC session.

Region:

Division:

NAME: Male/Female: Date of Birth: Age:

Contact details: Email: Mobile Number: Facebook Name:

Preferred contact mode: (Indicate all: email, phone, Skype, Viber, WhatsApp,
Zoom, Googlemeet, FB, Messenger, etc.)
Messenger
Mobile number

FORM 2: LAC Facilitator Information Sheet


This form should be accomplished by the designated LAC Facilitator on or before the first LAC session.

Region:

Division:

NAME: Male/Female: Date of Birth: Age:

Contact details: Email: Mobile Number: Facebook Name:

Preferred contact mode: (Indicate all: email, phone, Skype, Viber, WhatsApp,
Zoom, Googlemeet, FB, Messenger, etc.)
Messenger
Mobile number

FORM 3: LAC Session Report


This form should be accomplished by the LAC Facilitator at the end of every LAC session.

LAC ID: REGION

LAC FACILITATOR: LAC SESSION NO.:

DATE ANF TIME OF SESSION: VENUE/PLATROFM OF SESSION:

Number of members present (attach attendance document):


Materials and resources:

______ Self-Learning Module


______ Activity sheets
______ Digital resources
______Online resources
______ Smartphone
______ PC
______ LAC session guide
______ Others (please specify)

____________________________________

Part A
Please indicate the extent to which you agree with each of the following statements by ticking the
appropriate box.

(SD = Strongly Disagree; D = Disagree; N = Neutral; A = Agree; SA = Strongly agree)


Comments/Remarks
(For example, if you
disagree or strongly
disagree, please
SD D N A SA indicate why)
MEMBER PARTICIPATION
1. All of the members came prepared
for the LAC session
2. All of the members had an
opportunity to share and discuss
their assignment, insights, and
ideas
3. Members listened to each other’s
insights and ideas.
4. The members’ assignments showed
an understanding of the lessons in
the SLM.
5. The members demonstrated
engagement in and/or enthusiasm
for the learning tasks during the
session (including providing
feedback on each other’s
assignment).
FACILITATION
6. I managed the sharing and discussion
during the LAC session by keeping
the discussion focused on the lesson
or topic.
7. I encouraged all the members to
actively participate in the LAC
session (i.e., for the teachers to
share their work and ideas/
insights).
8. I provided useful feedback on the
teachers’ assignments.

PART B
Please provide the information requested.

1. The best part of the session (i.e. what went well):

2. Problems or challenges encountered and how they were resolved:

3. Other topics discussed apart from the recommended topics, if any:


4. Recommendations/Plans for next LAC session:

FORM 4: LAC ENGAGEMENT REPORT


This form should be accomplished by each LAC Member at the end of every LAC session.
NAME OF MEMBER: LAC SESSION ID:

REGION: DATE OF LAC SESSION:

DIVISION: NUMBER OF LAC SESSION:

Part A
Please indicate the extent to which you agree with each of the following statements by ticking the
appropriate box.

(SD = Strongly Disagree; D = Disagree; N = Neutral; A = Agree; SA = Strongly agree)


Comments/Remarks
(For example, if you
disagree or strongly
disagree, please
SD D N A SA indicate why)
THE LAC SESSION
1. I learned a lot from my colleagues in
this LAC session.
2. The LAC session deepened my
understanding of the SLM content.
3. My perspective on the topic/s
covered has changed as a result of
the LAC session.
4. I participated actively in the LAC
session by sharing my assignment
and insights, asking questions, and
giving feedback on what colleagues
shared.
5. I interacted with different people
during the LAC session.
ACTION PLAN

6. I feel motivated to apply in my


region/division/district what I have
learned in this lesson.
7. I intend to apply what I have learned
from the lesson in my
region/division/district
PART B
Please provide the information requested.

1. I need further clarification and/or resources on the following topics:


2. I encountered the following problems or challenges:

3. Other comments/suggestions:
Template for LAC Plan

Phase Activities Persons Involved Time Frame Resources Success Indicators


Fund Source of Fund

Planning

Implementation

Evaluation

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