REGION I

DIVISION OF PANGASINAN II
Canarvacanan, 2436, Binalonan
Pangasinan, Philippines

DISTRICT/MUNICIPAL LEVEL LAC

Date

ATTY. DONATO D. BALDERAS, JR.

Schools Division Superintendent
Pangasinan Division II
Binalonan, Pangasinan

Sir:

May I request permission to conduct a DISTRICT LAC on ________(Date)_____________ to be

held at __ (Venue)_____________________________. Participants in this activity are
___________________________________ with an expected number of ______________ attendees
charged to (MOOE, others specify).

The objectives of the said LAC SESSION are the following:

1.
2.
3.

Attached is the LAC Session Proposal. I hope for your favourable approval on my request.
Thank you very much.

Amount/Estimated Expenses: ________________________________

Fund Source charge to: (MOOE, Others specify)

Sincerely yours,

__________________
(Proponent)

Recommending Approval:

____________________________________ (For Elementary)

School Head Public School District Supervisor

APPROVED:

For the Schools Division Superintendent:

(For Elementary) (For Secondary)

VIVIAN S. PAGATPATAN, Ph.D. ELY S. UBALDO, Ed.D.

OIC, Asst. Schools Division Superintendent OIC, Asst. Schools Division Superintendent

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 REGION I
DIVISION OF PANGASINAN II
Canarvacanan, 2436, Binalonan
Pangasinan, Philippines

SCHOOL LEVEL LAC

Date

ATTY. DONATO D. BALDERAS, JR.

Schools Division Superintendent
Pangasinan Division II
Binalonan, Pangasinan

Sir:

May I request permission to conduct a SCHOOL LAC on ________(Date)_____________ to be

held at __ (Venue)_____________________________. Participants in this activity are
_______________________________ with an expected number of ______________ attendees
charged to (MOOE, others specify).

The objectives of the said LAC SESSION are the following:

1.
2.
3.

Attached is the LAC Session Proposal. I hope for your favourable approval on my request.
Thank you very much.

Amount/Estimated Expenses: ________________________________

Fund Source charge to: (MOOE, Others specify)

Sincerely yours,

__________________
(Proponent)

Recommending Approval:

____________________________________
School Head

APPROVED:

For the Schools Division Superintendent:

(For Elementary) (For Secondary)

VIVIAN S. PAGATPATAN, Ph.D. ELY S. UBALDO, Ed.D.

OIC, Asst. Schools Division Superintendent OIC, Asst. Schools Division Superintendent

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 REGION I
DIVISION OF PANGASINAN II
Canarvacanan, 2436, Binalonan
Pangasinan, Philippines

LAC SESSION PROPOSAL TEMPLATE

I. LAC SESSION TITLE

II. DATES OF IMPLEMENTATION & VENUE

DAY 1 DAY 2 DAY 3 DAY 4

August 11, 2017 August 25, 2017 Sept. 8, 2017 Sept. 22, 2017

III. DESCRIPTION OF THE LAC SESSION & LEGAL BASIS

(Discuss Activity Design)
IV. OBJECTIVES
1.
2.
3.
V. TARGET PARTICIPANTS
*Sample A – for District/Municipal Level

SCHOOLS MT - I T-III T - II T-I TOTAL

School A
School B
School C

*Sample B – for School Level

MT - I T-III T - II T-I TOTAL

2 1 6 7
5 8 5 3

VI. FUND SOURCE

(Note: This is a sample representation only)

ESTIMATED EXPENSES NO. OF PAX AMOUNT TOTAL FUNDING

(Please write in detail) AMOUNT REQUIREMENT
Food/ Snacks MOOE
Printing of Handouts
Total

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VII. PROPOSED ACTIVITY MATRIX
(Please write details of the activity – This is a four session, 2 Hour activity, school-based sample. The LAC
session is designed to be conducted every 2nd Friday of the Month. You may revise depending on your
requirements)

DAY 4
TIME DAY 1 DAY 2 DAY 3
August 11, 2017 August 25, 2017 Sept. 8, 2017 Sept. 22, 2017
4:00PM – 4:15PM Opening
Program
4:16 – 4:30 AM
PM 4:30 – 5:00 AM

VIII. PEOPLE INVOLVED

a. WORKING COMMITTEE
(Please revise whenever necessary)

OVER-ALL CHAIRMAN (PLANNING COMMITTEE) TECHNICAL COMMITTEE

1. Chairman: (Proponent) 1. Chairman
2. Vice-chairman 2. Vice-chairman

ATTENDANCE COMMITTEE ACTIVITY/WORKSHOP

1. Chairman 1. Chairman
2. Vice-chairman 2. Vice-chairman

b. RESOURCE SPEAKERS

NAME OF SPEAKERS POSITION TOPIC

1.
2.

XIV. ASSESSMENT METHOD

- Presentation of outputs
- Others, specify

Recommending Approval: Prepared by:

__________________________________ _______________________________
(Copy appropriate signatories if it is for Proponent / Organizer
elementary, secondary, municipal or
district)
APPROVED:

For the Schools Division Superintendent:

(For Elementary) (For Secondary)

VIVIAN S. PAGATPATAN, Ph.D. ELY S. UBALDO, Ed.D.

OIC, Asst. Schools Division Superintendent OIC, Asst. Schools Division Superintendent

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