(Inclosure No. 3 to DepEd Order No. 2, s.

2014)

School Plan to Address Needs (Submission is by School / No Alteration in the Template & Template is still subject
to change upon issuance of DepEd Order for Early Registration SY 2016-17)

Division: __ ______ ___________________ Region: __ VIII__________________

Date Accomplished: ___________________________

Please indicate additional inputs needed

Tentative Enrolment A. Additional Inputs Needed (please indicate number)

Grade Level Textbooks (total
M F T Classroom Teachers only per Grade Seats
Level)
1. Kindergarten
2. Grade 1
3. Grade 2
4. Grade 3
5. Grade 4
6. Grade 5
7. Grade 6
TOTAL

Learners under the B. Inputs Needs

Tentative Enrolment
ADMs Teacher - Facilitator Modules
Age 9
Age 10
Age 11
Age 12 & above
TOTAL

Learners under the B. Inputs Needs

Tentative Enrolment
ALS Teacher - Facilitator Modules
Age 9
Age 10
Age 11
Age 12 & above
TOTAL

Tentative Enrolment C. Additional Inputs Needed (please indicate number)

Categories of Disability
M F T Classroom Teachers Textbooks Seats
Visual Impairment
Hearing Impairment
Intellectual Disability
Speech/Language Impairment
Serious Emotional Disturbance
Autism
Orthopedic Impairment
Special Health Problems
Multiple Disabilities
TOTAL

D. Proposed Differentiated Program Intervention E. Assistance Needed

1. Formal Delivery System:

2. ADMs

3. Special Education in Inclusive Setting

Submitted by:

___________________________________________________
Name and Signature of School Head

___________________________________________________
Designation
Cell Phone Number _________________________________
email address ______________________________________
_________

_________

________
________