LAC Facilitator Information Sheet

Schools Division: District:

School: School Head:
LAC Facilitator: Gender: __M ___F
Date of Birth: Age:
Contact Details: Email Address:

Phone Number: Facebook Name:

Mobile Number

Home Address:

What is the best way to reach you? Please rank Do you have easy access to the Internet? (i.e.,
according to preference: It is easy for you to send and receive email,
__Personal Mobile check FB, etc.)
__Phone(landline) __Yes
__Email __No
__Others, please specify:
_____________________________________
Highest Educational Attainment (check one) Course(s)/Degree(s) completed: (please
__College specify)
__With MA Units
__Master’s Degree
__With PhD Units
__PhD Degree
Designation/Assignments (please check all that Teacher Rank:
apply): __Teacher I
__Subject Teacher __Teacher II
__Class Adviser __Teacher III
__Administrator/Head Teacher __Master Teacher I
__Grade Level Coordinator __Master Teacher II
__Others (please specify): __Others (please specify):
_____________________________________ ___________________________________
Grade Levels Currently Taught: Length of time teaching the present grade
__Kindergarten level:
__Grade I __Less than a year
__Grade2 __1-5 years
__Grade 3 __6-10 years
_Grade4-6 __11-15 years
__Junior HS __16-20 years
__Senior HS __21 years and above
Previous grade levels taught: Number of years of teaching experience:
__K to 3 __Less than a year __11-15 years
__Grade 4 to 6 __1-5 years __16-20 years
__Grade 7 to 10 __6-10 years __21 years and above
Does your school have LACs other than the Have you attended training on early literacy
ELLN Digital LAC? and numeracy instruction? If yes, please
__Yes specify the training program and the length
__No (duration) of the program
__Yes
__No