Republic of the Philippines

Department of Education
Region X
DIVISION OF LANAO DEL NORTE

INTERNAL ASSESSMENT FORM ON INFRASTRUCTURE, PHYSICAL FACILITIES, FURNITURE AND REAL ESTATE SUPPORT PACKAGE

School: San Antonio E/S School ID: __127241___ Contact Person:___Mrs. Teodora B. Gumapon Contact Details: 09050257836
Types of Intervention Details Total No. of No. of Learners that Needs Very Important Less Important Remarks
Enrolment Intervention ( Yes / No ) ( Yes / No )
Classroom/Building Army Type Building 180 180 yes no For Demolition
Semi Permanent
School Stage Semi Permanent 180 180 yes For completion
School Fence none No sch. fence
Toilet WatSan 3 rooms 180 180 yes Needs to be repaired
Classroom 3 w/ toilet
Handwashing Facilities Wat San 180 180 yes Needs to be repaired
Water Supply Centralized faucet 180 180 yes Good condition
Laboratories/ Workshops ICT Room 180 86 yes Very small area
Libraries none 180 No library
Furniture Sala set, cabinets, 180 yes Good condition
book shelves, tables,
chairs
Appliances speakers 180 yes Good condition
Painting/Repainting Repainting 180 yes completed
Others: Please specify

Prepared by: Noted by

TEODORA B. GUMAPON RASMILA M. COSAIN
Teacher SEPS-SOCMOB
 Republic of the Philippines
Department of Education
Region X
DIVISION OF LANAO DEL NORTE

INTERNAL ASSESSMENT FORM ON LEARNERS’ SUPPORT PACKAGE

School:San Antonio E/S School ID: __127241__Contact Person:__Mrs. Teodora B. Gumapon_ Contact Details: __09050257836_____

Types of Intervention Details Total No. No. of Very Important Less Remarks
of Learners that ( Yes / No ) Important
Enrolment Needs ( Yes / No )
Intervention
Training for Boy Scouts & Girl Scouts 180 5 yes no Leadership
schoolchildren Training Course
Audio-visual education
materials such as
E-books
Educational films
E-libraries
Non-digital teaching aids
Math Apparatus & Science Apparatus yes Good Condition
no
Reference Books & Good Condition
Library Materials Math, Science, ESP no
yes
School Supplies Cartolina, manila paper, bondpaper, no Helpful for the
Pentel pens,paper clips, Ar Pan yes pupils
Uniform / Shoes School Uniforms & Shoes yes no Parents’ Expense

Financial Support 4 p’s yes no Only very few

are recipients
Stipends none
Others: Please specify

Prepared by: TEODORA B. GUMAPON Noted by: RASMILA M.

COSAIN
 Teacher SEPS-SOCMOB

Republic of the Philippines

Department of Education
Region X
DIVISION OF LANAO DEL NORTE

INTERNAL ASSESSMENT FORM ON TECHNOLOGYSUPPORT PACKAGE

School: San Antonio E/S School ID: 127241 Contact Person:__Mrs. Teodora B. Gumapon_____Details: __09050257836_____

Types of Intervention Details Total No. No. of Very Important Less Remarks
of Learners that ( Yes / No ) Important
Enrolment Needs ( Yes / No )
Intervention
Laptop 3 pcs 180 86 yes no Only 2 are usable
Computer -Desktop 7 pcs 180 86 yes no Good condition
Internet Connectivity none No internet
Television sets none No T.V. Set
DVD none No DVD
E-learning Materials none none
Speakers 2 pcs 180 180 yes no Good condition
Others: Please specify

Prepared by: Noted by

TEODORA B. GUMAPON RASMILA M. COSAIN
Teacher SEPS-SOCMOB
 Republic of the Philippines
Department of Education
Region X
DIVISION OF LANAO DEL NORTE

School: San Antonio E/S School ID: 127241 Contact Person: Mrs. Teodora B. Gumapon Contact Details: __09050257836_____

Types of Intervention Details Total No. of No. of Learners that Very Important Less Important Remarks
Enrolment Needs Intervention ( Yes / No ) ( Yes / No )
Medical-Dental Mission none 180 Needed by the
pupils
Vitamins none Needed by the
pupils
Deworming Oct. 14,2019 180 yes All pupils are
dewormed
School Feeding August- December 48 yes Good result
Nutritional supplements Gulayan sa 48 yes Good result
Paaralan
Eye check up none
Eyeglasses none
Others: Please specify

Prepared by: Noted by

TEODORA B. GUMAPON RASMILA M. COSAIN
Teacher SEPS-SOCMO
 Republic of the Philippines
Department of Education

INTERNAL ASSESSMENT FORM ON TEACHERS’ SUPPORT PACKAGE

School: San Antonio E/S School ID: 127241 Contact Person: Teodora B. Gumapon Contact Details: ___09050257836____

Types of Intervention Details Very Less Remarks

Important Important
( Yes / No ) ( Yes / No )
Teachers’ Training (please K to 12 Mass Training for Teachers yes no Very helpful
specify)
Eyeglasses All the teachers are using eyeglass yes no Teachers’ expense
Medicine Kit All the classrooms have Medicine kit yes no Teachers’ expense
Reference Books & Library Some Learning Areas have Reference Books yes no Good condition
Materials No Library only reading corners
School Supplies Bandpaper,cartolina,manila paper, pintel pens,pilot ink, yes no Very helpful
paper pastener, ballpens
Laptop 3 laptops yes no Only 2 are in good condition
Projector with LCD 3 pcs yes no Only 2 are in good condition
Others: Please specify

Prepared by: Noted by

TEODORA B. GUMAPON RASMILA M. COSAIN
Teacher SEPS-SOCMOB
 Republic of the Philippines
Department of Education

INTERNAL ASSESSMENT FORM ON SPECIAL PROJECTS/LAST MILES EDUCATION SUPPORT PACKAGE

School:San Antonio E/S School ID: _127241______ Contact Person:_Mrs. Teodora B. Gumapon Contact Details: _____09050257836__

Region: X Division: LANAO DEL NORTE Name of Coordinator: RASMILA M. COSAIN Contact Details: ______________

Types of Details Total Number of Number of Learners Very Important Less Important Remarks
Intervention Enrolment that Needs ( Yes / No ) ( Yes / No )
Intervention
Boat ( Pedals and none
Paddles )
Bikes of the none
Philippines
Solar Panels none
( Light EDPH
Solar Lamps none
(Light ED PH
Water Supply Centralized faucet 180 180 yes no Good condition
System
Others

Prepared by: Noted by

TEODORA B. GUMAPON RASMILA M. COSAIN
Teacher SEPS-SOCMOB

Republic of the Philippines

 Department of Education
Region X
DIVISION OF LANAO DEL NORTE

INTERNAL ASSESSMENT FORM ON ASSISTIVE LEARNING DEVICES FOR STUDENTS WITH SPECIAL NEEDS

School:_San Antonio Elementary School School ID: _127241__ Contact Person:__Mrs. Teodora B. Gumapon_ Contact Details: _09050257836_

Types of Intervention Details Total Number of Learners Very Important Less Important Remarks
Number of that Needs ( Yes / No ) ( Yes / No )
Enrolment Intervention
No-tech devices:

-pencil grips
-dry-erase boards none
-special chairs
Picture cards
Mid-tech devices:

-tape recorders none

-spelling check devices
-overhead projector
High-tech devices:
-software none
-computerized systems
-specialized keyboards
-peripheral devices
Others
Prepared by: Noted by
TEODORA B. GUMAPON RASMILA M. COSAIN
Teacher SEPS-SOCMOB