DEPARTMET OF EDUCATION
SCHOOLS DIVISION OF ABRA
Date
Tim
e
SUBJECT/
Topic
SAMR
Substi
tution
Augme
ntation
Modific
-ation
Redefinition
TEACHER
Signatur
e
SCHOOL
HEAD
REMARKS
If any
Date
Time
Name of
Teacher
Subject/Topic
Purpose
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Republic of the Philippines
DEPARTMET OF EDUCATION
Signature
Remarks
If any
TIME
Name of
Teacher/Barrower and
Signature
PURPOSE
DATE
Released
DATE
Retrieve
d
Signature of
the ICT
Coordinator
Remarks if any