GESPv2018 10 24

GOVERNMENT ELEMENTARY SCHOOL PROFILE , SY 2018-2019
TABLE BOX Page # TITLE

1 SCHOOL INFORMATION
1 2 Table 1. LEARNERS DATA, SY 2018-2019 (As of June 30, 2018)
2 3 Table 2. LEARNERS AGE PROFILE, SY 2018-2019 (As of June 30, 2018)
3 4 Table 3. REPEATERS AGE PROFILE, SY 2018-2019 (As of June 30, 2018)
4 5 Table 4. AGE PROFILE OF LEARNERS WITH SPECIAL EDUCATIONAL NEEDS (LSENs), SY 2018-2019 (As of June 30, 2018)
5 6 Table 5. AGE PROFILE OF GIFTED LEARNERS, SY 2018-2019 (As of June 30, 2018)
6 7 Table 6. ENROLLMENT AND NUMBER OF CLASSES BY SHIFT, SY 2018-2019 (As of June 30, 2018)
1 7 Box 1. NUMBER OF CLASSES, SY 2018 -2019 (As of June 30, 2018)
7 8 Table 7. LEARNERS DATA BY PROGRAM, SY 2018-2019 (As of June 30, 2018)
8 8 Table 8. GIFTED LEARNERS DATA, SY 2018-2019 (As of June 30, 2018)
9 9 Table 9. LEARNERS WITH SPECIAL EDUCATIONAL NEEDS (NON-GRADED) DATA, SY 2018-2019 (As of June 30, 2018)
10 (continuation of definition of Table 9)
10 11 Table 10. LEARNERS WITH SPECIAL EDUCATIONAL NEEDS (GRADED) DATA MAINSTREAMED IN REGULAR CLASS, SY 2018-2019 (As of June 30, 2018)
11 12 Table 11. LEARNERS WITH SPECIAL EDUCATIONAL NEEDS (GRADED) DATA IN SELF-CONTAINED CLASS, SY 2018-2019 (As of June 30, 2018)
12 13 Table 12. LEARNERS WITH SPECIAL EDUCATIONAL NEEDS (LSENs) UNDER THE HOMEBOUND AND HOSPITAL BOUND PROGRAM
13 14 Table 13. PERSONNEL DATA (Locally-funded and DepEd Subsidized Teachers Working in the School), SY 2018-2019 (As of June 30, 2018)
14 14 Table 14. TEACHING RELATED AND NON-TEACHING PERSONNEL DATA (Nationally-funded), SY 2018-2019 (As of June 30, 2018)
15 15 Table 15. TEACHING PERSONNEL DATA (Nationally-funded), SY 2018-2019 (As of June 30, 2018)
16 16 Table 16. TEACHER ASSIGNMENTS (Nationally-funded teachers working in the school), SY 2018-2019 (As of June 30, 2018)
17 16 Table 17. NUMBER OF TEACHERS BY GRADE LEVEL
(Nationally-funded teachers actually working in the school), SY 2018-2019 (As of June 30, 2018)
18 16 Table 18. NUMBER OF TEACHERS BY TEACHING ASSIGNMENT IN GRADES 5 AND 6
(Nationally-funded teachers actually working in the school), SY 2018-2019 (As of June 30, 2018)
19 17 Table 19. TEACHERS’ DATA HANDLING LEARNERS WITH SPECIAL EDUCATIONAL NEEDS (LSENs)
(Nationally-funded teachers only), SY 2018-2019 (As of June 30, 2018)
20 18 Table 20. NUMBER OF TEACHERS BY HIGHEST TEACHING DEGREE ATTAINMENT
2 18 Box 2. LEARNING ACTION CELL (LAC) SESSION, SY 2018-2019
3 18 Box 3. ACTION RESEARCH, SY 2018-2019
21 19 Table 21. MOOE ALLOCATION, UTILIZATION AND LIQUIDATION
FROM JANUARY 2017 TO DECEMBER 2017
4 19 Box 4. AVAILABILITY OF ELECTRICAL SUPPLY, SY 2018-2019 (As of June 30, 2018)
22 19 Table 22. NUMBER OF FUNCTIONAL COMPUTERS IN THE SCHOOL BY FUNDING SOURCE, SY 2018-2019 (As of June 30, 2018)
23 20 Table 23 . NUMBER OF FUNCTIONAL ICT EQUIPMENT IN THE SCHOOL BY FUNDING SOURCE, SY 2018-2019 (As of June 30, 2018)
24 21 Table 24. NUMBER OF ASSISTIVE TECHNOLOGY AND ADAPTIVE DEVICES FOR LSENs, SY 2018-2019 (As of June 30, 2018)
25 22 Table 25. NUMBER OF EQUIPMENT AND TOOLS IN THE SCHOOL FOR LSENs, SY 2018-2019 (As of June 30, 2018)
5 23 Box 5. DATA ON INTERNET CONNECTIVITY, SY 2018-2019 (As of June 30, 2018)
26 23 Table 26. AVERAGE MONTHLY EXPENSE (IN PESOS) OF INTERNET CONNECTION BY FUNDING SOURCE, SY 2018-2019 (As of June 30, 2018)
6 24 Box 6. SCHOOL SITE DATA, SY 2018-2019 (As of June 30, 2018)
27 25 Table 27. VULNERABILITIES, For the months of June 2017 to May 2018
28 25 Table 28. DISASTER PREPAREDNESS, For the months of June 2017 to May 2018
29 26 Table 29. DISASTERS/CALAMITIES, For the months of June 2017 to May 2018
30 27 Table 30. DISASTERS/CALAMITIES (Human-Induced Hazards - Armed Conflict), For the months of June 2017 to May 2018
31 27 Table 31. RESULT OF DISASTER INCIDENCES, For the months of June 2017 to May 2018
7 28 Box 7. OTHER CONFLICT-RELATED DATA, For the months of June 2017 to May 2018
8 29 Box 8. SAFE LEARNING FACILITIES, For the months of June 2017 to May 2018
9 29 Box 9. INTEGRATION OF CLIMATE CHANGE ADAPTATION (CCA) AND DISASTER RISK REDUCTION AND MANAGEMENT (DRRM), For the months of June 2017 to May 2018
10 30 Box 10. SCHOOL DISASTER RISK REDUCTION AND MANAGEMENT (SDRRM) TEAM, For the months of June 2017 to May 2018
32 31 Table 32. LEARNING AREAS WITH DRRM-RELATED CONCEPTS, For the months of June 2017 to May 2018
33 31 Table 33. TEACHING PERSONNEL WHO RECEIVED COURSES/TRAINING ON DRRM/CCA, For the months of June 2017 to May 2018
34 31 Table 34. LEARNERS WHO RECEIVED COURSES/TRAINING ON DRRM/CCA, For the months of June 2017 to May 2018
35 32 Table 35. HEALTH AND NUTRITION, SY 2018-2019
A. Number of learners who were vaccinated by the Department of Health in the school this SY 2018-2019 from June 4, 2018 to August 31, 2018
B. Number of learners who underwent vision screening according to results from June 4, 2018 to August 31, 2018
C. Number of learners by nutritional status as assessed from June 4, 2018 to August 31, 2018
D. Number of learners who were dewormed from June 4, 2018 to August 31, 2018
11 33 Box 11. SCHOOL CLINIC, SY 2018-2019
12 34 Box 12. AVAILABILITY OF WATER SUPPLY, SY 2018-2019 (As of June 30, 2018)
36 34 Table 36. NUMBER OF EXISTING WASH FACILITIES, SY 2018-2019 (As of August 31, 2018)
37 35 Table 37. ORAL HEALTH, PREVIOUS SY 2017-2018
38 35 Table 38. MEDICAL AND NURSING SERVICES, PREVIOUS SY 2017-2018
13 36 Box 13. MENTAL HEALTH, PREVIOUS SY 2017-2018
14 37 Box 14. TOBACCO CONTROL, SY 2018-2019
15 37 Box 15. NATIONAL PREVENTIVE DRUG EDUCATION, SY 2018-2019
16 38 Box 16. FEEDING PROGRAM, SY 2018-2019 (As of August 31, 2018)
17 38 Box 17. FOOD HANDLING, SY 2018-2019 (As of August 31, 2018)
18 39 Box 18. SOLID WASTE MANAGEMENT, SY 2018-2019 (As of June 30, 2018)
19 39 Box 19. OPERATION AND MAINTENANCE OF SANITATION FACILITIES, SY 2018-2019 (As of June 30, 2018)
20 39 Box 20. MENSTRUAL HYGIENE, SY 2018-2019 (As of June 30, 2018)
21 40 Box 21 . SCHOOL GOVERNMENT PROGRAM (SGP), SY 2018-2019
22 40 Box 22 . SUPREME PUPILS GOVERNMENT (SPG) ACTIVITIES, SY 2018-2019
23 40 Box 23. CAREER GUIDANCE PROGRAM, SY 2018-2019
24 41 Box 24 . SCHOOL SPORTS PROGRAM, SY 2018-2019 (As of June 30, 2018)
AVAILABLE SPORTS EVENTS, CLUBS, AND FACILITIES
Table 39 . SCHOOL SPORTS PROGRAM, SY 2018-2019 (As of June 30, 2018)

39 42
SPORTS PERSONNEL (DepEd Funded) DATA
40 43 Table 40. TRAVEL DETAILS (ONE-WAY) FROM SCHOOL, SY 2018-2019
25 43 Box 25. SCHOOL LOCATION, SY 2018-2019

GESPv2018.10.24
Republic of the Philippines

DEPARTMENT OF EDUCATION
PLANNING SERVICE
Education Management Information System Division
GOVERNMENT ELEMENTARY SCHOOL PROFILE

INSTRUCTIONS
This form shall be accomplished by the head of all government elementary schools. In the case of schools with annexes, extensions, etc., a separate school profi
extension, etc.
The head of the school shall sign the forms certifying to the correctness of the data, and shall be responsible and accountable for any inaccuracy or false
submit the accomplished forms to the respective Schools Division Office (SDO) on or before September 30, 2018.
Important: Read the definitions/instructions found at the bottom of each table before filling up the form. No item should be left blank. Instead, "zero (
written. Shaded boxes shall not be filled.
SCHOOL INFORMATION
SY 2018-2019
Name of School : NATO-BUTUAN E/S Region :

(Official Name) Division :
School District :
(Previous Name, if any) Legislative District :
Address : NATO Telephone Number :
No. Street/Sitio/Purok Barangay Mobile Number :
ANINI-Y ANTIQUE 5717 Fax Number :
Municipality/City Province Zip Code Website (if any) :
E-Mail Address :
Date Established (mm/dd/yyyy) :
Page 1 of 43
Please check (a ) if the school is: Please check (a ) if the school has the following Curricu
✘ 0 a Central School ✘ 1 Kindergarten
✘ an Annex/Extension School - Please Indicate Mother School ID: ✘ 1 Grades 1 to 6
✘ an Implementing Unit (has book of accounts or has fiscal autonomy)

If check (a ), should have any of the finance position: Senior Bookkeeper & Disbursing Officer II in Table 14.
Certified True and Correct by : Checked by Schools District Office : Verified by the Schools Divis
School Head : MA.SHEILA S. CAZENAS Head of the Office : Head of the Office :
(Signature Over Printed Name) (Signature Over Printed Name)
Position Title : HT-III Date : Position Title : Date : Position Title :
Page 1 of 43
0 0 1 114949
District ID School ID
he Philippines
OF EDUCATION
G SERVICE
nformation System Division
NTARY SCHOOL PROFILE

RUCTIONS
schools with annexes, extensions, etc., a separate school profile shall be accomplished by every annex,
hall be responsible and accountable for any inaccuracy or false data/information reported. He/She shall
r 30, 2018.
g up the form. No item should be left blank. Instead, "zero ( 0 )" or "not applicable (n/a) " shall be
FORMATION
18-2019
VI
ANTIQUE
ANINI-Y
LONE
09175969205
cazenas30@gmail.com
1960
Page 1 of 43
Please check (a ) if the school has the following Curricular Offering Classification (COC):
Verified by the Schools Division Office :
(Signature Over Printed Name)
Date :
Page 1 of 43
Table 1. LEARNERS DATA, SY 2018-2019 (As of June 30, 2018)
Learners w/ Special TOTAL
Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Educational Needs
(Kindergarten to
Particulars
(Non-Graded) LSENs Non-Graded)
Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female
TOTAL ENROLLMENT 0 0
Monograde 8 3 12 11 9 9 16 6 14 8 11 9 9 11 0 0 65 57
Multigrade 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
CCT/4Ps Recipient 2 1 1 2 6 3 4 1 5 3 6 3 4 5 0 0 28 18
Indigenous Peoples Learner 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 2 1
Muslim Learner 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Learner in Alternative Delivery Modes 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
a. Distance Education (DistEd) for SPED 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 #REF!
b. Enhanced-Instructional Management by Parents, Community
and Teachers (e-IMPACT) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Modified In-School Off-School Approach (MISOSA) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Other School-Initiated Intervention 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Balik-Aral 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Repeater 0 0 1 0 2 0 1 1 0 0 0 0 0 0 0 4 1
Transferee from Other Public Schools (in any Previous SY) 0 1 2 1 0 0 0 0 0 1 0 0 0 0 0 2 3
Transferee from Private Schools (in any Previous SY) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Notes:
1. Learner - refers to an individual who may be enrolled in one or multiple programs.
2. Total Enrollment - refers to the total number of learners enrolled in the school regardless of program. This is also the sum of monograde and multigrade classes.
3. Elementary Enrollment - refers to the total number of learners enrolled in the first stage of compulsory and mandatory formal basic education which is composed of Kindergarten to Grade 6.
Kindergarten Enrollment - refers to the total number of learners enrolled in one (1) year preparatory education for children at least five (5) years old within the school year as stipulated in DepEd Order No. 20 s.
2018 as pre-requisite for Grade 1.
4. Learners with Special Educational Needs (Non-Graded) Enrollment - refers to similarly grouped learners who are not yet ready for inclusion in the regular class.
5. Monograde Enrollment - refers to learners being taught in classes consisting of a single grade only.
6. Multigrade Enrollment - refers to learners being taught in classes consisting of two or more grades handled by one teacher.
7. CCT/4Ps Recipient - refers to a learner ages 3-18 whose families are included in the Conditional Cash Transfer (CCT) under the Pantawid Pamilyang Pilipino Program (4Ps) of the Department of Social Welfare and Development (DSWD). These families were selected from the poorest
households in municipalities with high poverty incidence. One relevant feature of 4Ps is the provision of educational cash grant of P3,000.00 for one school year or ten months at P300.00/month per learner in elementary level and P5,000.00 for one school year or ten months at P500.00/month
per learner in secondary level (JHS and SHS) for educational expenses on condition that these learners attend school. Maximum of three learners per household is allowed.
8. Indigenous Peoples Learner - refers to a learner born of either or both parents who are IP as defined in RA 8371 Indigenous Peoples Republic Act of 1997 (i.e., groups of people or homogenous societies identified by self-ascription and ascription by others who have continuously lived as an
organized community on communally bounded and defined territory sharing common bonds of language, customs, traditions and other distinctive cultural traits).
9. Muslim Learner - refers to a learner who is born of either or both parents practicing the Islam religion or faith.
10. Learner in Alternative Delivery Modes (ADM) - refers to a learner who is enrolled in Alternative Delivery Modes (i.e., alternative modalities of education delivery within the formal system that allow schools to deliver quality education to marginalized students and those
at risk of dropping out by helping them overcome personal, social, and economic constraints in schooling).
These include programs such as:
a. Distance Education (DistEd) for SPED - refers to an ADM which addresses the accessibility problem of learners with disabilities ages 6-19. Due to the distance between the school and their homes the families of these learners cannot access to the special education program in the regular
school. Likewise, these learners belong to the families with low socio-economic status and their parents cannot afford the expenses that go with their education.
b. Enhanced Instructional Management by Parents, Community and Teachers (e-IMPACT) - refers to an intervention infused with technology and aligned with the K to 12 Curriculum of the Department of Education. This approach utilizes the services of parents, community members
including the learners themselves in managing teaching and learning. This is implemented from Grades 1-6 using Program Teaching and Peer Instruction. For Program Teaching, Grades 4-6 learners are teaching Grades 1-3 learners. In Peer Instruction, a leader in the higher grades, let say
will lead his or her classmates in studying a lesson in a particular subject. This is also to solve lack of teachers and classrooms.
c. Modified In-School Off-School Approach (MISOSA) - refers to an ADM which serves children under difficult circumstances through community partnership. This is implemented from Grades 4 - 6 because they are considered independent learners.
d. Other School-Initiated Intervention - refer to innovative and homegrown interventions developed by schools to prevent the Student-At-Risk-of-Dropping-Out (SARDOs) from dropping out and to increase their achievement rate.
11. Balik-Aral - refers to a learner who went back to school and resume study after a year/years of dropping out or discontinuing study.
12. Repeater - refers to a learner who failed or left a particular grade level in any previous school year and is enrolled in the same grade level where he/she left or failed.
13. Transferee from Other Public Schools (in any Previous SY) - refers to a learner who was enrolled in another public school in any previous school year.
14. Transferee from Private Schools (in any Previous SY) - refers to a learner who was enrolled in a private school in any previous school year.
Reminders: 1. Total Enrollment in this table will tally with the totals in Table 2.
2. Repeater in this table will tally with the totals in Table 3.
Certified True and Correct by : Checked by Schools District Office : Verified by the Schools Division Office :
School Head : MA. SHEILA S. CAZENAS Head of the Office : Head of the Office :
(Signature Over Printed Name) (Signature Over Printed Name) (Signature Over Printed Name)
Position Title : HEAD TEACHER III Date : Position Title : Date : Position Title : Date :
Page 2 of 43
Table 2. LEARNERS AGE PROFILE, SY 2018-2019 (As of June 30, 2018)
(Kindergarten to
Age LSENs Non-Graded)
(Non-Graded)
Below 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 8 3 5 2 0 0 0 0 0 0 0 0 0 0 0 0 13 5
6 0 0 8 9 0 0 0 0 0 0 0 0 0 0 0 0 8 9
7 0 0 1 0 4 7 5 2 0 0 0 0 0 0 0 0 10 9
8 0 0 0 0 3 2 7 3 6 3 0 0 0 0 0 0 16 8
9 0 0 0 0 1 0 2 0 5 5 0 0 0 0 0 0 8 5
10 0 0 0 0 1 0 2 0 3 0 4 8 0 0 0 0 10 8
11 0 0 0 0 0 0 0 1 0 0 3 1 3 5 0 0 6 7
12 0 0 0 0 0 0 0 0 0 1 0 2 4 0 0 3 4
13 0 0 0 0 0 0 0 0 0 0 2 0 4 0 0 0 6 0
14 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1
15 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1
16 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0
18 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 & above 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL 8 3 14 11 9 9 16 6 14 8 11 9 9 11 0 0 81 57
Notes:
1. The total enrollment of the school as of June 30, 2018 will be distributed across grade levels, by single age or age group and sex.
2. Computation of the age of learners will be based on his/her last birthday. Thus, if the learner is 5 years 11 months as of June 30, the age of the learner is counted as 5 years.
Reminder: Totals in this table will tally with the totals in Table 1 (Total Enrollment).
Position Title : HEAD TEACHE

Date : Position Title : Date : Position Title : Date :
Page 3 of 43
Table 3. REPEATERS AGE PROFILE, SY 2018-2019 (As of June 30, 2018)
TOTAL
Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 (Kindergarten to
Age Grade 6)
Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female
Below 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0
8 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1
9 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0
10 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0
11 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 & above 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL 0 0 1 0 2 0 0 1 0 0 0 0 0 0 3 1
Notes:
1. The total repeaters of the school as of June 30, 2018 will be distributed across grade levels, by single age or age group and sex.
2. Computation of the age of repeaters will be based on his/her last birthday. Thus, if the learner is 6 years 11 months as of June 30, the age of the learner is counted as 6 years.
Reminder: Totals in this table will tally with the totals in Table 1 (Repeater).
Position Title : HAED TEACHER III Date : Position Title : Date : Position Title : Date :
Page 4 of 43
Table 4. AGE PROFILE OF LEARNERS WITH SPECIAL EDUCATIONAL NEEDS (LSENs), SY 2018-2019 (As of June 30, 2018)
(Kindergarten to
Age LSENs Non-Graded)
(Non-Graded)
Below 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 & above 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Notes:
1. Age Profile includes gifted learners.
2. The total enrollment of the school as of June 30, 2019 will be distributed across grade levels, by single age or age group and sex.
Reminders: Totals of LSENs (Kindergarten to Grade 6) in this table must be less than to the totals in Table 1 (Total Enrollment, Kindergarten to Grade 6).
Totals of LSENs (Non-Graded) in this table will tally with the totals in Table 1 (Total Enrollment, Learners w/ Special Educational Needs (Non-Graded)).
Table 4 will be accomplished ONLY by elementary schools with SPED classes and SPED centers.
Position Title : HEAD TAECHER III Date : Position Title : Date : Position Title : Date :
Page 5 of 43
Table 5. AGE PROFILE OF GIFTED LEARNERS, SY 2018-2019 (As of June 30, 2018)
Kindergarten TOTAL
Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 (Kindergarten to
Age (Headstart)
Grade 6)
Below 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Notes:
1. Gifted learners are those whose potential is distinctly above average in one or more of the following domains of human ability: intellectual, creative, social and physical. Giftedness designates the
possession and the use of outstanding natural abilities, called aptitudes, in at least one ability domain, to a degree that places an individual at least among the top 10% of age peers in the school.
2. Headstart Program for the Gifted - is a preparatory program for learners who manifest superior intelligence beyond their chronological age.
3.The total enrollment of the school as of June 30, 2018 will be distributed across grade levels, by single age or age group and sex.
Reminders: Totals in this table will tally with the totals in Table 8 (Gifted Learners Data).
Table 5 will be accomplished ONLY by elementary schools with SPED classes and SPED centers.
Position Title : HAED TEACHER III Date : Position Title : Date : Position Title : Date :
Page 6 of 43
Table 6. ENROLLMENT AND NUMBER OF CLASSES BY SHIFT, SY 2018-2019 (As of June 30, 2018)
1st Shift 2nd Shift 3rd Shift TOTAL
Particulars
Male Female Male Female Male Female Male Female
Kindergarten 0
Enrollment 8 3 0 0 0 0 8 3 0
Number of Classes 1 0 0 1 0
Grades 1 to 6 0
Enrollment 0 0 0
Number of Classes 0 0
Learners with Special Educational Needs (Non-Graded) 0
Enrollment 0 0 0
Number of Classes 0 0
0
Note: Shift - refers to time schedules corresponding to different sets of classes (e.g., morning and afternoon shifts). Night classes are not considered a shifting schedule.
Reminders: 1. Table 4 shall be filled even if only one shift is offered by the school.
2. Totals of the Enrollment in this table will tally with the totals in Table 1 (Total Enrollment).
Box 1. NUMBER OF CLASSES, SY 2018 -2019 (As of June 30, 2018)
1. For Monograde classes, please indicate the number of classes by grade level.
Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 TOTAL

(K to Gr 6)
1 1 1 1 1 1 1 7
2. For Multigrade classes, please check the appropriate grade levels combined.
Example, if the school have two (2) Multigrade Classes:

MG Class 1 : Grade 5 Grade 6 MG Class 2 : Grade 1 Grade 2 Grade 3
þ þ þ þ þ
Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6
MG Class 1       
MG Class 2       
MG Class 3       
3 . For ALIVE classes, please indicate the number of classes by grade level.
(K to Gr 6)
0 0 0 0 0 0 0 0
4. For Learners with Special Educational Needs GIFTED Classes, please indicate the number of classes by grade level.

(K to Gr 6)
0 0 0 0 0 0 0 0
5 . For Learners with Special Educational Needs NON-GRADED Classes, please indicate the number of classes.
Kindergarten Level 1 Level 2 Level 3 Transition
0 0 0 0 0
Notes:
1. Monograde Classes - refers to the number of classes by grade level from Kindergarten to Grade 6 offering regular curricula.
2. Multigrade Classes - refers to number of classes with a combination of two or more grade levels offering regular curricula.
3. ALIVE Classes - refers to the number of classes by grade level from Kindergarten to Grade 6 offering Arabic Language and Islamic Values Education.
4. LSENs Gifted Classes - refers to the number of classes by grade level from Kindergarten to Grade 6 offering Gifted & Talented Program.
5. LSENs Non-Graded Classes - refers to the number of classes organized mainly for learners with severe or profound difficulties who are provided with
interventions focused on self-help skills and other life skills in a self-contained class.
Reminder: Box 1_Numbers 4 & 5 will be accomplished ONLY by elementary schools with SPED classes and SPED centers.
School Head : _____ MA. SHEILA S. CAZENAS Head of the Office : ___________________________________ Head of the Office : ___________________________________
Position Title : _______________ HAED TEACHER III Position Title : ___________________ Date: ______________ Position Title : ___________________ Date: ______________
Page 7 of 43
Table 7. LEARNERS DATA BY PROGRAM, SY 2018-2019 (As of June 30, 2018)
TOTAL
Enrollment by Program (Kindergarten to Grade 6)
1. Arabic Language and Islamic
Values Education (ALIVE)
1.a. Muslim 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1.b. Non-Muslim 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2. Special Science Elementary
0 0 0 0 0 0 0 0 0 0 0 0 0 0
School (SSES)
Note: Enrollment by Program - refers to the number of learners according to programs offered in elementary school.
Types of Special Programs:
1. Arabic Language and Islamic Values Education (ALIVE) - a program which aims to preserve the Arabic language and Muslim culture through its inclusion in the regular basic education curriculum.
2. Special Science Elementary School (SSES) - a program which aims to enrich the science curriculum in public elementary school.
Table 8. GIFTED LEARNERS DATA, SY 2018-2019 (As of June 30, 2018)

Kindergarten TOTAL
Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6
(Headstart) (Kindergarten to Grade 6)
0 0
Notes:
1. Gifted learner - refers to a learner who demonstrates high performance capability in intellectual, creative, leadership, arts or in specific academic areas and who by reason
thereof, requires services or activities not ordinarily provided by the school.
2. Kindergarten (Headstart) - refers to a SPED kindergarten program for learners who manifest superior intelligence beyond their chronological age.
3. SPED class - refers to an organized group of learners with special educational needs receiving care, intervention and educational services in the SPED Center or regular school with SPED Program.
4. SPED center - refers to the learning center that caters to learners with special educational needs operating within a regular school of a standalone learning center.
Reminder: Table 8 will be accomplished ONLY by elementary schools with SPED classes and SPED centers.
Page 8 of 43
Table 9. LEARNERS WITH SPECIAL EDUCATIONAL NEEDS (NON-GRADED) DATA, SY 2018-2019 (As of June 30, 2018)
Primary Level TOTAL
Kindergarten Transition (Kindergarten to Transition)
Classification/Types of Learners with Special Educational Needs Level I Level II Level III
Male Female Male Female Male Female Male Female Male Female Male Female
With Diagnosis from Licensed Medical Specialist:
1. Visual Impairment 0 0 0 0 0 0 0 0 0 0 0 0
2. Hearing Impairment 0 0 0 0 0 0 0 0 0 0 0 0
3. Learning Disability 0 0 0 0 0 0 0 0 0 0 0 0
4. Intellectual Disability 0 0 0 0 0 0 0 0 0 0 0 0
5. Autism Spectrum Disorder 0 0 0 0 0 0 0 0 0 0 0 0
6. Emotional-Behavioral Disorder 0 0 0 0 0 0 0 0 0 0 0 0
7. Orthopedic/ Physical Handicap 0 0 0 0 0 0 0 0 0 0 0 0
8. Speech / Language Disorder 0 0 0 0 0 0 0 0 0 0 0 0
9. Cerebral Palsy 0 0 0 0 0 0 0 0 0 0 0 0
10. Special Health Problem/ Chronic Disease 0 0 0 0 0 0 0 0 0 0 0 0
11. Multiple Disabilities 0 0 0 0 0 0 0 0 0 0 0 0
With Manifestations:
1. Difficulty in Seeing 0 0 0 0 0 0 0 0 0 0 0 0
2. Difficulty in Hearing 0 0 0 0 0 0 0 0 0 0 0 0
3. Difficulty in Applying Knowledge 0 0 0 0 0 0 0 0 0 0 0 0
4. Difficulty in Remembering, Concentrating, Paying Attention and Understanding 0 0 0 0 0 0 0 0 0 0 0 0
5. Difficulty in Applying Adaptive Skills 0 0 0 0 0 0 0 0 0 0 0 0
6. Difficulty in Displaying Inter-Personal Behavior 0 0 0 0 0 0 0 0 0 0 0 0
7. Difficulty in Mobility (Walking, Climbing and Grasping) 0 0 0 0 0 0 0 0 0 0 0 0
8. Difficulty in Communicating 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL 0 0 0 0 0 0 0 0 0 0 0 0
Notes:
1. Non Graded - refers to learners with severe or profound difficulties who are provided with interventions focused on self-help skills and other life skills in a self-contained class.
2. Kindergarten - refers to the Early Intervention Program for learners with special educational needs.
3. Primary Level - refers to the level after kindergarten where learners with special educational needs are still being prepared for mainstreaming in regular classes. Learners with special educational needs are allowed to stay in the program for a
maximum of three (3) years in each of the three (3) levels. However, learners with special educational needs can be mainstreamed in regular classes if found to be ready based on performance.
a. Level I - refers to the first two years in SPED Classes

b. Level II - refers to the next two years in SPED Classes
c. Level III - refers to the last two years (5th and 6th) in the SPED Program
4. Transition - refers to level/program for learners with special educational needs who have completed the primary level that could not pursue academic subjects and/or over-aged for the elementary level.
Classification of Learners with Special Educational Needs:

1. With Diagnosis from Specialist - refers to learners who have undergone assessment of licensed professionals like Psychologists, Psychmetricians, and Medical Specialists who can determine the level of disability of any learner.
2. With Manifestations - refers to learners manifesting difficulties in particular activities (e.g., cognitive, communication, mobility, hearing, seeing, etc.) who were observed by teachers on daily lessons/activities or through anecdotals.
Reminders: 1. LSENs with two or more manifestations or in diagnosis, the data must be included in the primary classification of disability or diffulty.
2. For visible conditions like blind (no eyeball) physical (no legs) or closed ears, even without a diagnosis, the data must be entered in the visible disability.
3. Table 9 will be accomplished ONLY by elementary schools with SPED classes and SPED centers.
(Continuation of definition on the next page)
`
Page 9 of 43
(Cont. of Table 9)
LSENs With Diagnosis from Licensed Medical Specialist:
1. Visual Impairment - refers to a learner with an impairment that even with correction, adversely affects a child's educational performance. This includes both partial sight and blindness.
2. Hearing Impairment - refers to a learner with an impairment, whether permanent or fluctuating that adversely affects a child’s educational performance such as deafness.
3. Learning Disability - refers to a learner with a disorder in perception, listening, thinking, reading, writing, spelling, and arithmetic although normal in sensory, emotional and intellectual abilities.
4. Intellectual Disability - refers to a learner with significantly subaverage general intellectual functioning which originates during the developmental period and associated with impairment in adoptive behavior like maturation,
learning and social adjustment.
5. Autism Spectrum Disorder - refers to a learner characterized by varying degrees of impairment in communication skills and social interactions and in restrictive, repetitive patterns of behavior.
6. Emotional-Behavioral Disorder - refers to a learner with a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects a child's educational performance:
(i) an inability to learn that cannot be explained by intellectual, sensory, or health factors, (ii) an inability to build or maintain satisfactory interpersonal relationships with peers and teachers, (iii) inappropriate types of behavior or
feelings under normal circumstances, (iv) a general pervasive mood of unhappiness or depression, (v) a tendency to develop physical symptoms or fears associated with personal or school factors.
7. Orthopedic /Physical Handicap - refers to a learner with any condition that interferes with a child's ability to use his or her body.
8. Speech/Language Disorder - refers to a learner with a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child’s educational performance.
9. Cerebral Palsy -refers to a learner that is caused by damage to developing brain either before or during birth, or in the first few years of life. The impairment depends on where in the brain the damage occurs.
10. Special Health Problem/Chronic Illness - refers to a learner with a chronic or acute health problems such as asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition,
hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and Tourette syndrome; that adversely affect a child's educational performance.
11. Multiple Disabilities - refers to a learner with a combination of disabilities that causes severe educational needs that require multiple special education programs such as mental retardation-blindness or mental retardation-orthopedic
impairment.
LSENs With Manifestations:

1. Difficulty in Seeing - refers to a learner that manifest difficulty in vision that even with correction, adversely affects a child educational performance. They include those that are totally blind, functionally blind or low vision.
2. Difficulty in Hearing - refers to a learner that have difficulty in hearing, hard of hearing, suffering from hearing loss or deafness.
3. Difficulty in Applying Knowledge- refers to a learner that has a problem that interferes with learning basic skills such as reading, writing, acquiring skills and/or math. It can also delay higher level thinking skills such as
organization, time planning, abstract reasoning, long and short term memory and attention.
4. Difficulty in Remembering, Concentrating, Paying Attention and Understanding - refers to a learner that manifest significant limitations in general intellectual functioning; in adaptive functioning (communication, self-
care, home living, health and safety, social skills, functional academics, community use, leisure and work) which exist concurrently; it includes those medically diagnosed as learners with: Reading Disability or Dyslexia;
Written Expression Disability; Spelling Disability; Handwriting Disability or Dysgraphia; Mathematical Disability or Dyscalculia.
5. Difficulty in performing adaptive skills (self-care) - refers to a learner manifesting difficulty in washing oneself, caring of body parts, toileting, dressing, eating and drinking.
6. Difficulty in displaying interpersonal behavior (Emotional and Behavioral) - refers to a learner whose conditions are characterized by emotional or behavioral responses in school programs so different from appropriate
age, cultural or ethnic norms which affects their educational performance (academic, social, vocational or personal skills) more than temporary and responses are stressful to environment behavior is exhibited in two
different settings (one of which is school related). They are also unresponsive to direct intervention in general education.
7. Difficulty in Mobility (Walking, Climbing and Grasping) - refers to a learner that manifest difficulty in maintaining one’s position or changing a body position. They include those diagnosed as having cerebral palsy, spina
bifida and muscular dystrophy.
8. Difficulty in Communicating - refers to a learner whose developmental conditions are causing problems in communication, learning and social behaviors. It is typically characterized by difficulty in: Understanding
others; Producing message; Communicating using devices.
School Head : MA. SHEILA S. CAZENAS Head of the Office: Head of the Office:
Position
HEAD
TitleTEACHER III Date : _____________ Position Title : ________________ Date : Position : Date :
Page 10 of 43
Table 10. LEARNERS WITH SPECIAL EDUCATIONAL NEEDS (GRADED) DATA MAINSTREAMED IN REGULAR CLASS, SY 2018-2019 (As of June 30, 2018)
TOTAL
Classification/Types of Learners with Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6
(Kindergarten to Grade 6)
Special Educational Needs
1. Visual Impairment 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2. Hearing Impairment 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3. Learning Disability 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4. Intellectual Disability 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5. Autism Spectrum Disorder 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6. Emotional-Behavioral Disorder 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7. Orthopedic/ Physical Handicap 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8. Speech / Language Disorder 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9. Cerebral Palsy 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10. Special Health Problem/ Chronic Disease 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11. Multiple Disabilities 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1. Difficulty in Seeing 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2. Difficulty in Hearing 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3. Difficulty in Applying Knowledge 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4. Difficulty in Remembering, Concentrating,
Paying Attention and Understanding 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5. Difficulty in Applying Adaptive Skills 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

6. Difficulty in Displaying Inter-Personal Behavior 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7. Difficulty in Mobility (Walking, Climbing and Grasping) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8. Difficulty in Communicating 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Note: For the definitions, please refer to LSENs Non-Graded Data (Table 9).
Certified True and Correct by : Checked by District Office : Verified by the Division Office :
School Head : Head of the Office : MA. SHEILA S. CAZENAS Head of the Office :
Position Title : Date : ____________________ Position Title : HEAD TEACHER III Date : Position Title : Date :
Page 11 of 43
TO BE REPLACED -- for confirmation with SID
Table 7. LEARNERS WITH SPECIAL EDUCATIONAL NEEDS (NON-GRADED) DATA, SY 2018-2019 (As of June 30, 2018)
Primary Level TOTAL
Kindergarten Transition (Kindergarten to Transition)
Areas of Difficulties Level I Level II Level III
Male Female Male Female Male Female Male Female Male Female Male Female
1. Difficulty in Remembering or Concentrating, paying attention and understanding
2. Difficulty in displaying interpersonal behavior (Emotional and Behavioral)
3. Difficulty in Communicating
4. Difficulty in Mobility (Walking, Climbing and Grasping)
5. Difficulty in Hearing
6. Difficulty in Seeing
7. Difficulty in performing adaptive skills (self-care)
8. Multiple Impairment/Disability
TOTAL
Note: Table 7 data is FINAL based on Learners Information System (LIS) for Beginning of the School Year 2018-2019. to be deleted
1. Non Graded - refers to learners with severe or profound difficulties who are provided with interventions focused on self-help skills and other life skills in a self-contained class.
2. Kindergarten - refers to the Early Intervention Program for learners with special educational needs.
3. Primary Level - refers to the level after kindergarten where learners with special educational needs are still being prepared for mainstreaming in regular classes. Learners with special educational needs are allowed to stay in the
program for a maximum of three (3) years in each of the three (3) levels. However, learners with special educational needs can be mainstreamed in regular classes if found to be ready based on performance.
a. Level I - refers to the first two years in SPED Classes

b. Level II - refers to the next two years in SPED Classes
c. Level III - refers to the last two years (5th and 6th) in the SPED Program
4. Transition - refers to level/program for learners with special educational needs who have completed the primary level who could not pursue academic subjects and/or over-aged for the elementary level
Areas of Difficulties:
1. Difficulty in Remembering or Concentrating, paying attention and understanding - refers to a learner that manifest significant limitations in general intellectual functioning; in adaptive functioning (communication, self-care,
home living, health and safety, social skills, functional academics, community use, leisure and work) which exist concurrently; it includes those medically diagnosed as learners with: Reading Disability or Dyslexia; Written
Expression Disability; Spelling Disability; Handwriting Disability or Dysgraphia; Mathematical Disability or Dyscalculia.
2. Difficulty in displaying interpersonal behavior (Emotional and Behavioral) - refers to a learner whose conditions are characterized by emotional or behavioral responses in school programs so different from appropriate age,
cultural or ethnic norms which affects their educational performance (academic, social, vocational or personal skills) more than temporary and responses are stressful to environment behavior is exhibited in two different settings
(one of which is school related). They are also unresponsive to direct intervention in general education.
3. Difficulty in Communicating - refers to a learner whose developmental conditions are causing problems in communication, learning and social behaviors. It is typically characterized by difficulty in: Understanding others;
Producing message; Communicating using devices.
4. Difficulty in Mobility (Walking, Climbing and Grasping) - refers to a learner that manifest difficulty in maintaining one’s position or changing a body position. They include those diagnosed as having cerebral palsy, spina bifida
and muscular dystrophy.
5. Difficulty in Hearing - refers to a learner that have difficulty in hearing, hard of hearing, suffering from hearing loss or deaf.
6. Difficulty in Seeing - refers to a learner that manifest difficulty in vision that even with correction, adversely affects a child educational performance. They include those that are totally blind, functionally blind or low vision.
7. Difficulty in performing adaptive skills (self-care) - refers to a learner manifesting difficulty in washing oneself, caring of body parts, toileting, dressing, eating and drinking.
8. Multiple Impairment/Disability - refers to a learner diagnosed with cerebral palsy with other disabilities, deaf-blindness, hearing impairment with other disabilities, autism and ADHD and those who have combination of those
previously mentioned.
School Head : Head of the Office: Head of the Office:
Position Title : ________________ Date : Position Ti : Date : Position : Date :
Page 7 of 26
Table 8. LEARNERS WITH SPECIAL EDUCATIONAL NEEDS (GRADED) DATA, SY 2018-2019 (As of June 30, 2018) TO BE REPLACED -- for confirmation with SID
TOTAL
Areas of Difficulties
Mainstreamed in Regular Class:
1. Difficulty in Remembering or Concentrating,
paying attention and understanding
2. Difficulty in displaying interpersonal behavior
(Emotional and Behavioral)
Self - contained Class:
1. Difficulty in Remembering or Concentrating,
paying attention and understanding
2. Difficulty in displaying interpersonal behavior
(Emotional and Behavioral)
TOTAL
Notes: Table 8 data is FINAL based on Learners Information System (LIS) for Beginning of the School Year 2018-2019. to be deleted
For the definitions of Areas of Difficulties, please refer to Table 7 (page 7).
a. Mainstreamed in Regular Class - refers to the learners with special educational needs who are placed in regular classes.
b. Self- contained Class - refers to the learners with special educational needs who are purely in special education classes.
Reminder: If a learner with special education needs is partially mainstreamed in regular classes or in special education classes, he or she shall be counted in the category where the learner spent the most number of hours.
Position Title : __________________ Date : ____ Position Title : Date : Position Title : Date :
Page 8 of 26
Table 11. LEARNERS WITH SPECIAL EDUCATIONAL NEEDS (GRADED) DATA IN SELF-CONT
Classification/Types of Learners with Kindergarten Grade

Special Educational Needs
Male Female Male
1. Visual Impairment 0 0 0
2. Hearing Impairment 0 0 0
3. Learning Disability 0 0 0
4. Intellectual Disability 0 0 0
5. Autism Spectrum Disorder 0 0 0
6. Emotional-Behavioral Disorder 0 0 0
7. Orthopedic/ Physical Handicap 0 0 0
8. Speech / Language Disorder 0 0 0
9. Cerebral Palsy 0 0 0
10. Special Health Problem/ Chronic Disease 0 0 0
11. Multiple Disabilities 0 0 0
1. Difficulty in Seeing 0 0 0
2. Difficulty in Hearing 0 0 0
3. Difficulty in Applying Knowledge 0 0 0
4. Difficulty in Remembering, Concentrating, 0 0 0
Paying Attention and Understanding
5. Difficulty in Applying Adaptive Skills 0 0 0
6. Difficulty in Displaying Inter-Personal Behavior 0 0 0
7. Difficulty in Mobility (Walking, Climbing and Grasping) 0 0 0
8. Difficulty in Communicating 0 0
TOTAL 0 0 0
Note: For the definitions, please refer to LSENs Non-Graded Data (Table 9).
Certified True and Correct by :

School Head :
Position Title : Date : ___________________
A IN SELF-CONTAINED CLASS, SY 2018-2019 (As of June 30, 2018)
Grade 1 Grade 2 Grade 3 Grade 4
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
s and SPED centers.
Checked by District Office :

Head of the Office : MA.SHEILA S, CAZENAS
Position Title : HEAD TEACHER III Date :
TOTAL
Grade 5 Grade 6
Male Female Male Female Male Female
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
Verified by the Division Office :

Head of the Office :
Position Title : Date :
Table 12. LEARNERS WITH SPECIAL EDUCATIONAL NEEDS (LSENs) UNDER THE HOMEBOUND AND HOSPITAL BOUND PROGRAM
HOMEBOUND HOSPITAL BOUND
Age Profile Grade Placement Length of Time in the Program Age Profile Grade Placement Length of Time in the Program
Type of LSENs 5-10 11-15 16-20 21-25 5-10 11-15 16-20 21-25
Transition 5-10 11-15 16-20 21-25 Transition 5-10 11-15 16-20 21-25
years years years years TOTAL K to 6 TOTAL TOTAL years years years years TOTAL K to 6 Program TOTAL TOTAL
Program years years years years years years years years
old old old old old old old old
Visual Impairment 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Hearing Impairment 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Learning Disability 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Intellectual Disability 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Autism Spectrum
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Disorder
Emotional-
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Behavioral Disorder
Orthopedic/Physical
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Handicap
Speech/Language
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Disorder
Cerebral Palsy 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Special Health
Problem/Chronic 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Disease
Multiple Disability 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Notes:
1. Home Bound - refers to an educational program designed for children with special needs who are enrolled in the nearest school to their residence, but can not go to school on a regular schedule.
Community volunteers, para-teacher, parents or any member of the family are trained to assist the child at home.
2. Hospital Bound - refers to an educational program designed for LSENs with severe disturbance, profound level of disability, bed-bound , with crippling, chronic or serious health
disabilities/impairments and recovering patient (LSENs).
3. Age Profile (Homebound/Hospital bound) - refers to a range of age per type of learners with special educational needs.
4. Grade Placement (Homebound/Hospital bound) - refers to what program the learners are placed or enrolled.
5. Length of time (Homebound/Hospital bound) - refers to the number of years that the learner spent in the program.
`
School Head : ______________ MA. SHEILA S. CAZENAS Head of the Office : ___________________________________ Head of the Office : ___________________________________
Position Title : _______ HT III Position Title : ___________________ Date: ______________ Position Title : ___________________ Date: ______________
Page 13 of 43
Table 13. PERSONNEL DATA (Locally-funded and DepEd Subsidized Teachers Working in the School), SY 2018-2019 (As of June 30, 2018)
Funding Source
DepEd Subsidized
Class Special Education Fund (SEF) Local Gov't Unit TOTAL
Others (Contract of Service) *
Provincial Municipal/City (LGU) funded Locally-funded
Kindergarten 0 0 0 0 0
Elementary (excluding ALIVE) 0 0 0 0 0
ALIVE * 0
1. Locally-funded teachers working in the school - teachers not having plantilla positions and whose compensation is chargeable against the local budget.
These are classified according to the following:
a. Special Education Fund (SEF) Teachers - teachers whose salaries are being paid by the Local School Board Fund (Provincial or Municipal/City) where the school is located.
b. Local Government Unit (LGU) funded Teachers – teachers paid out of the general fund (not the SEF) of the LGU.
c. Others – teachers who are being funded by other sources not mentioned above (e.g., Parents-Teachers Association, etc.).
2. DepEd Subsidized/COS Teachers – teachers not having plantilla positions but paid by DepEd through honorarium (e.g., Asatidz, etc.).
3. ALIVE Teachers – teachers assigned to teach ALIVE classes.
Reminder: * - Those serving two or more schools simultaneously shall be counted only in the school with the most teaching loads or number of learners handled, in that order.
Table 14. TEACHING RELATED AND NON-TEACHING PERSONNEL DATA (Nationally-funded), SY 2018-2019 (As of June 30, 2018)
NATIONALLY-FUNDED PERSONNEL
POSITIONS ASSIGNED IN THE SCHOOL
TOTAL
Number of Personnel detailed to Personnel detailed from other school(s)/
Number of personnel actually working Nationally-funded personnel working in
Position Title positions assigned DepEd office(s)
in the school TOTAL the school
in the school per Position(s) DepEd Secondary DepEd office(s)/
On leave (Col.5+Col.6 +
latest PSI-POP vacant office(s) school(s) school(s) outside the
division or other TOTAL Col.7+Col.11 )
within the within the Male Female TOTAL
Male Female TOTAL government agencies Male Female TOTAL
division division (Col.3+Col.13) (Col.4+Col.14) (Col.16+Col.17)
Col. 1 Col. 2 Col. 3 Col. 4 Col. 5 Col. 6 Col. 7 Col. 8 Col. 9 Col. 10 Col. 11 Col. 12 Col. 13 Col. 14 Col. 15 Col. 16 Col. 17 Col. 18
School Principal IV 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
School Principal III 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
School Principal II 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
School Principal I 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Head Teacher V 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Head Teacher IV 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Head Teacher III 1 0 1 1 0 0 0 0 0 0 1 0 0 0 0 1 1
Head Teacher II 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Head Teacher I 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Guidance Coordinator 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Guidance Counselor 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* Senior Bookkeeper 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* Disbursing Officer II 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL 1 0 1 1 0 0 0 0 0 0 1 0 0 0 0 1 1
Note: * - Applicable only in the school that are Implementing Unit.

Reminders: 1. Totals in column 12 must tally with entries in column 2.
2. For the definitions, please refer to Teaching Personnel Data (Table 15).
Position Title : HT-III Date : Position Title : Date : Position Title : Date :
Page 14 of 43
Table 15. TEACHING PERSONNEL DATA (Nationally-funded), SY 2018-2019 (As of June 30, 2018)
NATIONALLY-FUNDED PERSONNEL
Number of positions POSITIONS ASSIGNED IN THE SCHOOL
assigned in the school TOTAL
Teachers detailed to Teachers detailed from other
per latest PSI-POP Number of teachers actually Nationally-funded teachers working in the
school(s)/ DepEd office(s)
Position Title working in the school TOTAL school
Items Position(s) DepEd Secondary DepEd office(s)/
As of Created TOTAL On leave TOTAL (Col.5+Col.6 +
March 31, from April Vacant office(s) school(s) school(s) outside the
(2a+2b) within the within the division or other (Col.8+Col.9+ Col.7+Col.11 ) TOTAL Male Female TOTAL
2018 1 to June Male Female TOTAL Col.10) Male Female (Col.13+
(Col.3+Col.4) division division government agencies (Col.3+Col.13) (Col.4+Col.14) (Col.16+Col.17)
30, 2018 Col.14)
Col. 1 (2a) (2b) Col. 2 Col. 3 Col. 4 Col. 5 Col. 6 Col. 7 Col. 8 Col. 9 Col. 10 Col. 11 Col. 12 Col. 13 Col. 14 Col. 15 Col. 16 Col. 17 Col. 18
a. Teaching Positions
Master Teacher IV 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Master Teacher III 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Master Teacher II 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Master Teacher I 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Teacher III 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Teacher II 1 1 0 1 1 0 0 0 0 0 0 1 0 0 1 1
Teacher I 6 0 6 0 6 6 0 0 0 0 0 0 6 0 0 6 6
SPED Teacher V 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SPED Teacher IV 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SPED Teacher III 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SPED Teacher II 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SPED Teacher I 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL 7 0 7 0 7 7 0 0 0 0 0 0 7 0 0 0 0 7 7
b. Assignment (Number of teachers actually working in the school):

Handling Kindergarten classes 0 1 1 0 0 1 1
Handling Grades 1-6 0 1 1 0 0 1 1
Handling ALIVE classes 0 1 1 0 0 1 1
Handling SPED classes 0 1 1 0 0 1 1
Handling ALS classes (Mobile Teacher) 0 1 1 0 0 1 1
District ALS Coordinator 0 1 1 0 0 1 1
School ALS Coordinator 0 1 1 0 0 1 1
Handling Full Time Ancilliary Services 0 1 1 0 0 1 1
TOTAL 0 8 8 0 0 0 0 8 8
Totals in Tables 15a and 15b must tally
1. Nationally-funded personnel - teaching, teaching-related and non-teaching personnel having plantilla positions, including those with provisional appointments.
2. Number of positions assigned in the school per latest PSI-POP - number of plantilla items assigned to the school.
3. Number of teachers actually working in the school - teaching, teaching-related and non-teaching personnel with plantilla positions who are actually performing their specific assignments in the school.
4. On leave personnel - personnel who are on leave for the whole school year approved by the School Division Superintendent.
5. Position(s) vacant - plantilla positions that are unfilled whether existing plantilla or newly created positions.
6. Personnel detailed to DepEd office(s) within the division - personnel assigned/designated to the district office or to the division office.
7. Personnel detailed to Secondary school(s) within the division - personnel assigned/designated to secondary schools within the division.
8. Personnel detailed to DepEd office(s)/school(s) outside the division or other government agencies - personnel assigned/designated to other DepEd office(s)/school(s) outside the division or other government agencies.
9. Personnel detailed from other school(s)/ DepEd office(s) - personnel who are actually working in the school but whose items belong from secondary school(s) or from other DepEd office(s) like the district, division, regional, central office or from other school division(s).
Reminders: 1. In Table 15a, totals in column 12 must tally with entries in column 2.
2. In Table 15b, if a teacher is handling two or more assignments, he/she should be counted in his/her assignment where he/she has the most number of loads.
3. In Table 15a, totals in column 18 must tally with entries in Table 16 column 7.
4. Totals in Tables 15a & 15b must tally.
Page 15 of 43
Table 16. TEACHER ASSIGNMENTS (Nationally-funded teachers working in the school), SY 2018-2019 (As of June 30, 2018)
Carries full-time class teaching load Assigned part-time to class teaching,
(360 min. or more) part-time to ancillary services TOTAL
Assigned full-time to
Position Title ancillary services
(Col.2+Col.3+Col.4+
Not assigned to ancillary Assigned to ancillary services as Class teaching 200 min. per day Class teaching less than 200 min. Col.5+Col.6)
services additional load or more per day
Col. 1 Col. 2 Col. 3 Col. 4 Col. 5 Col. 6 Col. 7

Master Teacher IV 0
Master Teacher III 0
Master Teacher II 0
Master Teacher I 0
Teacher III 0
Teacher II 1 1 2
Teacher I 6 6 12
SPED Teacher V 0
SPED Teacher IV 0
SPED Teacher III 0
SPED Teacher II 0
SPED Teacher I 0
TOTAL 0 7 7 0 0 14
Table 16 Column 7 must tally with Table 15a Column 18
Ancillary services - those rendered as a guidance teacher, librarian, property custodian, office clerk, canteen manager, coordinator (ALS, Boy/Girl Scout, etc.), teacher nurse. Class advisorship is not included.
Reminder: Totals in column 7 of this table must be equal to the totals in Table 15a (column 18 - Total Nationally-funded personnel working in the school).
Table 17. NUMBER OF TEACHERS BY GRADE LEVEL

(Nationally-funded teachers actually working in the school), SY 2018-2019 Table 18. NUMBER OF TEACHERS BY TEACHING ASSIGNMENT IN GRADES 5 AND 6
(As of June 30, 2018) (Nationally-funded teachers actually working in the school), SY 2018-2019 (As of June 30, 2018)
Number of Teachers Grade 5 Grade 6
Grade Level Learning Areas
Male Female TOTAL Male Female TOTAL Male Female TOTAL
Kindergarten 0 1 1 English 0 1 1 0 1 1
Grade 1 0 1 1 Mathematics 0 1 1 0 1 1
Grade 2 0 1 1 Filipino 0 1 1 0 1 1
Grade 3 0 1 1 Science 0 1 1 0 1 1
Grade 4 0 1 1 Araling Panlipunan (AP) 0 1 1 0 1 1
Edukasyong Pantahanan at Pangkabuhayan (EPP)/

Grade 5 0 1 1 0 1 1 0 1 1
Technology and Livelihood Education (TLE)
Grade 6 0 1 1 Music, Art, Physical Education, Health (MAPEH) 0 1 1 0 1 1
SPED 0 0 0 Edukasyon sa Pagpapakatao (EsP) 0 1 1 0 1 1
TOTAL 0 7 7 TOTAL 0 8 8 0 8 8
Reminders: 1. If a teacher is teaching more than one grade level, he/she

can be counted more than once. Reminders: 1. If a teacher is teaching more than one learning area or grade level, he/she can be counted more than once.
2. Grades 5 and 6 of this table must be less than or equal to 2. Grades 5 and 6 of this table can be greater than or equal to Grades 5 and 6 in Table 17.
Grades 5 and 6 in Table 18.
Page 16 of 43
Table 19. TEACHERS’ DATA HANDLING LEARNERS WITH SPECIAL EDUCATIONAL NEEDS (LSENs)
Types of Learners with Special Educational Needs Years in Service Years of Teaching LSENs
LD/ ASD/ EBD/ Multi- 16 13

Position Title VI/ HI/ ID/ Difficulty in Difficulty in OH/ ComDics/ Disability/
Difficulty in 0-3 4-6 7-9 10-12 13-15 years 0-3 4-6 7-9 10-12 years
Difficulty in Difficulty in Difficulty in Performing Displaying Difficulty in Difficuly in Combination
Seeing Applying Remembering Adaptive Interpersonal Mobility Communicating of 2 or more years years years years years and years years years years and
Hearing
KNowledge Skills Behavior disabilities above above
Master Teacher IV 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Master Teacher III 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Master Teacher II 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Master Teacher I 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Teacher III 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Teacher II 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Teacher I 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SPED Teacher V 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SPED Teacher IV 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SPED Teacher III 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SPED Teacher II 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SPED Teacher I 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Notes:
1. If a teacher is handling more than one group of LSENs, he/she can be counted more than once.
2. Years in Service - refers to the number of years in service as a teacher.
3. Years of Teaching LSENs - refers to the number of years of teaching LSEN.
School Head : ____ MA. SHEILA S. CAZENAS Head of the Office : _____________________________________ Head of the Office : _____________________________________
(Signature over Printed Name) (Signature over Printed Name) (Signature over Printed Name)
Position Title : __ HT-III Position Title : ________________ Date : _______________ Position Title : ________________ Date : _______________
Page 17 of 43
Table 20. NUMBER OF TEACHERS WITH HIGHEST EDUCATIONAL ATTAINMENT
Number of Teachers
Highest Educational Attainment
Male Female TOTAL
Bachelor Degree 0 7 7
Master Degree Units 0 0 0
Master Degree 0 0 0
Doctorate Degree Units 0 0 0
Doctorate Degree 0 0 0
TOTAL 0 7 7
Reminder: A teacher should be counted based on his/her highest educational attainment regardless if it is related to his/her specialization
subject or not (i.e. Master of Public Administration (MPA), Master in Business Administration, Doctor in Philosophy (Ph.D) etc.)
Box 2. LEARNING ACTION CELL (LAC) SESSION, SY 2018-2019

(Please provide appropriate answers)
1. Do you conduct LAC Session/s in your school? 1

✘ Yes ✘ No
If Yes, indicate the number of LAC Session/s conducted:
1.a. Conducted last SY 2017-2018 2
1.b. Planned to be conducted this SY 2018-2019
Box 3. ACTION RESEARCH, SY 2018-2019

1. Do you conduct Action Research in your school? ✘ Yes 1

✘ No
If Yes, indicate the number of Action Research conducted:
1.a. Completed for the past three school years (SYs 2015 to 2017)
1.b. On-going
1.c. To be conducted
School Head : __ MA. SHEILA S. CAZENAS Head of the Office : _____________________________________ Head of the Office : _____________________________________
Position Title : HT-III Position Title : ________________ Date : _______________ Position Title : ________________ Date : _______________
Page 18 of 43
Table 21. MOOE ALLOCATION, UTILIZATION AND LIQUIDATION Box 4. AVAILABILITY OF ELECTRICAL SUPPLY, SY 2018-2019 (As of June 30, 2018)
FROM JANUARY 2017 TO DECEMBER 2017 (Check as appropriate).
MOOE Amount in PhP 1. Electrical Supply Sources:
Allocation 53,500.00 1
✘ Grid Supply
Utilization 53,500.00 ✘ Off Grid Supply
Liquidation 53,500.00 ✘ Solar Power
1. Maintenance and Other Operating Expenses (MOOE) - is the allocated ✘ Generator
funds for public elementary and secondary schools that can be spent on
activities and necessities (i.e. electricity and water) that support learning 0 Others, please specify
programs and help maintain a safe and healthy environment in schools.
✘ No source of electricity
2. Average Cost of Monthly Bills/Maintenance: (Please indicate the amount in PhP)

2. MOOE Allocation - refers to the MOOE provided for the previous fiscal
3. What is the funding source?
year.
1✘ School MOOE ✘ School Canteen Fund
3. MOOE Utilization - refers to the amount of MOOE utilized from the ✘ LGU ✘ Private Individual/Sector
MOOE allocation of the previous fiscal year.
✘ PTA ✘ Others, please specify
4. MOOE Liquidation - refers to the amount of MOOE liquidated from the
MOOE utilized from the MOOE allocation of the previous fiscal year.
4. Number of hours that the electricity is usually available in a day:
1. Grid Supply - electricity coming from major or local power distributors (e.g., electric cooperatives, Meralco, etc.).
2. Off Grid Supply - electricity coming from alternative source of power (e.g., solar power, generator, etc.).
3. No source of electricity - without existing electrical supply at all.
Table 22. NUMBER OF FUNCTIONAL COMPUTERS IN THE SCHOOL BY FUNDING SOURCE, SY 2018-2019 (As of June 30, 2018)
NUMBER OF FUNCTIONAL COMPUTERS BY FUNDING SOURCE
Types of Computer Other Government
DepEd DepEd Private
LGU/SEF PTA Agencies Others TOTAL
DCP non-DCP Donations
Academic Use
Desktop 7 0 0 0 0 0 0 7
Notebook/Netbook 0 0 0 0 0 0 0 0
Tablet 0 0 0 0 0 0 0 0
Desktop Virtual Terminal 0 0 0 0 0 0 0 0
Administrative Use
Desktop 0 0 0 0 0 0 0 0
Notebook/Netbook 0 0 0 0 0 0 0 0
Tablet 0 0 0 0 0 0 0 0
Desktop Virtual Terminal 0 0 0 0 0 0 0 0
TOTAL 7 0 0 0 0 0 0 7
1. Indicate the number of functional computers according to the following funding sources:
a. DepEd DCP - computers procured through the DepEd Computerization Program.
b. DepEd non-DCP - computers procured through other DepEd downloaded funds.
c. LGU/SEF - computers procured from the Special Education Fund (SEF) and the budgets of Local Government Units (LGU): provincial, municipal or barangay units.
d. PTA - computers funded from the Parents-Teachers Association (PTA).
e. Private Donations - computers donated/procured by private individuals, corporations, alumni associations, non-government organizations, philanthropic organizations or through foreign-assisted funds.
f. Other Government Agencies - computers funded from other government agencies such as DTI, DOST, CICT, etc.
g. Others - computers procured from other sources not listed above.
2. Computer - refers to electronic devices for storing and processing data such as :
a. Desktop - refers to a computer that is designed to be used on a table.
b. Notebook/Netbook - refers to a laptop computer that can easily be transported.
c. Tablet - refers to a portable computer that has a touchscreen feature as the primary means of input.
d. Desktop Virtual Terminal - refers to a computer terminal consisting of monitor, keyboard and mouse connected to a terminal device that connects to a computer host. (Reminder: do not count the computer host).
3. Computer for Academic Use - refers to computer units utilized in the classroom/laboratory as an aid to instruction.
4. Computer for Administrative Use - refers to computer units used for encoding administrative data of the school (e.g., enrolment, attendance, disbursements, financial statements, and other reports).
Certified True and Correct by: Checked by Schools District Office : Verified by the Schools Division Office :
School Head : __ MA. SHEILA S. CAZENAS Head of the Office : _____________________________________ Head of the Office : _____________________________________
Position Title HT-III Position Title : ________________ Date : _______________ Position Title : ________________ Date : _______________
Page 19 of 43
Table 23. NUMBER OF FUNCTIONAL ICT EQUIPMENT IN THE SCHOOL BY FUNDING SOURCE, SY 2018-2019 (As of June 30, 2018)
NUMBER OF FUNCTIONAL ICT EQUIPMENT BY FUNDING SOURCE
Types of ICT Equipment Other Government
DepEd DepEd Private
LGU/SEF PTA Agencies Others TOTAL
DCP non-DCP Donations
Academic Use
LED TV 0 0 0 0 0 0 0 0
Network Switch 0 0 0 0 0 0 0 0
Printer 0 0 0 0 0 0 0 0
Projector 0 0 0 0 0 0 0 0
UPS 0 0 0 0 0 0 0 0
Wireless Router 0 0 0 0 0 0 0 0
Administrative Use
LED TV 0 0 0 0 0 0 0 0
Network Switch 0 0 0 0 0 0 0 0
Printer 0 0 0 0 0 0 0 0
Projector 0 0 0 0 0 0 0 0
UPS 0 0 0 0 0 0 0 0
Wireless Router 0 0 0 0 0 0 0 0
TOTAL 0 0 0 0 0 0 0 0
ICT Equipment - refers to electronic devices such as harware and software that are intended to perform information processing and communication functions.
a. LED TV - refers to a type of television that uses light-emitting diodes (LED).
b. Network Switch - refers to a device used to network multiple computers together.
c. Printer - refers to a machine for printing text or illustrations on paper.
d. Projector- refers to a machine that projects images onto a screen or a wall.
e. UPS - Uninterruptible Power Source, refers to an electronic equipment that provides battery backup when the electrical power source fails.
f. Wireless Router - refers to electronic device that works as router and as a wireless access point, to provide access to the internet or a private computer network.
School Head : ______________________________________ Head of the Office : _____________________________________ Head of the Office : _____________________________________
Position Title : _________________ Date : ____________ Position Title : ________________ Date : _______________ Position Title : ________________ Date : _______________
Page 20 of 43
Table 24. NUMBER OF ASSISTIVE TECHNOLOGY AND ADAPTIVE DEVICES FOR LSENs, SY 2018-2019 (As of June 30, 2018)
Number of Devices
Types of Devices
Functional Non-Functional TOTAL
A. ASSISTIVE TECHNOLOGY DEVICES
1 Computer Set 0 0 0
2 Talking Calculator 0 0 0
3 Braille Machine 0 0 0
4 Job Access with Speech (JAWS) 0 0 0
5 LCD Projector 0 0 0
6 Computer Printer 0 0 0
7 Microsoft Screen Magnifier 0 0 0
8 One Touch Magic Screen 0 0 0
9 Braille Printer/Embosser 0 0 0
10 Telescope 0 0 0
11 Talking Desktop 0 0 0
12 Chair with Writing Board 0 0 0
13 Augmentative/Alternative 0
0 0
Communication (AAC) Systems 0
14 Big Keys Keyboard 0 0 0
15 Remote Control with enlarged Buttons 0 0 0
16 Musical Instruments 0 0 0
17 Sewing Machine 0 0 0
18 Braille Translation Software 0 0 0
19 Braille Embosser-single sided 0 0 0
20 Braille Embosser-Double sided 0 0 0
21 Accessible Graphing Talking Calculator 0 0 0
22 Ergonomic trackballs 0 0 0
23 Foot mouse 0 0 0
24 Head Mouse &Eye Trackers 0 0 0
25 Crutches 0 0 0
26 Wheelchair 0 0 0
27 Screen Reader 0 0 0
28 Tape Recorder 0 0 0
29 Amplified Answering Machines 0 0 0
30 Telephone Amplifiers 0 0 0
31 Bluetooth Hearing Aid 0 0 0
32 Hearing Aid 0 0 0
33 Clerical Chair 0 0 0
TOTAL 0 0 0
B. ADAPTIVE DEVICES
1 First Aid Kit 0
2 Rubber Mat 0
3 Water Jug 0
4 Whistle 0
5 Stop Watch 0
6 Buzzer 0
7 Sleeping Bag 0
8 Tent 0
9 Safety Wall Mirror 0
10 Speech Synthesizer 0
11 Big Bubbles Kit 0
TOTAL 0 0 0
Notes:
1. Assistive device is any device that helps someone do something that might not other otherwise be able to do well or at all;
Generally, the term is used for devices that help people overcome a handicap such as a mobility, vision, mental, dexterity or hearing loss.
2. Adaptive device is any device that are used to assist with completing activities of daily living.
School Head : ______________________________________ Head of the Office : __________________________ Head of the Office : __________________________
Position Title : _________________ Date : ____________ Position Title : _____________ Date : ________ Position Title : __________ Date : _________
Page 21 of 43
Table 25. NUMBER OF EQUIPMENT AND TOOLS IN THE SCHOOL FOR LSENs, SY 2018-2019 (As of June 30, 2018)
Number of Equipment and Tools
Types of Equipment and Tools
Functional Non-Functional TOTAL
1 Cake Turntable 0 0 0
2 Pie Pan 0 0 0
3 Sheet Pan 0 0 0
4 Mixing Bowl 0 0 0
5 Double Boiler 0 0 0
6 Pastry Blender 0 0 0
7 Gas Range 0 0 0
8 Refrigerator 0 0 0
9 Measuring Cups 0 0 0
10 Measuring Spoons 0 0 0
11 Kitchen Knife 0 0 0
12 Wooden Spoons 0 0 0
13 Blender Machine 0 0 0
14 Fire Extinguisher 0 0 0
15 Frying Pan 0 0 0
16 Pastry Tubes 0 0 0
17 Roasting Pan 0 0 0
18 Spatula 0 0 0
19 Strainer 0 0 0
20 Tong 0 0 0
21 Portable Electric Drill 0 0 0
22 Claw Hammer 0 0 0
23 Cross Cut Saw 0 0 0
24 Gloves 0 0 0
25 Seedling Tray 0 0 0
26 Sprinkler 0 0 0
27 Prunning Shear 0 0 0
28 Spade 0 0 0
29 Garden Hose 0 0 0
30 Dipping Can 0 0 0
TOTAL 0 0 0
Note: Equipment/Tools or Devices for LSENs are instructional supports and which are appropriate assistive/materials or technology.
These are powerful tool to increase a child's independence and depending on disability or difficulty as down syndrome, hearing loss,
intellectual and learning disabilities, muscular dystrophy. This includes devices, equipment, instruments and software .
School Head : ______________________________________ Head of the Office : _________________________ Head of the Office : __________________________
Position Title : _________________ Date : ____________ Position Title : __________Date : ___________ Position Title : __________ Date : _________
Page 22 of 43
Box 5. DATA ON INTERNET CONNECTIVITY, SY 2018-2019 (As of June 30, 2018)
1. Are there internet service providers in the area? ✘ 1 Yes ✘ No

If Yes, check the appropriate internet service provider/s servicing the area:
✘ BAYANTEL ✘ 1 GLOBE ✘ SMART ✘ WIT Global (Satellite)
✘ DIGITEL ✘ PLDT ✘ SUN ✘ Others, please specify
2. Does the school subscribe to any of the internet service provider/s listed above? ✘ 1 Yes ✘ No
If Yes, indicate the purpose:
2.a. For administrative use ✘ 1 Yes ✘ No
2.b. For classroom instruction use ✘ Yes ✘ No
3. How fast is your internet connection when not in use? Use www.speedtest.net to test the speed.
Date Tested: 11-22-18 Ping (ms): 161 Upload (Mbps): 3.09
Time Tested: 1:11 Download (Mbps): 9.36
Internet Service Provider (ISP) - refers to the organization that provides services for accessing, using, or participating in the internet.
Table 26. AVERAGE MONTHLY EXPENSE (IN PESOS) OF INTERNET CONNECTION BY FUNDING SOURCE,
SY 2018-2019 (As of June 30, 2018)
Average Monthly
Types of Internet Connection Internet Service Provider Funding Source
Expense
(Wired, Fixed wireless, Satellite, (Select from available (DepEd DICP, MOOE, School Funds, LGU/SEF, PTA,
USB Modem) ISPs above) (in PhP) Private Donations, Other Government Agencies, etc.)
FIXED WIRELESS GLOBE 1,800.00 MOOE
Indicate the average monthly expense of internet connection by funding source.

1. Types of Internet Connection:
a. Wired - internet connection using the phone lines from the service provider to a client.
b. Fixed wireless - internet connection through radio frequency bands with directional radio antenna on each end of the signal.
c. Satellite - internet connection using satellite dish supplied by an internet provider.
d. USB Modem - internet connection using USB dongle (e.g., SMART Bro, Globe Tattoo).
2. Average Monthly Expense - average cost spent for the internet connection in Philippine Peso.
School Head : ___________________________ Head of the Office : _____________________________Head of the Office : _____________________________
Position Title : ___________ Date : _________ Position Title : _________________ Date : _________Position Title : _________________ Date : _________
Page 23 of 43
Box 6. SCHOOL SITE DATA, SY 2018-2019 (As of June 30, 2018)
1. School Site Ownership and/or Proof of Occupancy 2. Total Land Area (in square meters): 4. Within Ancestral Domain :
a. Ownership in the name of: (Check as appropriate) With Usufruct Agreement?
1
✘ DepEd ✘ Other Government Agency 3. Mode of Acquisition of School Site: (Check as appropriate) 1 Yes
✘ ✘
No
✘ LGU ✘ Private Entity / Individual/s Year With Certificate of Ancestral Domain Title (CADT)?
Mode
Acquired ✘
Yes 1 No
✘
b. With Document? 1
✘ Yes ✘
No 1
✘ Donation 1960
If Yes, what Document Type: (Check as appropriate) ✘ Purchase 5. Within Ancestral Land :
1 Original Certificate of Title (OCT)
✘ ✘ Usufruct Agreement With Usufruct Agreement?
✘
Transfer Certificate of Title (TCT) ✘ Expropriation ✘
Yes 1 No
✘
✘ Certificate of Land Ownership Award (CLOA) ✘ Deed of Exchange (Land Swapping) With Certificate of Ancestral Land Title (CALT)?
✘ Special Patent ✘ Presidential Proclamation ✘
Yes 0 No
✘ Presidential Proclamation ✘ Special Patent
1 Tax Declaration
✘
Certificate of Land Ownership Award 6. Legal Ownership Issues : (Check as appropriate)
✘
✘ Deed of Absolute Sale (CLOA) ✘
With Adverse Claim
1 Deed of Donation
✘ ✘ Special Land Use Permit (SLUP) ✘
Encroachment
✘ Certificate of Stewardship ✘
With Illegal Settlers
✘ Others, pls. specify
✘ Special Land Use Permit (SLUP) ✘
Others, pls. specify
✘ Contract of Usufruct
✘ Memorandum of Agreement or Understanding 7. School Site within : (Check as appropriate)
✘ Lease Agreement 1 Protected Areas
✘
✘ Others, pls. specify ✘

Areas classified as Timberland and Forestland
1. School Site Ownership and/or Proof of Occupancy - refers to any legal and official document that acts as a competent proof of one's ownership and/or occupancy of the subject property.
Document Type:
Certificate of Title - refers to the transcript of the decree or registration made by the Register of Deeds.
a. Original Certificate of Title (OCT) - refers to a document when the land has been adjudicated and decreed in the name of its owner in registration proceeding and the title issued for the first time is pursuant of such decree.
b. Transfer Certificate of Title (TCT) - refers to a document when the land title is cancelled and replaced by another title by reason of sale or transfer.
c. Certificate of Land Ownership Award (CLOA) - refers to a proof of ownership of the agrarian reform beneficiary with respect to private and agricultural land covered under RA 6657.
d. Special Patent - refers to grant, cede, and convey full ownership of alienable and disposable lands formerly covered by a reservation of lands of the public domain and is issued upon the promulgation of a special law or act of Congress or by the DENR
Secretary as authorized by the President.
e. Presidential Proclamation - refers to a proclamation issued by the President reserving an untitled land for public use.
f. Tax Declaration - refers to a document issued by the Assessor's Office of the jurisdiction (e.g. city or municipality) evidencing the payment of taxes on the use of the real property.
g. Deed of Absolute Sale - refers to a document executed by the vendor evidencing the absolute (without conditions) sale of the real property in favor of the vendee.
h. Deed of Donation - refers to a document executed by the donor, under the formalities required by law, evidencing the donation of the property.
i. Certificate of Stewardship - refers to a document awarded to individuals or families actually occupying or tilling portions of forest lands pursuant to LOI 1260 for a period of 25 years’ renewable for another 25 years.
j. Special Land Use Permit (SLUP) - refers to a privilege granted by the State to a person to occupy, possess and manage in consideration of specified return, any public forest lands for a specific use or purpose.
k. Contract of Usufruct - refers to a document which stipulates that DepEd/school is allowed of full use or perpetual right of use of property without consideration as long as the property is used solely for educational or designated purposes.
l. Memorandum of Agreement or Understanding/Lease Agreement - refers to a document executed by the legal owner/occupant of the land setting unnecessary the conditions on the use of the property.
m. Others - refers to the other documents that are competent proof of ownership and occupancy.
(Continuation of definition on the next page)
Note: In case the school head does not have adequate information on the items listed above, the assistance of the Industrial Arts Teacher/Division Physical Facilities Coordinator/ Division Project Engineer can be asked.
School Head : ___________________________________ Head of the Office : ______________________________ Head of the Office : ______________________________
Position Title : ___________ Date : ______________ Position Title : ___________ Date : ______________ Position Title : ___________ Date : ______________
Page 24 of 43
(Cont.)
2. Total Land Area - refers to the size in square meters of all areas designated as land used for some particular purpose such as school building.
3. Mode of Acquisition of School Site - refers to the means of acquiring the school site.
a. Donation - includes the four (4) types of donation: .
a.1. Simple Donation - refers to a type of donation whereby a person, through an act of liberality disposes a piece of land in favor of the government.
a.2. Conditional Donation - refers to a type of donation which imposes a condition (e.g., "that the land shall be used only for education"). In such case, the property is reverted to the owner when the condition as stipulated in the
donation is not met.
a.3. Inter Vivos Donation - refers to a type of donation that is in effect during the lifetime of the donor.
a.4. Mortis Causa - refers to a type of donation that takes effect only after the donor's death. Donations by mortis causa should conform to the formalities required of the last will.
b. Purchase - refers to a mode of acquisition of school sites by direct purchase from the legal owner who voluntarily sold it as evidenced by a Deed of Sale duly executed, notarized and registered with the Register of Deeds.
c. Expropriation - refers to a mode of acquisition of school sites by the government through the exercise its power of eminent domain (i.e. by taking private property for public use upon payment of just compensation).
d. Exchange (Land Swapping) - refers to a mode of acquisition of school sites by exchanging an existing school site for a new site for justifiable reasons as identified by law.
e. Presidential Proclamation - refers to a mode of acquisition of school sites by virtue of a declaration by the President under the procedures established by law.
4. Within Ancestral Domain - refers to all areas generally belonging to Indigenous Cultural Communities / Indigenous People (ICCs/IPs) comprising lands, inland waters, coastal areas, and natural resources therein, held under a claim of
ownership, occupied or possessed by ICCs/IPs, communally or individually since time immemorial. It covers the total environment, including the spiritual and cultural bonds to the areas which the ICCs/IPs possess, occupy and use and to
which they have claims of ownership.
a. Certificate of Ancestral Domain Titles (CADT) - refers refers to a title formally recognizing the rights of possession and ownership of ICCs/IPs over their ancestral domains identified and delineated in accordance with RA No. 837
otherwise known as the Indigenous People’s Rights Act of 1973.
5. Within Ancestral Land - refers to occupied land, possessed and utilized by individuals, families and clans who are members of the ICCs/IPs since time immemorial. Ancestral lands include residential lots, rice terraces or paddies, private
forests, swidden farms and tree lots. These may be found within ancestral domains.
a. Certificate of Ancestral Land Title (CALT) - refers to a title formally recognizing the rights of ICCs/IPs over their ancestral lands.
6. Legal Ownership Issues:
a. Adverse Claim - refers to a written statement setting forth claim to the title or right to possession over a registered property, alleging how and under whom such alleged right was acquired.
b. Encroachment - refers to unlawful interference or gaining upon the land, property, other possessions, or the rights of another.
c. With Illegal Settlers - refers to groups of housing units illegally constructed on a land that the occupants have no legal claim.
7. School Site within:
a. Protected Areas – refers to identified portions of land and water set aside by reason of their unique physical and biological significance, managed to enhance biological diversity and protected against destructive human exploitation,
such as National Parks, Natural Parks, Natural Monuments, Protected Landscape, Protected Seascape, Game Refuge and Bird Sanctuaries, Resource Reserves, Managed Resource Protected Areas, Marine Reserves, Watershed Forest
Reserves, Natural Biotic Areas, Wildlife Sanctuaries, and Wilderness Areas.
b. Timberland and Forestland – refers to lands of the public domain which have been the subject of the present system of land classification and determined to be needed for forest purposes. Eventually, these lands will be proclaimed
as forest reserves by the President.
Note: In case the school head does not have adequate information on the items listed above, the assistance of the Industrial Arts Teacher/Division Physical Facilities Coordinator/Division Project Engineer can be asked.
Table 27. VULNERABILITIES, For the months of June 2017 to May 2018
In your own opinion, what are the top 3 conditions, circumstances or features of your schools and the surrounding environment that increase your vulnerability or put life and property at great risk to natural and
human-induced disasters?
1. at risk in stormsurge,
2. tropical cyclone
3. flood
Note: This table should not be left blank.
Table 28. DISASTER PREPAREDNESS, For the months of June 2017 to May 2018
Did the school conducted multi-hazard drills? 1
✘ Yes ✘ No
If Yes, what type and how many times in a specific month?
Year 2017 Year 2018
Types of Multi-Hazard Drill July Aug. Sept. Oct. Nov. Dec. Jan. Feb. Mar. April May
June
Earthquake Drill 1 1 1
Flood Evacuation Drill
Fire Drill
Lockdown Drill 1 1
Lockdown Drill - emergency protocol to prevent entry or exit from a building or classroom during armed conflict, civilian violence,
or bomb threat / bombing incidents
School Head : ________________________________________ Head of the Office : ____________________________________ Head of the Office : _________________________________
Position Title : _______________ Date : _______________ Position Title : _________________ Date : _______________ Position Title : _________________ Date : _____________
Page 25 of 43
Table 29. DISASTERS/CALAMITIES, For the months of June 2017 to May 2018
How many times did the following incidents occur in your school and immediate surroundings?
Year 2017 Year 2018
Disasters/Calamities
June July Aug. Sept. Oct. Nov. Dec. Jan. Feb. Mar. April May
Natural Hazards
Drought 1 1 1
Earthquake 1
Fire (includes forest fire, fires as consequence of natural disasters

such as typhoons and earthquakes)
Flood
Landslide
Storm Surge
Tropical Cyclones (Storm, Typhoon, Tropical Depression, etc.) 1 1 1 1
Tsunami
Volcanic Eruption
Human-Induced Hazards
Crime against school head/s
(murder/homicide, physical injury, rape, sexual harassment, etc.)
Crime against learner/s
Crime against teacher/s
Crime against school property (theft, robbery, arson)
Hostage-taking within school premises
Kidnapping of personnel
Kidnapping of learner/s
Bombing in school premises
Bomb threat in school premises
Fire (Electrical wiring failure, etc.)
Health Threat
(Dengue, Malaria, Measles, food poisoning, disease outbreak)
Oil Spill
Other security threat as a result of civilian violence
(Kidnapping threats, shooting, etc.)
Structural collapse (as a result of engineering failures)
Others, please specify
Note: For the definitions, please see DepEd Order No. 23, s.2014.
School Head : ________________________________________ Head of the Office : ____________________________________ Head of the Office : __________________________________
Position Title : ________________ Date : _______________ Position Title : ___________________ Date : _____________ Position Title : _________________ Date : _____________
Page 26 of 43
Table 30. DISASTERS/CALAMITIES (Human-Induced Hazards - Armed Conflict), For the months of June 2017 to May 2018
Year 2017 Year 2018
Human-Induced Hazards - Armed Conflict
1. Indicate the number of incidents that the following state actors
and/or non-state actors were involved in an armed conflict in the past
months within the school and immediate surroundings:
State Actors:
Armed Forces of the Philippines (AFP)
Philippine National Police (PNP)
Non-State Actors:
Communist Party of the Philippines-New People's Army
and National Democratic Front (CPP-NPA-NDF)
Moro National Liberation Front (MNLF)
Bangsamoro Islamic Freedom Fighters (BIFF)
Maute Group
Abu Sayyaf Group (ASG)

2. Indicate the number of times that the Grave Child Rights Violations
were committed in the past months within the school and immediate
surroundings:
Killing and maiming of children

Recruitment or use of children as soldiers
Sexual violence against children
Abduction of children
Attacks against schools or hospitals
Denial of humanitarian access for children
1. Armed Conflict - refers to armed confrontations occuring between governmental armed forces and one or more armed groups, or between such groups arising in the Philippine territory. Armed
conflict incidents include armed encounters such as the All-Out-War in 2000, the September 2013 Zamboanga Siege, and rido, among others.
2. State and/or Non-State Actors - refers to those involved in the armed conflict.
Table 31. RESULT OF DISASTER INCIDENCES, For the months of June 2017 to May 2018
Year 2017 Year 2018
Result of Disaster Incidences
Number of Classrooms used as Evacuation Center
Number of Days the Classrooms were used as Evacuation
Center
Number of School Days lost due to class suspensions 1 1 1 1
Number of School Days lost due to armed conflict
School Head : ________________________________________ Head of the Office : ____________________________________ Head of the Office : __________________________________
Position Title : ________________ Date : _______________ Position Title : ___________________ Date : _____________ Position Title : _________________ Date : _____________
Page 27 of 43
Box 7. OTHER CONFLICT-RELATED DATA, For the months of June 2017 to May 2018
1. Does the school integrate peace education in their daily lessons and lesson plans? 1✘ Yes ✘ No
If Yes,
1.1. Since when? JUNE ONWARDS
1.2. What peace education materials do the school use? Please enumerate all materials used.
POSTERS, USE OF ICT TECHNOLOGIES

1.3. What subjects are integrated with peace education key messages/lessons? Please enumerate all subjects integrated with
peace education key messages/lessons.
ALL SUBJECT AREAS

2. Does the school conduct peace building activities (whether co-curricular or extra-curricular)? 1✘ Yes ✘ No
If Yes, enumerate all the peace building activities conducted the past school year?
ORIENTATION OF PARENT DURING CARD DAY

3. Has the school implemented Education in Emergency (EiE) strategies for immediate class resumption due to incidents of
armed conflict? ✘ Yes 1✘ No
If Yes,
3.1. Indicate the number of instances the school implemented EiE strategies for class resumption during the past school year?
Count is considered as one (1) per incident and not per day.
3.2. Indicate the number of days the school implemented EiE strategies for class resumption during the past school year?
Please indicate range of days (fewest to most) if multiple incidents occured.
3.3. Enumerate all the EiE strategies the school has used for class resumption during the past school year?
4. Were school personnel trained in integrating peace education in their daily lessons and lesson plans? ✘ Yes 1✘ No
If Yes,
4.1. How many personnel were trained?
4.2. Which organization/office provided/conducted the training/s? Please include the date of training/s.
5. Were school personnel trained in implementing EiE strategies? ✘ Yes 1✘ No

If Yes,
5.1. How many personnel were trained?
5.2. Which organization/office provided/conducted the training/s? Please include the date of training/s.
6. Does the school have a learner-family reunification plan in case of the occurrence of hazards during class hours?
✘ Yes 1✘ No
If Yes, are the parents and learners informed of the plan? ✘ Yes ✘ No
7. Does the school have a lockdown protocol? ✘ Yes 1✘ No

If Yes, are the parents and learners informed of the protocol? 1✘ Yes ✘ No
8. Has the school been declared as a "Zone of Peace"?* 1✘ Yes ✘ No

If Yes,
8.1. When was the school declared as a "Zone of Peace"?* S.Y 2017-2018
8.2. Has the declaration been formalized through a written agreement or code of conduct signed by duly recognized
representatives of stakeholders? ✘ Yes ✘ No
If Yes, check the appropriate stakeholders:
✘ Armed Forces of the Philippines (AFP) ✘ Non-State Armed Group
1 ✘ Philippine National Police (PNP) ✘ Others, please specify
1 ✘ Local Government Unit (LGU)
8.3. What regular activities are conducted in relation to the school being a "Zone of Peace"?*
Note: * - For the definition, please see DepEd Order No. 44, s. 2005 and DepEd Memorandum No. 109, s. 2017.
1. Peace Education – refers to the transformative education; education that seeks to change mindsets values and behaviors that have led to direct, structural, and other forms of violence in our
society; education that builds awareness, concern and action towards non-violence, justice, and environmental care (Executive Order No. 570, s. 2006).
2. Peace Building Activities – refers to a range of measures targeted to reduce the risk of lapsing or relapsing into conflict by strengthening national capacities at all levels for conflict
management, and to lay the foundation for sustainable peace and development. Peacebuilding strategies must be coherent and tailored to the specific needs of the country concerned, based
on national ownership, and should comprise a carefully prioritized, sequenced, and relatively narrow set of activities aimed at achieving the above objectives.
3. Education in Emergencies (EiE) – refers to “a set of linked project activities that enable structured learning to continue in times of acute crisis or long-term instability” (Nicolai, 2003). It
safeguards the rights of children to education by ensuring learning continuity amid disasters brought about by natural or human-induced hazards. EiE covers response and rehabilitation and
recovery efforts of the education sector and is guided by the Sustainable Development Goal (#4) of ensuring inclusive and equitable quality education and promoting lifelong learning
opportunities for all.
4. Learner-Family Reunification plan – refers to a functional protocol that outlines the redirection of a school’s occupants to a secured site away from the threat (could be within or outside
school grounds depending on the situation/hazard) and supports the effort to reunite learners with their families.
5. Lockdown plan – refers to a functional protocol that outlines the steps to ensure that a school’s occupants are kept safe from security risks brought about by armed intruders, armed conflict
from other sources, etc.
School Head : ______________________________________ Head of the Office : _____________________________ Head of the Office : ____________________________
Position Title : ______________ Date : _______________ Position Title : ____________ Date : _____________ Position Title : ____________ Date : ____________
Page 28 of 43
Box 8. SAFE LEARNING FACILITIES, For the months of June 2017 to May 2018
(Check as appropriate)
1. Does the school conduct risk assesment of school buildings?  Yes  No

If Yes, during which month/s?
June July Aug. Sept. Oct. Nov. Dec. Jan. Feb. Mar. April
         
Findings of risk assessment of school buildings:
 Cracks  Buckling (Beams/Columns)
 Deterioration  Leaks
 Destroyed electrical wirings  Others, please specify _____________________
2. Does the school conduct regular repair of facilities using their school funds?  Yes
June July Aug. Sept. Oct. Nov. Dec. Jan. Feb. Mar. April
         
3. Are the school facilities sensitive to the needs of persons with disability (e.g. ramp)? 
Box 9. INTEGRATION OF CLIMATE CHANGE ADAPTATION (CCA) AND DISASTER RISK REDUCTIO
MANAGEMENT (DRRM), For the months of June 2017 to May 2018
1. Have you incorporated CCA and DRRM in your School Improvement Plan (SIP)?  Yes
If Yes, please enumerate the Top 5 DRRM activities included in the SIP:
1
2
3
4
5
2. What CCA and DRRM activities in the School Improvement Plan (SIP) were included in your Annual
____________________________________________________________________________________
3. Is your school equipped with safety equipment?  Yes  No

4. Have you developed preparedness/contingency plans in case of disaster or emenrgency?
If Yes, which of these has the school developed?
 Plan for the Reunification of Learners and Family
 Area designated for Temporary Learning Spaces
 Prepositioning of emergency equipment
 Human resources/manpower
 Other resources (water, food, etc)
Page 20 of 26
 Establishment of escape routes and rendevous point same as Plan for the Reunification
 Protocol for redirecting the learners to a secured site same as Area designated for TLSs
 Buildable spaces for erecting TLSs same as Area designated for TLSs
 Equipment such as first aid kits, radio, flashlight and other tools for survival such as ropes, etc.
 Warm bodies mobilized for preparedness and response same as human resouces
 Other resources to ensure survival within the first 72 hours after a disaster same as other resour
 Usable exit routes and meeting places for evacuation same as Plan for the
 Others, please specify ____________________
Box 8. SCHOOL DISASTER RISK REDUCTION AND MANAGEMENT (SDRRM) TEAM, For the months of
1. Does your school have a SDRRM Coordinator or Focal Person?  Yes  No

2. Does your school have a SDRRM Team?  Yes  No
If Yes, during which of the following does your SDRRM Team do/have?
 Multistakeholder composition of SDRRM Team including but not limited to the representatives
BDRRMC, PTA, and CSOs
 Regular conduct of meetings
If Yes, please indicate how often your SDRRM Team conducts meeting.
 Yearly  Monthly
 Bi-annualy  Others, please specify _____________________
 Quarterly
 Student-led School Watching and Hazard Mapping per DO No. 23, s. 2015
If Yes, please indicate what month the activity was conducted.
June July Aug. Sept. Oct. Nov. Dec. Jan. Feb.
        
 Promoting Family Earthquake Preparedness per DO No. 27, s. 2015
If Yes, please indicate what month the activity was conducted.
June July Aug. Sept. Oct. Nov. Dec. Jan. Feb.
        
Have you presented its results to the PTA and LGU?  Yes 
Have you taken appropriate actions based on the results?  Yes
 Observance of National Fire Prevention Month per Proclamation No. 115-A, s. 1966
 Observance of National Disaster Consciousness Month per EO No. 137, s. 1999
 Earth Day Celebration per DO No. 65, s. 2010
 Quarterly Earthquake and Fire Drills including drills for other hazards in your locality per DO
 Brigada Eskwela per DO No. 24, s. 2008
If Yes, who were involved?
Page 20 of 26
 Parents  Learners
 Teachers  Others, please specify ____________________
 Information Dissemination Strategy/Contingency Plan during times of emergencies/disasters
 Proper documentation and reporting of damage, donations received, interventions received, and
Certified True and Correct by : Checked by Schools District Office : Verified by the Sch
School Head : ______________________ Head of the Office : ____________________________ Head of the Office
(Signature Over Printed Name) (Signature over Printed Name)
Position Title : _________ Date : ________ Position Title : ___________ Date : _____________ Position Title : _
Page 20 of 26
April May
 
Others, please specify _____________________________
 No
April May
 
Yes  No
(CCA) AND DISASTER RISK REDUCTION AND
 No
ent Plan (SIP) were included in your Annual Implementation Plan (AIP)?
_____________________________________________
 Yes  No
Page 20 of 26
same as Plan for the Reunification
same as Area designated for TLSs
same as Area designated for TLSs
t and other tools for survival such as ropes, etc. same as prepositioning of emergency equipment
same as other resources
same as Plan for the Reunification
EMENT (SDRRM) TEAM, For the months of June 2017 to May 2018
No
m including but not limited to the representatives from the
Others, please specify ___________________________________
Feb. Mar. April May

  
Feb. Mar. April May

  
No
 No
drills for other hazards in your locality per DO No. 48, s. 2012
Page 20 of 26
Others, please specify ____________________
cy Plan during times of emergencies/disasters
donations received, interventions received, and actions taken
Verified by the Schools Division Office :

Head of the Office : _________________________
(Signature over Printed Name)
Position Title : ___________ Date : __________
Page 20 of 26
Box 8. SAFE LEARNING FACILITIES, For the months of June 2017 to May 2018
1. Does the school conduct risk assesment of school buildings? 1

✘ Yes ✘ No

Year 2017 Year 2018
0 ✘ ✘ ✘ 1
✘ 0 ✘ ✘ ✘ ✘ ✘ ✘
Findings of risk assessment of school buildings:
1 Cracks
✘ ✘
Buckling (Beams/Columns)
✘
Deterioration 1 Leaks
✘
✘
Destroyed electrical wirings ✘
2. Does the school conduct regular repair of facilities using their school funds? ✘
Yes 0 No
Year 2017 Year 2018
✘ ✘ ✘ 1 ✘ ✘ ✘ ✘ ✘ ✘ ✘
###✘ ✘
3. Are the school facilities sensitive to the needs of persons with disability (e.g. ramp)? 0 Yes ✘
No
Box 9. INTEGRATION OF CLIMATE CHANGE ADAPTATION (CCA) AND DISASTER RISK REDUCTION AND
MANAGEMENT (DRRM), For the months of June 2017 to May 2018
1. Have you incorporated CCA and DRRM in your School Improvement Plan (SIP)? 0 Yes 1 No
✘
If Yes, please enumerate the Top 5 DRRM activities included in the SIP:
1
2
3
4
5
2. What CCA and DRRM activities in the School Improvement Plan (SIP) were included in your Annual Implementation Plan (AIP)?
3. Is your school equipped with safety equipment? 1 Yes

✘
✘ No
4. Have you developed preparedness/contingency plans in case of disaster or emenrgency? 1 Yes

✘ ✘
No
If Yes, which of the following has the school developed?
1 Plan for the Reunification of Learners and Family
✘
1✘ Human resources/manpower
1 Area designated for Temporary Learning Spaces

✘
1 ✘
Other resources (water, food, etc)
1 Prepositioning of emergency equipment

✘
1✘ Others, please specify
School Head : _________________________ Head of the Office : ____________________________ Head of the Office : _________________________
(Signature Over Printed Name) (Signature over Printed Name) (Signature over Printed Name)
Position Title : ___________ Date : ________ Position Title : ___________ Date : _____________ Position Title : ___________ Date : __________
Page 29 of 43
Box 10. SCHOOL DISASTER RISK REDUCTION AND MANAGEMENT (SDRRM) TEAM, For the months of June 2017 to May 2018
1. Does your school have a SDRRM Coordinator or Focal Person? 1

✘ Yes ✘ No
2. Does your school have a SDRRM Team? ✘ Yes 1

✘ No
If Yes, during which of the following does your SDRRM Team do/have?
✘ Multistakeholder composition of SDRRM Team including but not limited to the representatives from the
BDRRMC, PTA, and CSOs

✘ Regular conduct of meetings
If Yes, please indicate how often your SDRRM Team conducts meeting.
✘ Yearly ✘ Monthly
✘ Bi-annualy ✘ Others, please specify

✘ Quarterly
✘ Student-led School Watching and Hazard Mapping per DO No. 23, s. 2015
If Yes, please check the month/s the activity was conducted.
Year 2017 Year 2018
✘ ✘ ✘ ✘ ✘ ✘ ✘ ✘ ✘ ✘ ✘ ✘
✘ Promoting Family Earthquake Preparedness per DO No. 27, s. 2015

If Yes, please check the month/s the activity was conducted.
Year 2017 Year 2018
✘ ✘ ✘ ✘ ✘ ✘ ✘ ✘ ✘ ✘ ✘ ✘
Have you presented its results to the PTA and LGU? 0 Yes ✘ No
Have you taken appropriate actions based on the results? ✘ Yes ✘ No
1 Observance of National Fire Prevention Month per Proclamation No. 115-A, s. 1966
✘
1
✘ Observance of National Disaster Consciousness Month per EO No. 137, s. 1999
0 Earth Day Celebration per DO No. 65, s. 2010

1
✘ Quarterly Earthquake and Fire Drills including drills for other hazards in your locality per DO No. 48, s. 2012
1
✘ Brigada Eskwela per DO No. 24, s. 2008
If Yes, who were involved?
✘ 1 Parents ✘ 1 Learners
✘ 1 Teachers ✘ Others, please specify
✘1 Information Dissemination Strategy/Contingency Plan during times of emergencies/disasters
✘1 Proper documentation and reporting of damage, donations received, interventions received, and actions taken
✘ Others, please specify
School Head : _________________________ Head of the Office : ____________________________ Head of the Office : _________________________
Position Title : _________ Date : ________ Position Title : ___________ Date : _____________ Position Title : ___________ Date : __________
Page 30 of 43
Table 32. LEARNING AREAS WITH DRRM-RELATED CONCEPTS, For the months of June 2017 to May 2018
(Check the appropriate grade level/s if the DRRM-related concepts were taught in the following learning areas)
Learning areas with DRRM-related concepts Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6
Mother tongue 1
✘ 1
✘ 1
✘ 1
✘ 1
✘ 1
✘ ✘1
Filipino 0 1
✘ 1
✘ 1
✘ 1
✘ 1
✘ ✘1
English 0 1
✘ 1
✘ 1
✘ 1
✘ 1
✘ ✘1
Mathematics 0 1
✘ 1
✘ 1
✘ 1
✘ 1
✘ ✘1
Science 0 1
✘ 1
✘ 1
✘ 1
✘ 1
✘ ✘1
Araling Panlipunan (AP) 0 1
✘ 1
✘ 1
✘ 1
✘ 1
✘ ✘1
Edukasyon sa Pagpapakatao (EsP) 0 1
✘ 1
✘ 1
✘ 1
✘ 1
✘ ✘1
Music 0 1✘ 1✘ 1
✘ 1
✘ 1✘ 1
✘
Arts 0 1✘ 1✘ 1
✘ 1
✘ 0 0
Physical Education 0 1✘ 1✘ 1
✘ 1
✘ 1✘ 1
✘
Health 0 1✘ 1✘ 1
✘ 1
✘ 1✘ 1
✘
Edukasyong Pantahanan at Pangkabuhayan (EPP) 0 1✘ 1✘ 1
✘ 1
✘ 1✘ 1
✘
Technology and Livelihood Education (TLE) 0 1✘ 1✘ 1
✘ 1
✘ 1✘ 1
✘
Extra-curricular activities 0 0 0 0 0 0 0
Table 33. TEACHING PERSONNEL WHO RECEIVED COURSES/TRAINING ON DRRM/CCA

For the months of June 2017 to May 2018
Number of Teachers
Courses and/or Trainings on DRRM and CCA
Male Female TOTAL
DRRM courses and/or trainings in the last 5 years
0 0 0
(except psychosocial first aid)
Psychosocial first aid courses and/or trainings in the last
0 0 0
5 years
Climate Change Adaptation (CCA) courses and/or trainings in
0 0 0
the last 5 years
Indicate the number of teachers with plantilla positions, including those with provisional appointments and
who are actually performing their specific assignments in the school who have received special courses
and/or training on DRRM and CCA related courses as of May 31, 2018.
Reminder: If a teacher received more than one training, he/she should be counted once where
he/she has the most number of trainings attended.
Table 34. LEARNERS WHO RECEIVED COURSES/TRAINING ON DRRM/CCA

Number of Learners
Courses and/or Trainings on DRRM and CCA
Male Female TOTAL
DRRM courses and/or trainings 0 0 0
Climate Change Adaptation (CCA) courses and/or trainings in

0 0 0
the last 5 years
Reminder: If a learner received more than one training, he/she should be counted once where
he/she has the most number of trainings attended.
School Head : ______________________ Head of the Office : ___________________________Head of the Office : ____________________________
Position Title : _________ Date : ________ Position Title : ____________ Date : _________ Position Title : _____________ Date : ___________
Page 31 of 43
Table 35. HEALTH AND NUTRITION, SY 2018-2019
A. Number of learners who were vaccinated by the Department of Health in the school this SY 2018-2019 from June 4, 2018 to August 31, 2018
Grade 1 Grade 4
Types of Vaccines
Male Female Total Female
Measles Containing Vaccine 11 12 23
Tetanus Diphtheria 11 12 23
Human Papiloma Virus 8
B. Number of learners who underwent vision screening according to results from June 4, 2018 to August 31, 2018
TOTAL
Kindergarten Grade 1 Grade 2 Grade 3
Vision Screening Results (Kindergarten to Grade 3)
Male Female Male Female Male Female Male Female Male Female
Passed 0 0 0 0 0 0 0 0 0 0
Failed 0 0 0 0 0 0 0 0 0 0
TOTAL 0 0 0 0 0 0 0 0 0 0
C. Number of learners by nutritional status as assessed from June 4, 2018 to August 31, 2018
TOTAL
Learners with Special
Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Educational Needs (Kindergarten to Non-
Nutritional Status Graded LSENs)
(Non-Graded)
Weight
Normal 8 3 10 10 9 9 17 6 13 8 10 8 9 11 0 0 76 55
Obese 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Overweight 0 0 2 1 0 0 0 0 0 0 0 1 0 0 0 0 2 2
Severely Wasted 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1
Wasted 0 0 1 1 0 0 1 0 1 0 1 0 0 0 0 4 1
TOTAL 8 3 14 13 9 9 18 6 14 8 11 9 9 11 0 0 83 59
Height
Severely Stunted 1 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 3 1
Stunted 0 0 1 2 5 4 4 0 1 0 1 2 1 0 0 0 13 8
Normal 7 3 11 8 4 5 12 6 13 8 9 7 8 10 0 0 64 47
Tall 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL 8 3 12 10 9 9 17 6 14 8 11 9 9 11 0 0 80 56
Notes:
Learners Nutritional Status in Weight:
1. Normal - refers to a learner with normal weight for his/her age whose BMI-for-age fall between -2 to +2 z-score line or standard deviation (SD).
2. Obese - refers to a learner who is severely overweight for his/her height and whose BMI-for-age fall beyond +3 z-score line or standard deviation (SD).
3. Overweight - refers to a learner weighing too much for his/her height and whose BMI-for-age fall between +2 to +3 z-score line or standard deviation (SD).
4. Severely wasted - refers to a very thin learner whose BMI-for-age is below -3 z-score line or standard deviation (SD).
5. Wasted - refers to a thin learner whose BMI-for-age fall between -2 to -3 z-score line or standard deviation (SD).
Learners Nutritional Status in Height:
1. Severely Stunted - refers to a learner who is very short for his/her age and whose height-for-age (HFA) fall below -3 z-score line or standard deviation (SD).
2. Stunted - refers to a learner who is short for his/her age and whose height-for-age (HFA) fall between -2 to -3 z-score line or standard deviation (SD).
3. Normal - refers to a learner with normal height for his/her age and whose height-for-age (HFA) fall between -2 to +2 z-score line or standard deviation (SD).
4. Tall - refers to a learner who is tall for his/her age and whose height-for-age (HFA) fall beyond +2 z-score line or standard deviation (SD).
D. Number of learners who were dewormed from June 4, 2018 to August 31, 2018
Learners with Special TOTAL
Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Educational Needs (Kindergarten to
Non-Graded LSENs)
Number of Learners Dewormed (Non-Graded)
8 3 10 12 9 9 17 6 14 8 11 9 9 11 0 0 78 58
School Head : __________________________________________ Head of the Office : __________________________________________ Head of the Office : __________________________________________
Plantilla/Position Title : _______________ Date : __________________ Position Title : _______________ Date : __________________ Position Title : _______________ Date : __________________
Page 32 of 43
Box 11. SCHOOL CLINIC, SY 2018-2019
(Please check/provide appropriate answers)
1. Does the school have a designated school clinic? 0 Yes

✘ 1 No✘
2. How many weighing scales does the school have?
Number of Units Available

Type of Weighing Scale
in the School
Bathroom 0
Beam balance 1
3. Which of the following tools does the school use for taking height?
✘ Tape Measure ✘ Microtoise ✘ Others, please specify
1 Steel tape
✘ ✘ Stadiometer
4. How many first aid kits does the school have? 4
5. How many medical thermometers does the school have? 0
6. How many blood pressure apparatus does the school have? 0
7. How many school personnel has a training on basic life support and/or first aid? 0
School Head : _____________________________ Head of the Office: __________________________ Head of the Office: _______________________________
Plantilla/Positio : _______________
Date : ____________ Position Title : _______________
Date : __________ Position Title : _______________ Date : ______________
Page 33 of 43
Box 12. AVAILABILITY OF WATER SUPPLY, SY 2018-2019 (As of June 30, 2018)
1. Is there a water source inside the school ground? 1

✘ Yes ✘ No
If Yes,
1.1. Main Water Supply Source:
✘ Piped water from local service provider ✘ Rainwater Catchments
1
✘ Water Well ✘ Others, please specify
✘ Natural source
1.2. Average Cost of Monthly Bills/Maintenance: (Please indicate the amount in PhP)
1.3. Who pays for the Cost of Monthly Bills/Maintenance?
0 School MOOE ✘ School Canteen Fund
✘ LGU ✘ Private Individual/Sector
1.4. Is the water source inside the school ground being used for drinking? 1
✘ Yes 0 No
1.5. Has the water source inside the school been tested to determine safety of the water? 1
✘ Yes 0 No
1.5.a. If Yes, did the test results show that the water source inside the school is safe to drink? 1
✘ Yes 0 No
1.5.b. How frequent is the water source tested for safety?
✘ Monthly 0 Annually
✘ Quarterly ✘ Others, please specify last 2 years
1.5.c. When was the last time the water source was tested? last 2 years
1.6. Are there times in the year when water is not available for an extended period of time? ✘ Yes 1
✘ No
2. Does the school have mechanism to ensure that the learners have safe drinking water? 1
✘ Yes ✘ No
2.1. If Yes, what mechanism is used?
1✘ Teachers ask the learners to bring their own drinking water to school
1
✘ Safe water in refillable containers are provided in designated areas within the school
1
✘ Water from an accessible water source is treated (i.e., boiled, etc.)
1. Local piped water - water source coming from local water service providers.
2. Water well - an excavation structure in the ground by digging, driving, boring or drilling to access water in underground aquifiers.
3. Rainwater catchment - water sourced from rainwater and collected thru a rainwater collector.
4. Natural source - water sourced from a spring or stream that is either located inside the school grounds or located outside school grounds but water is supplied via pipes.
Table 36. NUMBER OF EXISTING WASH FACILITIES, SY 2018-2019 (As of August 31, 2018)
Functional Total Number Number
Usage Non-Functional of of
with soap without soap Facilities Water Outlets
Facilities for group handwashing 0 2 1 3 5
Facilities for individual handwashing 0 5 1 6 5

1. Group handwashing facility - a facility to be used in supervised handwashing and toothbrushing activtity that can accommodate at least 10 learners.
2. Individual handwashing facility - a facility in the classroom, drinking points, near toilets, near the canteen, etc. that learners can be used for handwashing at critical times.
3. Functional facilities for handwashing - the hand washing facility is accessible, with daily water supply, learner-appropriate height and with appropriate drainage.
4. Non-functional facilities for handwashing - the hand washing facility is broken, clogged or damaged in such a way that it cannot be used.
5. Water Outlet - any opening where water comes out for handwashing (e.g., Faucets, Punch Pipes, etc.).
Position Title : Date : Position Title : _______________
Date : __________ Position Title : _______________
Date : __________
Page 34 of 43
Table 37. ORAL HEALTH, PREVIOUS SY 2017-2018
TOTAL
Details Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6
Number of Learners Examined 0 0 0 0 0 0 0 0
Decayed, Missing, and Filled Teeth (DMFT) - Permanent Teeth
No. of Learners with DMFT 0 0 0 0 0 0 0 0
No. of DMFT 0 0 0 0 0 0 0
Decayed, Missing, and Filled Teeth (DMFT) - Temporary Teeth
No. of Learners with DMFT 0 0 0 0 0 0 0 0
No. of DMFT 0 0 0 0 0 0 0 0
Number of Learners Found to Have Gum Disease 0 0 0 0 0 0 0 0
Number of Learners with Other Significant Dental Anomalies 0 0 0 0 0 0 0 0
Number of Learners who Underwent Flouridization 0 0 0 0 11,111,111 2,222,222 3,333,333 0
Notes:
1. Decayed, Missing, and Filled Teeth (DMFT) Index - refers to the common method use in oral epidemology for assessing dental carries prevalence as well as dental treatment needs among populations.
2. Gum Disease - refers to an inflammation of the gum line that can progress to affect the bone that surrounds and supports the teeth.
3. Dental Anomalies - refers to the craniofacial abnormalities of form, function or position of the teeth, bones, and tissues of the jaw and mouth.
4. Fluoridization - refers to the topical application of fluoride compounds onto the tooth surface to reduce the incidence of dental caries.

Table 38. MEDICAL AND NURSING SERVICES, PREVIOUS SY 2017-2018

TOTAL
Details Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6
Number of Learners Examined 0 0 0 0 0 0 0 0
Number of Learners with Findings 0 0 0 0 0 0 0 0

Number of Learners Given Interventions by Clinic Teachers and
0 0 0 0 0 0 0 0
DepEd Health Personnel
Number of Learners Referred to City/Rural Health Units or Other
0 0 0 0 0 0 0 0
Private Health Professionals
School Head : Head of the Office: Head of the Office: _______________________________

Position Title : Date : Position Title : __________________ Date : ______________ Position Title : _______________ Date : ______________
Page 35 of 43
Box 13. MENTAL HEALTH, PREVIOUS SY 2017-2018
1. Number of learners who sought guidance counseling or life coaching from the school’s guidance counselor or guidance advocate:
Grade Level Number of Learners

Kindergarten 0
Grade 1 0
Grade 2 0
Grade 3 0
Grade 4 0
Grade 5 0
Grade 6 0
TOTAL 0
2. Number of cases of violence against children committed in schools that were recorded by the school:
Types of Violence Cases Committed

Against Children Against Male Learners Against Female Learners Total
Physical violence 0 0 0
Sexual violence 0 0 0
Psychological violence 0 0 0
Other acts of violence 0 0 0
TOTAL 0 0 0
3. Number of cases of bullying or peer abuse that were recorded by the school:
Grade Level Number of Cases

Kindergarten 0
Grade 1 0
Grade 2 0
Grade 3 0
Grade 4 0
Grade 5 0
Grade 6 0
TOTAL 0
4. Number of cases of suicide and attempted suicide among learners and school personnel that were recorded by the school:
Number of Cases
Cases
Among Learners Among School Personnel
Suicide 0 0
Attempted suicide 0 0
Position Title : Date : Position Title Date : Position Title Date :
Page 36 of 43
Box 14. TOBACCO CONTROL, SY 2018-2019
1. Does the school display the following IEC materials:

1.a. "No Smoking" Signages (EO 26, s.2017, DO 48, s.2016) 1
✘ Yes ✘ No
1.b. Poster at the school gate about prohibition of selling of cigarettes within 100 meters from the perimeter of the school
(EO 26, s.2017)
1
✘ Yes 0 No
2. Does the school have an active Child Protection Committee (CPC)? 1
✘ Yes 1 ✘ No
2.a. How frequent does the CPC meet? ✘ Monthly 0 Quarterly 1 Annually
✘ 1 Others, please specify upon occurence
✘
2.b. Has the school's CPC met to discuss tobacco control? 1

✘ Yes 1
✘ No
2.c. When did the CPC last meet to discuss tobacco control? (mm/dd/yyyy) JULY 2018
2.d. Does the school's CPC monitor stores within the 100-meter perimeter of the school for reporting to authorities stores
that sell cigarettes? 1
✘
Yes ✘ No
2.e. How frequent does the CPC monitor the stores within the 100-meter perimeter of the school?
✘ Monthly ✘ Quarterly 1
✘ Annually ✘ Others, please specify
2.f. When did the CPC last monitor stores within the school's 100-meter perimeter to report violation
to authorities? (mm/dd/yyyy)
3. Measures Against Tobacco Industry Interference:

3.a. How many partnerships did the school have from May 2017 to August 2018? 0
3.b. How many of these partnerships have the proper partnership instrument needed (e.g., service contract, memorandum
of agreement (MOA), deed of donation (DOD)/deed of acceptance, memorandum of understanding, etc.)? 0
3.c. How many of the partnerships with memoranda of agreement/deeds of donation include a provision in the
MOA/DOD that the partner/donor is not connected to the tobacco industry, does not received funding from tobacco
companies, or does not sell cigarettes?
0
Box 15. NATIONAL PREVENTIVE DRUG EDUCATION, SY 2018-2019

1. Does the school implement a preventive drug education program? 1

✘ Yes ✘ No
2. Which of the following components are part of the school's preventive drug education program?
1 ✘ Curriculum integration 1 ✘ Partnership with the Barangay Anti-Drug Abuse Council
✘ Extra-curricular activities ✘ Others, please specify
3. Does the school have a National Drug Education Program (NDEP) Coordinator? 1
✘ Yes ✘ No
4. How many classrooms have NDEP Corners? 7
Position Title : _______________ Date : ______________ Position Title : _______________ Date : ______________ Position Title : _______________ Date : ______________
Page 37 of 43
Box 16. FEEDING PROGRAM, SY 2018-2019 (As of August 31, 2018)
1. Does the school have a feeding program? 1 ✘ Yes ✘ No

If Yes, what is the funding source of school feeding program?
✘ School MOOE ✘ LGU Fund ✘ Barangay Fund 1
✘ School-Based Feeding Program (SBFP)
✘ School Canteen Fund ✘ PTA Fund ✘ Private Individual/Sector Fund ✘ Others, please specify
2. Availability of agriculture and fishery resources in the school :
1
✘ Gulayan sa Paaralan, If check, which of the following types of vegetables are present in the school garden?
✘ Legumes 1 ✘ Leafy vegetables ✘ Fruit-bearing ✘ Rootcrops
✘ Fish Pond
✘ Agricultural Crops
✘ Livestock
✘ None
3. Does agricultural and fishery in the school used for feeding program? 1
✘ Yes ✘ No
If Yes, what is the funding source?
✘ School MOOE 1
✘ LGU Fund ✘ Barangay Fund ✘ Others, please specify
✘ School Canteen Fund ✘ PTA Fund ✘ Private Individual/Sector Fund
Box 17. FOOD HANDLING, SY 2018-2019 (As of August 31, 2018)

1. Does the school have a canteen? ✘ Yes 1

✘ No
If Yes,
1.a. Managed by: 1.b. Sanitary Permit 1.c. Validity Date 1.d. Do canteen personnel/food handlers
have health certificates?
✘ School ✘ Yes ✘ No
✘ Teacher-Coop ✘ Yes ✘ No

✘ Yes ✘ No
Sanitary Permit - is the official document issued by proper authorities to an establishment that has been determined to have met the minimum requirements for the
sanitary operation.
Position Title : Date : Position Title Date : Position Title Date :

Page 38 of 43
Box 18. SOLID WASTE MANAGEMENT, SY 2018-2019 (As of June 30, 2018)
1. Is your school compliant to the Ecological Solid Waste Management Act (RA 9003)? 1
✘ Yes ✘ No
2. How is the school implementing Solid Waste Management? (Check as appropriate)

1
✘ Composting ✘ Posting of signage ✘ Use of paper plates/cups instead of plastic
✘ Designation of trash collection point ✘ Recycling Projects ✘ Use of recycled materials are teaching tool
✘ Poster making and/or slogan making contest ✘ School representative at the Barangay Solid ✘ Use of reusable food containerts
✘ Waste Management Committee 1 Waste segregation
✘
3. Who are the school stakeholders actively engaged on the implementation of solid waste management? (Check as appropriate)
1
✘ Barangay ✘ Local business partners 0 Parents
✘ Community leaders ✘ Municipal/City government
Box 19. OPERATION AND MAINTENANCE OF SANITATION FACILITIES, SY 2018-2019 (As of June 30, 2018)
1. How often are the sanitation facilites cleaned? (Check only one)
1 ✘ Daily ✘ Once a week
✘ At least twice a week ✘ Less than once a week
1.1. Average Cost of Monthly Bills/Maintenance: (Please indicate the amount)

1.2. Who Pays for the Cost of Monthly Bills/Maintenance? (Check as appropriate)
✘ School MOOE ✘ School Canteen Fund
✘ LGU ✘ Private Individual/Sector

Box 20. MENSTRUAL HYGIENE, SY 2018-2019 (As of June 30, 2018)

Does the school have a provision for availability of sanitary pads? 0 Yes 1
✘ No
If Yes, where can the learners avail the sanitary pads?

✘ School Canteen ✘ Guidance Office
✘ School Clinic ✘ Others, please specify
School Head : _____________________________ Head of the Office: Head of the Office:
Plantilla/Positio : _______________
Date : ____________ Position Title : _______________ Date : ______________ Position Title : _______________ Date : ______________
Page 39 of 43
Box 21 . SCHOOL GOVERNMENT PROGRAM (SGP), SY 2018-2019
1. Do you have a Supreme Pupils Government (SPG) Council? 1✘ Yes ✘ No

2. Do you have a SPG Adviser? 1✘ Yes ✘ No
2.a. If yes, for how many years as adviser? 20
3. What is/are the subject/s handled by the adviser?
✘ Science ✘ Mathematics 1✘ Others, please specify
1✘ Filipino 1✘ Araling Panlipunan (AP)
4. What is the highest academic degree of the adviser?
1✘ Bachelor Degree ✘ Master Degree ✘ Doctorate Degree
✘ Master Degree Units ✘ Doctorate Degree Units
5. Are the SPG Adviser deloaded of some of their subjects handled? 1✘ Yes ✘ No
6. Does the school collect fees for the SPG acivities? ✘ Yes 1✘ No
7. Did the school incorporate a budget for SPG as part of SIP/APP ? ✘ Yes 1✘ No
8. Does the school have a room dedicated for the SPG Council ? ✘ Yes 1✘ No
9. Have the school SPG joined a division search for best SPG Council ? 0 Yes 1✘ No
10. Have your division won any National Award? 1✘ Yes 0 No
11. How many times have the Youth Formation Coordinator (YFC)/Project Development Officer I (PDO I) visited the school? 0
12. Do you provide Compensatory Time Off (CTO) for activities conducted by SPG advisers during Saturday ? ✘ Yes 1✘ No
Box 22 . SUPREME PUPILS GOVERNMENT (SPG) ACTIVITIES, SY 2018-2019

1. Have the SPG organized the participation of learners in Brigada Eskwela? 1✘ Yes ✘ No
2. Have the school lead in National Greening Program? ✘ Yes 1✘ No
3. Have the school conduct activities and awareness campaigns to encourage parents to enlist their
five (5) year old children for kindergarten? 1✘ Yes ✘ No
4. Have the school conducted book and toy drive and other school supplies for donation to schools with kindergarten? 0 Yes 1✘ No
5. Have the school SPG conducted activities to prevent learners from dropping-out of schools? ✘ Yes 1✘ No
6. Have the school SPG conducted English Speaking Campaigns and Reading and Tutorial Services ? ✘ Yes 1✘ No
7. Have the school SPG conducted activities to support Anti-Drug Abuse Education and Campaign? ✘ Yes 1✘ No
8. Have the school SPG assisted in ensuring that the school is a smoke/tobacco free place? ✘ Yes 1✘ No
9. Have the school SPG lead learners in organizing activities which start during the Teachers' Month Campaign
every September and which culminate during the World Teachers' Day celebration on October 5 ? ✘ Yes 1✘ No
10. Have the school SPG encourage and support the participation of learners in recognized co-curricular
clubs/organizations and activities? 0 Yes 1✘ No
Box 23. CAREER GUIDANCE PROGRAM, SY 2018-2019

1. Do you have a school guidance counselor? ✘ Yes 1✘ No

If yes, should have data on Guidance Counselor in Table 14.
2. How many years he/she is assigned as guidance counselor?

3. Do you have a guidance advocate? ✘ Yes 1✘ No
4. How many years he/she is as guidance advocate?
5. Have you conducted a career guidance activity? ✘ Yes 1✘ No
6. Has the school funded a career guidance activity? ✘ Yes 1✘ No
7. Do you have a guidance office? ✘ Yes 1✘ No
Position Title : Date : Position Title : Date : Position Title : Date :
Page 40 of 43
Box 24 . SCHOOL SPORTS PROGRAM, SY 2018-2019 (As of June 30, 2018)
AVAILABLE SPORTS EVENTS, CLUBS, AND FACILITIES
(Check multiple sports events, clubs, and facilities being offered in the school)
Sports Sports Sports Sports Sports Sports

Sports Program Sports Program
Event/s Club/s Facilities Event/s Club/s Facilities
✘ ✘ ✘ ✘ ✘ ✘
1. Archery 16. Women Artistic Gymnastics (WAG)
2. Arnis
✘ ✘ ✘ ✘ ✘ ✘
17. Ryhtmic Gymnastics (RG)
✘ ✘ ✘
3. Athletics (throwing) 18. Pencak Silat
✘ ✘ ✘
✘ ✘ ✘
4. Athletics (running) 1 19. Sepak Takraw
✘ ✘ ✘
✘
5. Badminton 20. Softball
✘ ✘ ✘
1
✘ ✘
✘
6. Basketball
✘
21. Swimming
✘ ✘ ✘ ✘
1
7. Baseball
✘ ✘ ✘
22. Table Tennis
✘ ✘ ✘
8. Billards
✘
23. Taekwondo
✘ ✘ ✘ ✘ ✘
✘ ✘
9. Boxing 24. Tennis
✘ ✘ ✘ ✘
✘
10. Chess 25. Volleyball
✘ ✘ ✘ ✘ ✘
1
11. Dance Sports
✘ ✘
26. Wrestling
✘ ✘ ✘ ✘
12. Football
✘ ✘
27. Wushu
✘ ✘ ✘ ✘
✘
13. Futsal 28. Bocce
✘ ✘ ✘ ✘ ✘
14. Aerobic Gymnastics

✘ ✘
29. Goal Ball
✘ ✘ ✘ ✘
15. Men Artistic Gymnastics (MAG)

✘ ✘ ✘
Notes:
1. Sports events - current sports events being offered by the school.
2. Sports club - current sports clubs being offered by the school.
3. Sports facilities - current venues being used for sports events.
School Head : _____________________________________ Head of the Office : ________________________________ Head of the Office : _________________________
Position Title : _________________ Date : ____________ Position Title : ________________ Date : ____________ Position Title : ______________ Date : _________
Page 41 of 43
Table 39 . SCHOOL SPORTS PROGRAM, SY 2018-2019 (As of June 30, 2018)
SPORTS PERSONNEL (DepEd Funded) DATA
(Please provide appropriate answers, refer to the notes and reminders)
Number of
Number of Number of
Non teaching
Number of Number of PE teacher/s Non PE teacher/s
Sporting Events Coach/es Officiating Official/s with sports with sports
personnel
with sports
specialization specialization
specialization
1. Archery 0 0 0 0 0
2. Arnis 0 0 0 0 0
3. Athletics (throwing) 0 0 0 0 0
4. Athletics (running) 1 0 0 0 0
5. Badminton 1 0 0 0 0
6. Basketball 0 0 0 0 0
7. Baseball 0 0 0 0 0
8. Billards 0 0 0 0 0
9. Boxing 0 0 0 0 0
10. Chess 0 0 0 0 0
11. Dance Sports 0 0 0 0 0
12. Football 0 0 0 0 0
13. Futsal 0 0 0 0 0
14. Aerobic Gymnastics 0 0 0 0 0
15. Men Artistic Gymnastics (MAG) 0 0 0 0 0
16. Women Artistic Gymnastics (WAG) 0 0 0 0 0
17. Ryhtmic Gymnastics (RG) 0 0 0 0 0
18. Pencak Silat 0 0 0 0 0
19. Sepak Takraw 0 0 0 0 0
20. Softball 0 0 0 0 0
21. Swimming 0 0 0 0 0
22. Table Tennis 0 0 0 0 0
23. Taekwondo 0 0 0 0 0
24. Tennis 0 0 0 0 0
25. Volleyball 0 0 0 0 0
26. Wrestling 0 0 0 0 0
27. Wushu 0 0 0 0 0
28. Bocce 0 0 0 0 0
29. Goal Ball 0 0 0 0 0
Notes:
1. Coaches - identified personnel (DepEd funded) who is qualified/currently handling the identified sporting event.
2. Officiating Officials - identified personnel (DepEd funded) who is qualified/can handle officiating the identified sporting event.
3. PE teachers - identified BSPE personnel (DepEd funded) and their sports specialization.
4. Non PE teacher - identified personnel teaching academics (DepEd funded) and their sports specialization.
5. Non teaching personnel - identified non academic personnel (DepEd funded) and their sports specialization.
Reminders:
1. PE teacher/s may identify multiple sporting events.
2. Non PE teacher/s may identify multiple sporting events.
3. Non teaching personnel may identify multiple sporting events.
School Head : ________________________________ Head of the Office : _________________________________ Head of the Office : ________________________________
Position Title : _______________ Date : __________ Position Title : __________________ Date : ___________ Position Title : __________________ Date : ___________
Page 42 of 43
Table 40. TRAVEL DETAILS (ONE-WAY) FROM SCHOOL, SY 2018-2019
For each ONE-WAY trip from your school to the specified reference points (i.e., Schools Division Office, Municipal Office, and Nearest Schools), indicate the following:
1. Travel cost - How much does it USUALLY* cost to travel from your school to the reference point? Specify your answers in Pesos.
2. Travel time - How many minutes does it USUALLY* take to travel from your school to the reference point?
3. Time spent walking - Given the USUAL* travel time in item 2, how much of this is spent walking? Specify your answers in minutes.
4. Travel time if walking the entire way - If you were to walk the entire way from your school to the reference point, how long would it take? Estimate your answer in minutes.
5. Crossing any body of water without a bridge - Do you need to cross any body of water (e.g., river, lake, sea) without a bridge to travel from your school to the reference point? Specify if yes or no.
6. Passing difficult terrain - Do you need to pass difficult terain (e.g., mountains, forests) to travel from your school to the reference point? Specify if yes or no.
Your school's access to the NEAREST:

From your Public School Private School
From your
school to your Elementary Junior High School Senior High School Elementary Junior High School Senior High School
Travel Details school to your
Schools
Municipal Indicate School ID: Indicate School ID: Indicate School ID: Indicate School ID: Indicate School ID: Indicate School ID:
Division Office
Office
(SDO)
114949
1. Travel cost (in PhP) 62.00 10.00 0.00 0.00 0.00 0.00 0.00 0.00
2. Travel time (in minutes) 80 10 0 0 0 0 0 0
3. Time spent walking (in minutes) 0 15 0 0 0 0 0 0
4. Travel time if walking the entire way (in minutes) 0 45 0 0 0 0 0
5. Crossing any body of water without a bridge (yes/no) ✘ Yes ✘ Yes ✘ Yes ✘ Yes ✘ Yes ✘ Yes ✘ Yes ✘ Yes
6. Passing difficult terrain (yes/no) ✘ Yes ✘ Yes ✘ Yes ✘ Yes ✘ Yes ✘ Yes ✘ Yes ✘ Yes
Notes : 1. USUAL* - most frequent.

2. For Integrated Schools (Elementary, JHS and/or SHS Schools) and Secondary Schools details should be provided separately for each level
(e.g., Integrated School: Elementary - Php 20; JHS - Php 20)
EXAMPLE:
Over the course of 5 years, a school head has travelled from her school to the Schools Division Office 50 times already. During that time, the total cost of travelling from the school to the Schools Division office was as follows:
- P40 when taking public transportation (i.e., two jeepney rides);
- P200 for gas when the school service was available.
And, the travel time was as follows:
- 60 minutes when taking public transportation which required her to walk between jeepney stops;
- 30 minutes when the school service was available which did not require her to walk.
Out of those 50 trips, 40 trips were via the school service. Hence, the USUAL travel cost and travel time from the school to the Schools Division Office should be based on trips using the school service, as follows:
- Travel cost = P200;
- Travel time = 30 minutes;
- Time spent walking = 0 minute.
Box 25. SCHOOL LOCATION, SY 2018-2019
Location descriptions for your school: (Check all applicable) Notes: * - facing or directly beside a national road/public road
1 ✘ Along the highway * ✘ On a small island **** ✘ Near a faultline ***** ** - on an inclined or steeped area
✘ By the hillside ** 1
✘ Near the coastline ***** ✘ Others, please specify *** - on an elevated area
✘ On top of a mountain *** ✘ Near a river or waterway ***** **** - an island with an area less than 200 sq. km.
***** - near if within 1.5 km from the school
School Head : Head of the Office : Head of the Office :

Page 43 of 43
Table 7. LEARNERS WITH SPECIAL EDUCATIONAL NEEDS (NON-GRADED) DATA,
Kindergarten Primary Level Transition TOTAL
Area of Exceptionalities (Kindergarten to Transition)

Based on Manifestation:
Difficulty Seeing
Difficulty Hearing
Difficulty Walking, Climbing and
Grasping
Difficulty Remembering, Concentrating,
Paying Attention and Understanding
Difficulty Communicating
TOTAL
1. Kindergarten - refers to the Early Intervention Program for learners with exceptionalities.
2. Primary Level - refers to the level after kindergarten where learners with exceptionalities are still being prepared for mainstreaming in regular classes. Learners with exceptionalities are allowed to stay in the program for a maximum of three
(3) years in each of the three (3) levels. However, learners with exceptionalities can be mainstreamed in regular classes if found to be ready based on performance.
3. Transition - refers to level/program for learners with exceptionalities who have completed the primary level and/or over-aged for the elementary level.
Areas of Exceptionalities:
1. Visual Impairment - an impairment that even with correction, adversely affects a child's educational performance. This includes both partial sight and blindness.
2. Hearing Impairment - an impairment, whether permanent or fluctuating that adversely affects a child’s educational performance such as deafness.
3. Learning Disability - a disorder in perception, listening, thinking, reading, writing, spelling, and arithmetic although normal in sensory, emotional and intellectual abilities.
4. Intellectual Disability - formerly labeled as “mental retardation,” it is defined as significantly subaverage general intellectual functioning which originates during the developmental period and associated with impairment in adoptive behavior
like maturation, learning and social adjustment.
5. Autism Spectrum Disorder - characterized by varying degrees of impairment in communication skills and social interactions and in restrictive, repetitive patterns of behavior.
6. Emotional-Behavioral Disorder - a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects a child's educational performance: (i) an inability to learn that
cannot be explained by intellectual, sensory, or health factors, (ii) an inability to build or maintain satisfactory interpersonal relationships with peers and teachers, (iii) inappropriate types of behavior or feelings under normal circumstances,
(iv) a general pervasive mood of unhappiness or depression, (v) a tendency to develop physical symptoms or fears associated with personal or school factors.
7. Orthopedic /Physical Handicap - any condition that interferes with a child's ability to use his or her body.
8. Speech/Language Disorder - a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child’s educational performance.
9. Cerebral Palsy - is caused by damage to developing brain either before or during birth, or in the first few years of life. The impairment depends on where in the brain the damage occurs.
10. Special Health Problem/Chronic Illness - chronic or acute health problems such as asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia,
nephritis, rheumatic fever, sickle cell anemia, and Tourette syndrome; that adversely affect a child's educational performance.
11. Multiple Disabilities - a combination of disabilities that causes severe educational needs that require multiple special education programs such as mental retardation-blindness or mental retardation-orthopedic impairment.
Reminders: Table 5 will be accomplished ONLY by elementary schools with SPED classes and SPED centers.
Certified True and Correct by : Checked by District Office : Verified by the Division Office :
402715780.xlsx OLD SPED 1 Page 5 of 16

Table 20. DISASTERS/CALAMITIES (Human-Induced Hazards - Armed Conflict)
(If applicable, check under the months that these occurred)
Disasters/Calamities June July Aug. Sept. Oct. Nov. Dec. Jan. Feb. Mar. Apr. May
Human-Induced Hazards - Armed Conflict
Armed conflict incident experienced in the past months within the
school and immediate surroundings            
Specify the state and/or non-state actors (select all that apply)
State Actors:
Armed Forces of the Philippines (AFP)            
Philippine National Police (PNP)            
__________________________________________            
None            
Non-State Actors:
Communist Party of the Philippines-New People's Army
and National Democratic Front (CPP-NPA-NDF)            
Moro National Liberation Front (MNLF)            
Bangsamoro Islamic Freedom Fighters (BIFF)            
Maute Group            
Abu Sayyaf Group (ASG)            
Others, please specify exact name of group, tribe, or clan
__________________________________________            
None    
PED
 2014
     
Grave Child Rights Violations committed in the past months within the
school and immediate surroundings
Killing and maiming of learners            

Recruitment or use of children as soldiers            
Sexual violence against children            
Abduction of children            
Attacks against schools or hospitals            
Denial of humanitarian access for children            
Table ____. RESULTS OF DISASTER
For the months of June 2017 to May 2018, please provide appropriate answers.
Disasters/Calamities June July Aug. Sept. Oct. Nov. Dec. Jan. Feb. Mar. Apr. May
Page 21 of 30
Box 9. AVAILABILITY OF WATER SUPPLY, SY 2018-2019 (As of June 30, 2018)
1. Is there a water source inside the school ground?  Yes  No

If Yes,
1.1. Main Water Supply Source:
 Piped water from local service provider  Rainwater Catchments
 Water Well  Others, please specify ____________________
 Natural source
1.2. Average Cost of Monthly Bills/Maintenance: (Please indicate the amount in PhP)_________________
1.3. Who pays for the Cost of Monthly Bills/Maintenance?
 School MOOE  School Canteen Fund
 LGU  Private Individual/Sector
 PTA  Others, please specify ____________________
1.4. Is the water source inside the school ground being used for drinking?  Yes  No
1.5. Has the water source inside the school been tested to determine safety of the water?  Yes  No
1.5a. If Yes, did the test results show that the water source inside the school is safe to drink?  Yes  No
1.5b. How frequent is the water source tested for safety?
 Monthly  Annually
 Quarterly  Others, please specify ____________________
1.5c. When was the last time the water source was tested? ____________________
1.6. Are there times in the year when water is not available for an extended period of time (e.g., in summer)?
 Yes  No
2. Does the school have mechanism to ensure that the learners have safe drinking water?  Yes  No
2.1. If Yes, what mechanism is used?
 Teachers ask the learners to bring their own drinking water to school
 Safe water in refillable containers are provided in designated areas within the school
 Water from an accessible water source is treated (i.e., boiled, etc.)
1. Local piped water - water source coming from local water service providers.
2. Water well - an excavation structure in the ground by digging, driving, boring or drilling to access water in underground aquifiers.
3. Rainwater catchment - water sourced from rainwater and collected thru a rainwater collector.
4. Natural source - water sourced from a spring or stream that is either located inside the school grounds or located outside school grounds but water is supplied via pipes.
Table 26. NUMBER OF EXISTING WASH FACILITIES, SY 2018-2019 (As of August 31, 2018)
Functional Total Number Number
Usage Non-Functional of of
with soap without soap Facilities Water Outlets
Facilities for group handwashing
Facilities for individual handwashing

1. Group handwashing facility - a facility to be used in supervised handwashing and toothbrushing activtity that can accommodate at least 10 learners.
2. Individual handwashing facility - a facility in the classroom, drinking points, near toilets, near the canteen, etc. that learners can be used for handwashing at critical times.
3. Functional facilities for handwashing - the hand washing facility is accessible, with daily water supply, learner-appropriate height and with appropriate drainage.
4. Non-functional facilities for handwashing - the hand washing facility is broken, clogged or damaged in such a way that it cannot be used.
5. Water Outlet - any opening where water comes out for handwashing (e.g., Faucets, Punch Pipes, etc.).
402715780.xlsx 5omie Box9-Table26 Page 24 of 27

Box . SCHOOL GOVERNMENT PROGRAM (SGP), SY 2018-2019
a. Do you have a Supreme Pupils Government (SPG)/Supreme Student Government (SSG) Council?  Yes  No
b. Do you have a SPG/SSG Adviser?  Yes  No
b.1. If yes, for how many years as adviser? ___________
c. What is/are the subject/s handled by the adviser?
 Science  Mathematics  Others, please specify ____________
 Filipino  Araling Panlipunan (AP)
d. What is the highest academic degree of the adviser?
 Bachelor Degree  Master Degree  Doctorate Degree
 Master Degree Units  Doctorate Degree Units
e. Are the SPG/SSG Adviser deloaded of some of their subjects handled?  Yes  No
f. Does the school collect fees for the SPG/SSG acivities?  Yes  No
g. Did the school incorporate a budget for SPG/SSG as part of SIP/APP ?  Yes  No
h. Does the school have a room dedicated for the SPG/SSG Council ?  Yes  No
i. Have the school SPG/SSG joined a division search for best SPG/SSG Council ?  Yes  No
j. Have your division won any National Award?  Yes  No
k. How many times have the Youth Formation Coordinator (YFC)/Project Development Officer I (PDO I) visited the school? ________
l. Do you provide Compensatory Time Off (CTO) for activities conducted by SPG/SSG advisers during Saturday ? ________________
Box . SUPREME PUPILS GOVERNMENT (SPG)/SUPREME STUDENT GOVERNMENT (SSG) ACTIVITIES, SY 2018-2019
a. Have the SPG/SSG organized the participation of learners in Brigada Eskwela?  Yes  No
b. Have the school lead in National Greening Program?  Yes  No
c. Have the school conduct activities and awareness campaigns to encourage parents to enlist their
five (5) year old children for kindergarten?  Yes  No
d. Have the school conducted book and toy drive and other school supplies for donation to schools with kindergarten?  Yes  No
e. Have the school SPG/SSG conducted activities to prevent learners from dropping-out of schools?  Yes  No
f. Have the school SPG/SSG conducted English Speaking Campaigns and Reading and Tutorial Services ?  Yes  No
g. Have the school SPG/SSG conducted activities to support Anti-Drug Abuse Education and Campaign?  Yes  No
h. Have the school SPG/SSG assisted in ensuring that the school is a smoke/tobacco free place?  Yes  No
i. Have the school SPG/SSG lead learners in organizing activities which start during the Teachers' Month Campaign  Yes  No
every September and which culminate during the World Teachers' Day celebration on October 5 ?  Yes  No
j. Have the school SPG/SSG encourage and support the participation of learners in recognized co-curricular
clubs/organizations and activities?  Yes  No
Box . CAREER GUIDANCE PROGRAM, SY 2018-2019

a. Do you have a school guidance counselor?  Yes  No

If yes, should have data on Guidance Counselor in Table 14.
b. How many years he/she is assigned as guidance counselor? _____

c. Do you have a guidance advocate?  Yes  No
d. How many years he/she is as guidance advocate? _____________
e. Have you conducted a career guidance activity?  Yes  No
f. Has the school funded a career guidance activity?  Yes  No
g. Do you have a guidance office?  Yes  No
School Head : __________________________ Head of the Office : ____________________________ Head of the Office : _________________________
Position Title : _________ Date : ________ Position Title : ___________ Date : ________ Position Title : ___________ Date : _________
Page 28 of 30
Box__. SCHOOL GOVERNMENT PROGRAM (SGP), SY 2018-2019
a. Do you have a Supreme Student Government (SSG)/Supreme Pupils Government (SPG) Council?  Yes  No
b. Do you have a SSG/SPG Adviser?  Yes  No
b.1. If yes, for how many years as adviser? _____
c. What is the subject handled by the adviser?
 Scienc  Mathematics  Others, specify ______
 Filipino  ARPAN
d. What is the highest academic degree of the adviser?
 Undergraduate  Post Graduate
 Masteral Graduate
e. Are the SSG/SPG Adviser deloaded of some of their subjects handled?  Yes  No
f. Does the school collect fees for the SSG/SPG acivities?  Yes  No
g. Did the school incorporate a budget for SSG/SPG as part of SIP/APP ?  Yes  No
h. Does the school have a room dedicated for the SSG/SPG Council ? e  Yes  No
i. Have the school SSG/SPG joined a division seacrch for best SSG/SPG Council ?  Yes  No
j. Have your division won any National Award ?  Yes  No
k. How many times have the Youth Formation Coordinator/Project Development Officer I visited the school? _______
l. Do you provide Compensatory Time Off for activities conducted by SSG/SPG advisers during Saturday ? _____
PROPOSED ADDITION
Box___. SUPREME STUDENT GOVERNMENT (SSG) ACTIVITIES, SY 2018-2019
a. Have the SSG/SPG organized the participation of students in Brigada Eskwela?  Yes  No
b. Have the school lead in National Greening Program?  Yes  No
c. Have the school conduct activities and awarenedd campaigns to encourage parents to enlist their
five-year old children for kindergarten?  Yes  No
d. Have the school conducted book and toy drive and other school supplies for donation to schools with kindergarten?  Yes  No
e. Have the school SSG/SPG conducted activities to prevent students from dropping-out of schools?  Yes  No
f. Have the school SSG/SPG conducted English Speaking Campaigns, and Reading and Tutorial Services ?  Yes  No
g. Have the school SSG/SPG conducted activities to support Anti-Drug Abuse Education and Campaign?  Yes  No
h. Have the school SSG/SPG assisted in ensuring that the school is a smoke/tobacco free place?  Yes  No
i. Have the school ssg/spg lead students in organizing activities which start during the Teachers' Month Campaign  Yes  No
every September and which culminate during the World Teachers' Day celebration on October 5 ?  Yes  No
j. Have the school SSG/SPG encourage and support the participation of students in recognized co-curricular
clubs/organizations and activities?  Yes  No
PROPOSED ADDITION
Box__ . CAREER GUIDANCE PROGRAM, SY 2018-2019
a. Do you have a school guidance counsellor?  Yes  No

b. How many years he/she is assigned as guidance counsellor? _____
c. Do you have a guidance advocate?  Yes  No
d. How many years he/she is as guidance advocate? ______
e. Have you conducted a career guidance activity?  Yes  No
f. Has the school funded a career guidance activity?  Yes  No
g. Do you have a guidance office?  Yes  No
Page 28 of 30
Box . SCHOOL SPORTS PROGRAM, SY 2018-2019
Available Sports Event/s, Club/s and Facilities in the School
(Check multiple sports events, clubs, and facilities being offered in the school.)
Sports Sports Sports Sports Sports Sports
Sports Program in the School Event/s Club/s Facilities Sports Program in the School Event/s Club/s Facilities
1. Archery    16. Women Artistic Gymnastics (WAG)   
2. Arnis    17. Ryhtmic Gymnastics (RG)   
3. Athletics (throwing)    18. Pencak Silat   
4. Athletics (running)    19. Sepak Takraw   
5. Badminton    20. Softball   
6. Basketball    21. Swimming   
7. Baseball    22. Table Tennis   
8. Billards    23. Taekwondo   
9. Boxing    24. Tennis   
10. Chess    25. Volleyball   
11. Dance Sports    26. Wrestling   
12. Football    27. Wushu   
13. Futsal    28. Bocce   
14. Aerobic Gymnastics    29. Goal Ball   
15. Men Artistic Gymnastics (MAG)    30. Others (please identify) __________   
Notes:
1. Sports events - current sports events being offered by the school.
2. Sports club - current sports clubs being offered by the school.
3. Sports facilities - current venues being used for sports events.
B. Number of Sports Coaches, Officiating Officials, PE Teachers, Non PE teachers, and Non teaching Personnel
Number of
Number of Number of
Number of Non teaching
Number of PE teacher/s Non PE teacher/s
Sporting Event Officiating personnel
Coach/es with sports with sports
Official/s with sports
specialization specialization
specialization
1. Archery
2. Arnis
3. Athletics (throwing)
4. Athletics (running)
5. Badminton
6. Basketball
7. Baseball
8. Billards
9. Boxing
10. Chess
11. Dance Sports
12. Football
13. Futsal
14. Aerobic Gymnastics
15. Men Artistic Gymnastics (MAG)
16. Women Artistic Gymnastics (WAG)
17. Ryhtmic Gymnastics (RG)
18. Pencak Silat
19. Sepak Takraw
20. Softball
21. Swimming
22. Table Tennis
23. Taekwondo
24. Tennis
25. Volleyball
26. Wrestling
27. Wushu
28. Bocce
29. Goal Ball
30. Others (please identify)
Notes:
1. Coaches - identified personnel (DepEd funded) who is qualified/currently handling the identified sporting event
2. Officiating Officials - identified personnel (DepEd funded) who is qualified/can handle officiating the identified sporting event
3. PE teachers - identified BSPE personnel (DepEd funded) and their sports specialization
4. Non PE teacher - identified personnel teaching academics (DepEd funded) and their sports specialization
5. Non teaching personnel - identified non academic personnel (DepEd funded) and their sports specialization
Reminders:
1. PE teacher/s may identify multiple sporting events
2. Non PE teacher/s may identify multiple sporting events
3. Non teaching personnel may identify multiple sporting events
Page 30 of 30
Table ___. AFTER SCHOOL SPORTS PROGRAM, SY 2018-2019
Check multiple sports events being offered in the school and multiple sports facilities available in the school
Box ____
Available Sports club/s in Available Sports Facilities in
Sporting Event the School the School
1 Archerly  
2 Arnis  
3 Athletics (throwing)  
4 Athletics (running)  
5 Badminton  
6 Basketball  
7 Baseball  
8 Billards  
9 Boxing  
10 Chess  
11 Dance Sports  
12 Football  
13 Frutsal  
14 Aerobic Gymnastics  
15 Mens Artistic Gymnastics  
16 Womens Artistic Gymnastics  
17 Ryhtmic Gymnastics  
18 pencak Silat  
19 Sepak Takraw  
20 Softball  
21 Swimming  
22 Table Tennis  
23 Taekwondo  
24 Tennis  
25 Volleyball  
26 Wrestling  
27 Wushu  
28 Bocce  
29 Goal Ball  
30 Others (please identify)
1. Sports club in schools - current sports events being offered by the school.
2. Sports facilities - current venues being used for sports events
Box ____
Note:
PE teacher/s may identify multiple sporting events
Non teaching personnel/s may identify multiple sporting events
Non PE teacher/s may identify multiple sporting events
Number of Non
Number of Officiating Number of PE teacher/s teaching personnel/s Number of Non PE
Sporting Event Number of Coach/es Official/s and their sporting and their sporting teacher/s and their
events events sporting events
1 Archerly
2 Arnis
3 Athletics (throwing)
4 Athletics (running)
5 Badminton
6 Basketball
7 Baseball
8 Billards
9 Boxing
10 Chess
11 Dance Sports
12 Football
13 Frutsal
14 Aerobic Gymnastics
15 Mens Artistic Gymnastics
16 Womens Artistic Gymnastics
17 Ryhtmic Gymnastics
18 pencak Silat
19 Sepak Takraw
20 Softball
21 Swimming
22 Table Tennis
23 Taekwondo
24 Tennis
25 Volleyball
26 Wrestling
27 Wushu
28 Bocce
29 Goal Ball
30 Others (please identify)
1. Coaches - identified personnel (DepEd funded) who is qualified/currently handling the identified sporting event
2. Officiating Officials - identified personnel (DepEd funded) who is qualified/can handle officiating the identified sporting event
3. PE teachers - identified BSPE personnel (DepEd funded) and their sports specialization
4. Non teaching personnel - identified non academic personnel (DepEd funded) and their sports specialization
5. Non PE teacher - identified personnel teaching academics (DepEd funded) and their sports specialization
Certified True and Correct by : Verified by the Schools Division Office :
School Head : Head of the Office :

(Signature Over Printed Name) (Signature Over Printed Name)
Position Title : Date : Position Title : Date :
Page 30 of 30

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GOVERNMENT ELEMENTARY SCHOOL PROFILE , SY 2018-2019

TABLE BOX Page # TITLE

Table 39 . SCHOOL SPORTS PROGRAM, SY 2018-2019 (As of June 30, 2018)

40 43 Table 40. TRAVEL DETAILS (ONE-WAY) FROM SCHOOL, SY 2018-2019

25 43 Box 25. SCHOOL LOCATION, SY 2018-2019

Republic of the Philippines

GOVERNMENT ELEMENTARY SCHOOL PROFILE

Name of School : NATO-BUTUAN E/S Region :

✘ an Annex/Extension School - Please Indicate Mother School ID: ✘ 1 Grades 1 to 6

✘ an Implementing Unit (has book of accounts or has fiscal autonomy)

Position Title : HT-III Date : Position Title : Date : Position Title :

NTARY SCHOOL PROFILE

Verified by the Schools Division Office :

(Signature Over Printed Name)

c. Modified In-School Off-School Approach (MISOSA) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

d. Other School-Initiated Intervention 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Position Title : HEAD TEACHE

Box 1. NUMBER OF CLASSES, SY 2018 -2019 (As of June 30, 2018)

Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 TOTAL

Example, if the school have two (2) Multigrade Classes:

Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 TOTAL

Table 8. GIFTED LEARNERS DATA, SY 2018-2019 (As of June 30, 2018)

a. Level I - refers to the first two years in SPED Classes

Classification of Learners with Special Educational Needs:

(Continuation of definition on the next page)

LSENs With Manifestations:

5. Difficulty in Applying Adaptive Skills 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

a. Level I - refers to the first two years in SPED Classes

Classification/Types of Learners with Kindergarten Grade

Certified True and Correct by :

s and SPED centers.

Checked by District Office :

Verified by the Division Office :

Note: * - Applicable only in the school that are Implementing Unit.

b. Assignment (Number of teachers actually working in the school):

Col. 1 Col. 2 Col. 3 Col. 4 Col. 5 Col. 6 Col. 7

Table 17. NUMBER OF TEACHERS BY GRADE LEVEL

Grade 4 0 1 1 Araling Panlipunan (AP) 0 1 1 0 1 1

Edukasyong Pantahanan at Pangkabuhayan (EPP)/

Grade 6 0 1 1 Music, Art, Physical Education, Health (MAPEH) 0 1 1 0 1 1

SPED 0 0 0 Edukasyon sa Pagpapakatao (EsP) 0 1 1 0 1 1

Reminders: 1. If a teacher is teaching more than one grade level, he/she

LD/ ASD/ EBD/ Multi- 16 13

Master Teacher III 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

SPED Teacher III 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Box 2. LEARNING ACTION CELL (LAC) SESSION, SY 2018-2019

1. Do you conduct LAC Session/s in your school? 1

Box 3. ACTION RESEARCH, SY 2018-2019

1. Do you conduct Action Research in your school? ✘ Yes 1

2. Average Cost of Monthly Bills/Maintenance: (Please indicate the amount in PhP)

1. Are there internet service providers in the area? ✘ 1 Yes ✘ No

Indicate the average monthly expense of internet connection by funding source.

✘ Others, pls. specify ✘

Note: This table should not be left blank.

Flood Evacuation Drill

Fire (includes forest fire, fires as consequence of natural disasters

Others, please specify

Others, please specify

Killing and maiming of children

Number of School Days lost due to armed conflict

POSTERS, USE OF ICT TECHNOLOGIES

ALL SUBJECT AREAS

ORIENTATION OF PARENT DURING CARD DAY