Republic of the Philippines

Department of Education
Region 02 (Cagayan Valley)
SCHOOLS DIVISION OFFICE OF ISABELA
3000513-MALALINTA NATIONAL HIGH
SCHOOL
Malalinta, San Manuel, Isabela

BI-MONTH FEEDBACK FORM

SEPTEMBER 13--24, 2021
S.Y. 2021-2022

Teachers’ Name: ___________________ Subject/Section: _____________ Adviser Subject Teacher

1. As of today, how many learners do you have in your class? __________
2. How many parents/guardians did you have during the distribution? __________
3. How many learning packages were undelivered? __________
4. Have you conducted the orientation in your classes? Yes _____ No _____
How did you conduct? F2F/Distribution Day _____ Online/Call _____ GC _____ Home visits _____
5. How many learners have you reached for Week 1 & 2 ______
(Pls. specify the number of learners/platform) Online/Call _____ GC _____ Home Visit ______
6. How many learners have you not met yet? __________
7. What modality/ies have you used in teaching aside from Printed Modules? Radio-Based Instruction
_____ Others (pls. specify)
8. (For Advisers only.) How many among your learners received/picked up their learning package:
In School _____ Thru home delivery _____ Other designated points _____ Others _____
9. Did you have any issue/concern during the distribution? within these two weeks? (Pls. state)
__________________________________________________________________________________
10. Do you have any suggestion to better deliver our service to our learners?
_________________________________________________________________________________
Teachers’ Name: ___________________ Subject/Section: _____________ Adviser Subject Teacher
1. As of today, how many learners do you have in your class? __________
2. How many parents/guardians did you have during the distribution? __________
3. How many learning packages were undelivered? __________
4. Have you conducted the orientation in your classes? Yes _____ No _____
How did you conduct? F2F/Distribution Day _____ Online/Call _____ GC _____ Home visits _____
5. How many learners have you reached for Week 1 & 2 ______
(Pls. specify the number of learners/platform) Online/Call _____ GC _____ Home Visit ______
6. How many learners have you not met yet? __________
7. What modality/ies have you used in teaching aside from Printed Modules? Radio-Based Instruction
_____ Others (pls. specify)
8. (For Advisers only.) How many among your learners received/picked up their learning package:
In School _____ Thru home delivery _____ Other designated points _____ Others _____
9. Did you have any issue/concern during the distribution? within these two weeks? (Pls. state)
_________________________________________________________________________________
10. Do you have any suggestion to better deliver our service to our learners?
_________________________________________________________________________________

Prepared by:
 Republic of the Philippines
Department of Education
Region 02 (Cagayan Valley)
SCHOOLS DIVISION OFFICE OF ISABELA
3000513-MALALINTA NATIONAL HIGH
SCHOOL
Malalinta, San Manuel, Isabela

JOSEFINA N. GALIZA
Head Teacher III
BI-MONTH SURVEY/FEEDBACK FORM (For Advisers only)
SEPTEMBER 27- OCTOBER 8
S.Y. 2021-2022
1. How many of your learners are transferees:
From Pvt Schools _____ From Other Pub Schools _____ From SUCs/LUCs _____
2. How many are Balik-Arals? _____
3. How many are from the following Barangays:
Malalinta _____ Villa Cayaban _____ Mararigue _____ Sitio Asinan _____
Little Tadian, Alfonso Lista _____ Aurora ____ Others: _____
4. How many of your learners have the following:
a. Basic phone _____ g. No laptop/desktop computer _____
b. Smartphones _____ h. Cable TV _____
c. Tablet _____ i. No Cable TV _____
d. No phones (neither basic/smartphone/tablet) _____
e. Laptop j. Radio _____
f. Desktop Computer _____ k. No radio _____
5. How many of your learners have the ff:
a. Stable or Strong Internet Connectivity _____ c. No Internet Connectivity _____
b. Limited Internet Connectivity _____
6. How many preferred:
a. Modular Distance Learning: b. MDL Blended with RBI _____
Digital MDL _____ c. MDL Blended with TVI _____
Printed MDL _____ d. MDL Blended with Online _____
Both Digital & Printed _____ e. Online Distance Learning _____

Prepared by:

JOSEFINA N. GALIZA
Head Teacher III