Republic of the Philippines

Department of Education
REGION X – NORTHERN MINDANAO
SCHOOLS DIVISION OF ___________________
_____________ DISTRICT
(SCHOOL)

INTERVENTION PLAN
S.Y. ___________

Name of Recipient: _______________________ - Grade __ / (Section)

OBJECTIVES ACTIVITY/STRATEGY TIME FRAME PERSONS RESOURCES EXPECTED

INVOLVED NEEDED OUTPUT

Prepared by:
________________________ ___________________________ ________________________ __________________________ ________________________ Class Adviser
Faculty Representative PTA Representative Student Representative Barangay/Community
Representative (when
necessary)

Recommending Approval:

_________________________
Guidance Counselor/Designate
Vice-Chairperson, School CPC

Approved:

_________________________
School Head
Chairperson, School CPC

Date: __________________________