R epublic of the P hilippines

D epartment of E ducation
REG I O N I I I - C EN TRAL LUZO N
SC H O O LS D I VI SI O N O FFI C E- SC I EN C E C I TY O F M U N O Z
M U N O Z N ATI O N AL H I G H SC H O O L (AN N EX)

FORM 2: LAC Facilitator Information Sheet

This form should be accomplished by the designated LAC Facilitator on or
before the first LAC session.

Region: III

Division: SCIENCE CITY OF MUNOZ

NAME: Male/Female: Date of Birth: Age:

Contact details: Email: Mobile Number: Facebook Name:

Preferred contact (Indicate all: email, phone, Skype, Viber, WhatsApp,

mode: Zoom,
E-mail address

School Address: Brgy. Rizal, Science City of Muñoz, Nueva Ecija

School ID: 322801
Contact Number: 0966-385-4558
E-mail Address: 322801@deped.gov.ph