ADM EiE – Elementary – Schools Division of Antipolo City

Select Modality *Select Modality

Select School *

School Head's Name *

ADM Coordinator's Name *

Kindergarten – No. of Learners Affected – MaleType “0” if none, or not applicable

Kindergarten – No. of Learners Affected – FemaleType “0” if none, or not applicable

Grade 1 – No. of Learners Affected – MaleType “0” if none, or not applicable

Grade 1 – No. of Learners Affected – FemaleType “0” if none, or not applicable

Grade 2 – No. of Learners Affected – MaleType “0” if none, or not applicable

Grade 2 – No. of Learners Affected – FemaleType “0” if none, or not applicable

Grade 3 – No. of Learners Affected – MaleType “0” if none, or not applicable

Grade 3 – No. of Learners Affected – FemaleType “0” if none, or not applicable

Grade 4 – No. of Learners Affected – MaleType “0” if none, or not applicable

Grade 4 – No. of Learners Affected – FemaleType “0” if none, or not applicable

Grade 5 – No. of Learners Affected – MaleType “0” if none, or not applicable

Grade 5 – No. of Learners Affected – FemaleType “0” if none, or not applicable

Grade 6 – No. of Learners Affected – MaleType “0” if none, or not applicable

Grade 6 – No. of Learners Affected – FemaleType “0” if none, or not applicable

No. of Classes Affected *Type “0” if none, or not applicable

Reasons for Blended Learning / Modular Distance / Online Distance Modality *Reasons

Start Date

Expected End Date

Expected No. of Days

Actual No. of Days

Type of LRs used by Learners affected by calamities (Textbook/ SLMs/ Worksheets/ Digital copies)TextbooksSelf-learning Modules (SLMs)WorksheetsDigital CopiesCheck whichever is applicable

LRs to Pupil RatioLRs to Pupil Ratio

SelectIs there a gadget provided to learners affected by calamities?

No. of gadgets provided to learnersType “0” if none, or not applicable

Accomplished by *Your name

Date Accomplished *

RemarksComments / Suggestions / Recommendation