Republic of the Philippines

DEPARTMENT OF EDUCATION
Region VII, Central Visayas
TANJAY CITY DIVISION
Pamplona Cluster I
PAMPLONA NATIONAL HIGH SCHOOL
Cambalud, Poblacion, Pamplona, Negros Oriental

DISTRIBUTION AND RETRIEVAL OF MODULES FORM

Grade Level: HE - ABRASALDO Name of Class Adviser: RAQUIPERL O. ABRASALDO
Module Numbers: Week Number:
Date:

DISTRIBUTION PHASE RETRIEVAL PHASE

Modules Received from the Modules Returned by the Learner's Portfolio Submitted Total
No Name of Learners Sex Section Adviser Total
Issues/ Parent Total by the Parent Learner's
Issues/
Modules Signature Modules Portfolio Signature
Received Concerns Returned (LP) Concerns
ALL SUBJECTS ALL SUBJECTS ALL SUBJECTS Returned

1 ADALIA, ANDRES N. M
2 AMPER, JAY DALE V. M
3 BARRERA, JHONRIEL L. M
4 CARABANDES, RHYNE MICHAEL B. M
5 GUEVARRA, ROGEN PAUL E. M
6 LIBATON, JEREMIE E. M
7 LIBATON, LEMAR B. M
8 PUBLICO, JAMES LAWRENCE D. M
9 TIONGCO, MARVIN T. M
10 TORRES, JOHN ALVIC D. M
11 VILLAROSA, JAIME B M
12 ZERNA, REX MAR E. M
13
14
15
16
17
GRAND TOTAL MODULES DISTRIBUTED MODULES RETURNED LPs RECEIVED

Prepared by: RAQUIPERL O. ABRASALDO

(Signature Over Printed Name of Teacher)
 Republic of the Philippines
DEPARTMENT OF EDUCATION
Region VII, Central Visayas
TANJAY CITY DIVISION
Pamplona Cluster I
PAMPLONA NATIONAL HIGH SCHOOL
Cambalud, Poblacion, Pamplona, Negros Oriental

DISTRIBUTION AND RETRIEVAL OF MODULES FORM

Grade Level: HE - ABRASALDO Name of Class Adviser: RAQUIPERL O. ABRASALDO
Module Numbers: Week Number:
Group Number: Date:

DISTRIBUTION PHASE RETRIEVAL PHASE

Modules Received from the Modules Returned by the Learner's Portfolio Submitted Total
No Name of Learners Sex Section Adviser Total
Issues/ Parent Total by the Parent Learner's
Issues/
Modules Signature Modules Portfolio Signature
Received Concerns Returned (LP) Concerns
ALL SUBJECTS ALL SUBJECTS ALL SUBJECTS Returned

1 AMILER, JESICA T. F
2 AUGUSTO, MARGIE S. F
3 BELONTA, GEMARIE S. F
4 BRAVO, CHRISTINE MAE E. F
5 CAÑETE, NIÑA C. F
6 CUBO, MARY JOY G. F
7 DELA ROSA, GERALYN M. F
8 EJAN, RENA MAE S. F
9 GALLO, SHANDY HEART R. F
10 GUEVARRA, JANINE E. F
11 GENOVIA, GEORGINA T. F
12 LIBATON, RUFA E. F
13 OROY, MELUDIE G. F
14 PADURA, AILEEN JOY E. F
15 PIÑERO, CHRISTINE MAE F. F
16 REPE, BERNADETH R. F
17 RODRIGUEZ, ELEANOR T. F
18 RUALES, FRESIE-ANN S. F
19 TABIO, DENISEL T. F
20 TIONGCO, MARIE JEE T. F
21 TORRES, JOVELYN V.
22 ZERNA, RINA D.
23 BILINGAN, CRUZILITA F
GRAND TOTAL MODULES DISTRIBUTED MODULES RETURNED LPs RECEIVED

Prepared by: RAQUIPERL O. ABRASALDO

(Signature Over Printed Name of Teacher) #NAME?
 Republic of the Philippines
DEPARTMENT OF EDUCATION
Region VII, Central Visayas
TANJAY CITY DIVISION
Pamplona Cluster I
PAMPLONA NATIONAL HIGH SCHOOL
Cambalud, Poblacion, Pamplona, Negros Oriental

DISTRIBUTION AND RETRIEVAL OF MODULES INVENTORY FORM

Grade Level: Week Number:

Module Group (e.g. Math Group/Science Group): SCIENCE GROUPS

No. of Learners DISTRIBUTION PHASE RETRIEVAL/RETURN PHASE

Mod. Modules Received by Modules Returned by
No Name of CLC Coordinator Clustered CLC Nos.
Learning Area Total Learning Area Total
M F T Modules Signature Date Modules Signature Date
SCI AP ENG FIL Received SCI AP ENG FIL Returned

GRAND TOTAL
 Republic of the Philippines
DEPARTMENT OF EDUCATION
Region VII, Central Visayas
TANJAY CITY DIVISION
Pamplona Cluster I
PAMPLONA NATIONAL HIGH SCHOOL
Cambalud, Poblacion, Pamplona, Negros Oriental

DISTRIBUTION AND RETRIEVAL OF MODULES INVENTORY FORM

Grade Level: Week Number:

Module Group (e.g. Math Group/Science Group): MATH GROUPS

No. of Learners DISTRIBUTION PHASE RETRIEVAL/RETURN PHASE

Mod. Modules Received by Modules Returned by
No Name of CLC Coordinator Clustered CLC Nos. Learning Area Total Learning Area Total
M F T Modules Signature Date Modules Signature Date
Received Returned
Math TLE MAPEH EsP Math TLE MAPEH EsP

GRAND TOTAL
 Republic of the Philippines
DEPARTMENT OF EDUCATION
Region VII, Central Visayas
TANJAY CITY DIVISION
Pamplona Cluster I
PAMPLONA NATIONAL HIGH SCHOOL
Cambalud, Poblacion, Pamplona, Negros Oriental

ATTENDANCE SHEET

Clustered Community Learning Center (CLC): Name of Assigned Teacher:

Grade Level: CLC Coordinator:
Module Group (e.g. Math Group/Science Group): Date:

No. Name of Learners Sex Section TLE Specialization/TRACK/STRAND Name of Parent/Guardian Signature
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
 Republic of the Philippines
DEPARTMENT OF EDUCATION
Region VII, Central Visayas
TANJAY CITY DIVISION
Pamplona Cluster I
PAMPLONA NATIONAL HIGH SCHOOL
Cambalud, Poblacion, Pamplona, Negros Oriental

RECORD OF RECEIVED LEARNERS' PORTFOLIOS

Grade Level: 11 Name of Class Adviser: ALDRIN O. APOLI
Section: HUMSS - APOLI Week Number: 1 and 2
Directions: Write the week number only in the respective cell under the learning area of the LPs received from each learner. Count the number of
LPs received and write it the total LPs received. This form is good for two weeks. Hence, another form shall be used for the third week and so on.
Learners' Portfolio Received from Parent Total
NAME OF Signature of
No Name of Learners Sex
PARENT/GUARDIAN GROUP 1(SCIENCE) GROUP 2(MATH) Received Parent
ORAL COM 21ST EL Science PHILO GEN MATH Filipino CNF PE PPG
LPs
1 ABOY, JAMES CARL M
2 AGUIRRE, VANEXCEL M
3 ALVARICO, APRIL BOY M
4 ANDAGAN, JOREX M
5 BASAY, DEXTER JOHN M
6 DURAN, JOHN PHILIP M
7 EBARITA, MARJOE M
8 ITAO, JURJENIO M
9 NILLAS, WARD M
10 NOTIVO, CLIFFORD M
11 ACAIN, JOSE JONEL D. M
12 ACERO, KYLAH A. F
13 AVENIDO, MARY GRACE F
14 BACULAD, JASMINE ROSE F
15 CABATO, CHERRY MAE F
16 CARTALLA, ROSE GINA F
 Republic of the Philippines
DEPARTMENT OF EDUCATION
Region VII, Central Visayas
TANJAY CITY DIVISION
Pamplona Cluster I
PAMPLONA NATIONAL HIGH SCHOOL
Cambalud, Poblacion, Pamplona, Negros Oriental
RECORD OF RETURNED LEARNERS' PORTFOLIOS

Grade Level: 11 Name of Class Adviser: ALDRIN O. APOLI

Section: HUMSS - APOLI Week Number: 1 and 2
Directions: Write the week number only in the respective cell under the learning area of the LPs returned from each learner. Count the number of
LPs returned and write it the total LPs returned. This form is good for two weeks. Hence, another form shall be used for the third week and so on.
Learners' Portfolio Received from Parent Total
NAME OF Signature of
No Name of Learners Sex
PARENT/GUARDIAN GROUP 1(SCIENCE) GROUP 2(MATH) Returned Parent
ORAL COM 21ST EL Science PHILO GEN MATH Filipino CNF PE PPG
LPs
1 CASIL, MARICAR F
2 CATIPAY, JHEAN ANTHONIETTE F
3 CLARIN, RICHEL MAE F
4 FIGUEROA, YOSHABELLE YVONNE F
5 GLACITA, MICAH F
6 GUTIB, ROXANE O. F
7 TUMULAK, SOPHIA YZABELLE T. F
8 LABE, MARK M
9 ORTEGA, AXEL M
10 PALOMAR, JAY M
11 PALOMAR, RAYMAR M
12 REPOLLO, ARJAY M
13 RETES, MARK LOUIE M
14 SABUGA, DON JULIUS M
15 TORRES, MARK ANTHONY M
 Republic of the Philippines
DEPARTMENT OF EDUCATION
Region VII, Central Visayas
TANJAY CITY DIVISION
Pamplona Cluster I
PAMPLONA NATIONAL HIGH SCHOOL
Cambalud, Poblacion, Pamplona, Negros Oriental

RECORD OF RETURNED LEARNERS' PORTFOLIOS

Grade Level: 11 Name of Class Adviser: ALDRIN O. APOLI

Section: HUMSS - APOLI Week Number: 1 and 2
Directions: Write the week number only in the respective cell under the learning area of the LPs returned from each learner. Count the number of
LPs returned and write it the total LPs returned. This form is good for two weeks. Hence, another form shall be used for the third week and so on.
Learners' Portfolio Received from Parent Total
NAME OF Signature of
No Name of Learners Sex
PARENT/GUARDIAN GROUP 1(SCIENCE) GROUP 2(MATH) Returned Parent
ORAL COM 21ST EL Science PHILO GEN MATH Filipino CNF PE PPG
LPs
1 BANICO, FARAH MAE F
2 FELISILDA, MARY JEAN F
3 GUZMAN, CRIS MAE JOY F
4 LISONDRA, JONALY F
5 PALAPAR, MARITES F
6 PATOC, MERIAN F
7 PILARITA, IVY F
8 SALVA, JEAN F
9 SAMSON, ERLYN F
10 SOMOOC, MERIAM MAE F
11 YBANEZ, ALONA MARIE F
12 FLORENTINO, GORJOE A. M
13 VALLEGA, JOSEPH BEN M
14 ZERNA, JOHN PAUL M
15 ZERNA, VHONE CYRIL M