INSTRUCTIONS:

1. Enter all name of students under name of students column

2. Enter the gender of your students
3. Enter the address of students
4. Enter your means of communication with your students. This is for individual student. Examples of this are . Text, call, group chat, individual chat. Home visitation

5. In the space under under Date column and opposite to the name of the student, write the word COMMUNICATED if you able to contact or communicated him/her, otherwise
6. In the Details column, indicate the brief or central theme of your talks with learner if your communicated him/her, however if not communicate just leave it blank
7.Every Friday, print a hard copy of this form and submit it to your school head. Send the soft copy also to your school head either thru email add, messenger of any other means
8. Use always this form in your daily monitoring of your students. However, never erase any entry, just have another file by clicking file, save as, and then name the new file. In th
9. School head shall ensure that teachers who encountered difficulties in filling up this form must be given technical assistance.
10. This form is purposedly made so that those students who were not contacted will be given action by the school as early as possible.
11. If you have some clarification please feel free to contact your school head, district supervisor or your adopter.

EXAMPLE IN FILLING UP THE FORM BELOW

School: Baliki HS
District: CD 1
Subject Teacher: Agnes Seguia
Grade Level:Grade 7
Subject Teacher:English
DATE &
Means of
No. Name of Students SEX Address Date Date
communication Details
2/8/10 2/9/10
1 A M Purok 1, Baliki text - 09092678543 communicated the acitivity in the module not communicated
2 B M Purok 1, Baliki gc - english 7 communicated the acitivity in the module communicated
3 C M Purok 2 Baliki call - 09184657311 not communicated not communicated
4 D F Dunguan text - 09092639543 communicated verify the example communicated
5 E F Rangeban home visit communicated explain the steps communicated
6 F F Purok 3, Baliki gc - english 7 home visit no student home visit
7 g f Puro1, Baliki home visit communicated the father only for the stud is outcommunicated
Schoool: LT. ANDRES CALUNGSUD ELEMENTARY SCHOOL
District: MIDSAYAP NORTH
Teac cher; ANNA LISA G. EBO
GradeThree- Guava
DATE &
Means of
No. Name of Students SEX Address Date Date
communication Details
1 Marbeth Bijucos Male Purok Rosas
2 Russel Jhon Gabilan Male Purok Rosas
3 John Edward Basay Male Purok Rosas
4 Ralph Cedric Jimenez Male Purok Rosas
5 Matt Euhan Navarro Male Purok Rosas
6 Reinmark Saavedra Male Purok Rosas
7 Jhovier Singco Male Purok Rosaas
8 Kian Gabriel Sato Male Purok Rosas
9 April Joy Badong Female Purok Rosas
10 Kailee Dennisse Faranal Female Purok Rosas
11 Eliene Resse Juyad Female Purok Rosas
12 Rhea Angela Manos Female Purok Rosas
13 Justine Jade Mirambel Female Purok Rosas
14 Althea Navales Female Purok Rosas
15 Stephanie Pilapil Female Purok Rosas
16 Bernise Emery Placibe Female Purok Rosas
17 Princess Jenny Rafaela Female Purok Rosas
18
19
20
21
22
 23
24
25
26
27
28
29
30
31

Prepared by:
ANNA LISA G. EBO
Signature over printed name of subject teacher
t. Home visitation

municated him/her, otherwise write NOT COMMUNICATED if you failed to communicate that particular student.
just leave it blank
messenger of any other means.
nd then name the new file. In this way you have still your original file.

DATE & DETAILS OF COMMUNICATION WITH THE STUDENTS

Date Date Date
Details Details Details Details
2/10/10 2/11/10 2/12/10
mmunicated communicated almost done in the module
the acitivity in the module communicated the acitivity in the module
mmunicated not communicated
the progress of the module communicated verify the example
explain the steps communicated the progress of the modle
the acitivity in the module home visit the acitivity in the module
the assessment communicated the assessment
DATE & DETAILS OF COMMUNICATION WITH THE STUDENTS
Date Date Date
Details Details Details Details
School: LT. ANDRES CALUNGSUD ES
District: MIDSAYAP NORTH
Teaccher; MARITES MABAYAG
Gradde; THREE- GUAVA
DATE & DETAILS OF COMMUNICATION WITH THE STUDENTS
Means of
No. NAME OF PUPILS SEX Address communication Date Date Date Date
Details Details Details Details
Feb. 15, 2021 Feb. 16, 2021 Feb. 17, 2021 Feb. 18, 2021
1 Abo, Jelamin C. M Purok Rosas phone call not communicated comminicated activity in modules communicated communicated assessment in modules
2 Ampatuan, Jaspher D. M Purok Rosas home visit communicated assessment in modules comminicated assessment in modules communicated not communicated
3 Bangcaya, Wendelle Q. M Purok Rosas home visit communicated assessment in modules comminicated assessment in modules communicated communicated assessment in modules
4 Bargaso, Rell Dave G. M Purok Rosas phone call communicated assessment in modules comminicated assessment in modules communicated assessment in modules communicated assessment in modules
5 Gonzaga, Rehan Charl E. M Purok Rosas phone call communicated lacking og modules comminicated activity in modules communicated assessment in modules communicated assessment in modules
6 Belarmino, Melissa D. M Purok Rosas phone call communicated assessment in modules not communicated communicated communicated assessment in modules
7 Bersamin, Arjhen Mae S. M Purok Rosas phone call communicated assessment in modules not communicated communicated communicated assessment in modules
8 Calayon, Clara Jean B. M Purok Rosas text not communicated comminicated assessment in modules not communicated not communicated
9 Dalaguit Ritchell E. F Purok Rosas text communicated activity in modules comminicated assessment in modules not communicated communicated activity in modules
10 Ebo, Savanna J. F Purok Rosas phone call communicated assessment in modules comminicated assessment in modules not communicated communicated assessment in modules
11 Pontongan, Daisy Grace M. F Purok Rosas phone call communicated assessment in modules comminicated lacking modules communicated assessment in modules not communicated
12 Gamalinda, Alyssa A. F Purok Rosas phone call not communicated a not communicated communicated assessment in modules communicated assessment in modules
13 Lapiceros, Kate Mylee G. F Purok Rosas phone call communicated assessment in modules not communicated not communicated communicated assessment in modules
14 Mamokan, Bai Shania A. F Purok Rosas text communicated assessment in modules not communicated not communicated communicated assessment in modules
15 Pao, Crystalynn S. F Purok Rosas phone call communicated assessment in modules comminicated answer all the modules communicated activity in modules communicated
16 Caluyo, Emmanuel C. F Purok Rosas home visit communicated activity in modules comminicated assessment in modules communicated a communicated assessment in modules
17 Gamela, Rainier Justine P. F Purok Rosas home visit communicated assessment in modules comminicated assessment in modules communicated activity in modules communicated
18 Gamel, Renald Joshua P. F Purok Rosas phone call communicated assessment in modules comminicated assessment in modules communicated activity in modules not communicated
19 Hilario, Ray Carl C. F Purok Rosas phone call communicated assessment in modules comminicated activity in modules not communicated communicated assessment in modules
20 Perez, Try Joe G. M Purok Vanda phone call communicated activity in modules comminicated activity in modules not communicated communicated activity in modules
21 Sinon, Jhon Lester C. F Purok Vanda phone call communicated assessment in modules comminicated assessment in modules communicated assessment in modules not communicated assessment in modules
22 Suan, Reynan Jose P. F Purok Vanda text not communicated comminicated assessment in modules communicated assessment in modules communicated
23 Beloncio, Kea Chasty Rhane M Purok Vanda text not communicated comminicated assessment in modules communicated assessment in modules not communicated
24 Callote, Curtney Kylle R. M Purok Daisy phone call communicated assessment in modules comminicated assessment in modules communicated assessment in modules communicated assessment in modules
25 Ferolino, Nove Jean T. F Purok Daisy phone call communicated assessment in modules not communicated not communicated communicated assessment in modules
26 Pedroso, Rhea Mae C. F Purok Daisy phone call communicated assessment in modules comminicated lacking modules communicated assessment in modules not communicated assessment in modules
27 Villegas, Princess Rhianne F Purok Daisy phone call communicated activity in modules not communicated not communicated communicated activity in modules
28 Balao, Omer P. F Poblacion 5 home visit communicated activity in modules comminicated assessment in modules not communicated communicated activity in modules
29 Amado, Dwayne James C. F Purok waling 2x home visit communicated assessment in modules comminicated assessment in modules communicated activity in modules communicated assessment in modules
30 Celetaria, Justin Jay C. M Purok Sampaguita phon call communicated assessment in modules comminicated assessment in modules communicated assessment in modules communicated assessment in modules
31 Torres, Dens Eidderf C. F Purok Mercury phone call not communicated comminicated assessment in modules communicated assessment in modules communicated
32 Miral,, Lee Joon wu phone call communicated assessment in modules comminicated activity in modules communicated activity in modules communicated assessment in modules
Prepared by:
MARITES G. MABAYAG
Signature over printed name of Adviser
 Date
Details
Feb. 19,2021
communicated lacking in modules
communicated incomplete answer
communicated progress of the modules
communicated assessment in modules
communicated assessment in modules
communicated incomplete answer
communicated assessment in modules
communicated assessment in modules
not communicated
communicated explained the steps
communicated activity in modules
communicated assessment in modules
communicated assessment in modules
not communicated
communicated assessment in modules
communicated no answer of the modules
not communicated
not communicated
communicated assessment in modules
communicated assessment in modules
communicated progress of the modules
communicated progress of the modules
communicated a
not communicaassessment in modules
communicated assessment in modules
communicated incomplete answer
communicated no answer of the modules
communicated no answer of the modules
communicated assessment in modules
communicated assessment in modules
communicated progress of the modules
not communicaco answer o the modules