Republic of the Philippines

Department of Education
REGION IV-A CALABARZON
SCHOOLS DIVISION OF QUEZON
LOPEZ EAST DISTRICT
Lopez, Quezon

PROGRAM AND ACTIVITY EVALUATION

Learning and Development (L&D) Form No. 4A [Printed Form] (Rev. 2)
Reference: LED Memorandum No. 010, s. 2022

I. ACTIVITY AND PARTICIPATION DETAILS

II.
PROGRAM INFORMATION
Title of the Activity/ Program MNHS AND SCNHS REVISITING SALN GUIDELINES, SMEPA, IPCRF MIDYEAR
ASSESSMENT, SCHOOL PPA AND DeLEARN ORIENTATION.
Inclusive Date/s February 02, -04 2022
Venue/ Platform MNHS UNIQUE BUILDING/FACE TO FACE (GROUP A DAY1 AND GROUP B
DAY 2)
Lead Person/s Virginia C. Andal
Roselyn P. De Torres
Hilda D. Molas
PPA Type Learning and SLAC/ PLC / In-Service Training
Development Training-Workshop Conference/ Webinars
IS and TA Remote/ Online / Field/ Onsite
General Parent Assembly School Orientation
District/ School Partnership Activities GAD
Activities
IGP / General Conferences
Learning and Interventions / Innovations
Instruction Home Visits / Assistance and Support
Other

PARTICIPANT’S INFORMATION
Participant (Name, JUAN DE LA CRUZ
Optional)
Position/Designation SECONDARY SCHOOL TEACHER II
School MAGALLANES NATIONAL HIGH SCHOOL
Date of Evaluation FEBRUARY 02, 2022

II. PARTICIPATION CONSENT AND CONFIDENTIALITY AGREEMENT

Upon discussing participation consent and confidentiality agreement, the participant voluntarily agrees to the
following agreements: (A – Agree, DN – Do Not Agree). Encircle or cross out your choice of agreement.
However, the organizers and the Office of the PSDS request all participants agree with all the given
statements.
Participation Consent Confidentiality Agreement
I voluntarily take part in this evaluation A DN I shall refrain from utilizing any of the A DN
process as part of participation in this L&D information, including the items and

Office Address: Don Emilio Salumbides ES, San Vicente St.

Brgy. Magsaysay, Lopez, Quezon 4316
Contact No.: 0943-128-2229
Facebook: DepEd Tayo Lopez East – Quezon; Lopez East District Quezon
Email Address: [email protected]
 Republic of the Philippines
Department of Education
REGION IV-A CALABARZON
SCHOOLS DIVISION OF QUEZON
LOPEZ EAST DISTRICT
Lopez, Quezon

undertaking and exert full responsibility for structures cited in this evaluation, for
my responses. personal or any other use (e.g., online
I am not expecting any gifts or payments for A DN sharing and distribution) without the
this evaluation process. permission of the activity organizers.
I am giving the activity organizers full A DN I shall take responsible actions on the overall A DN
consent to utilize whatever data or confidentiality and non-disclosure of all the
information I declare in this form for information regarding this program
scholarly purposes, particularly in improving evaluation.
the L&D practice in the school and district.

III. END OF PROGRAM/ACTIVITY EVALUATION

Assess and rate each indicator using the given Highly

Evident Less Evident Not Evident Not
scale. However, if a particular criteria/indicator Evident
(E): (LE): (NE): Applicabl
is not applicable, just check the “N/A” column. (HE):
3 2 1 e (N/A)
4

Activity Proper 4 3 2 1 N/A

1. The activity is significant to the contextual needs of the participants. /
2. The learning session considers several strategies for meaningful and /
effective learning.
3. The organization and flow of the activities (e.g., presentations, /
workshops) are systematic and correctly in place.
4. The activity platform (e.g., Zoom Meeting) and/or training venue is /
conducive to learning collaboration and maximizes meaningful
opportunities.
5. The objectives of the activity are to achieve effectiveness and /
efficiency.
Resource Persons (Speakers, Presenters) 4 3 2 1 N/A
1. The resource persons (e.g., speakers, presenters) exhibit mastery of /
the subject matter.
2. The presentation skills of resource persons are commendable. /
3. The presentations highly engage the audience to participate and learn /
more.
4. The resource persons follow the intended learning experience design /
of the activity.
5. The resource person/s is/are able to present, discuss, and /
contextualize a strong link and application of theory into practice.
Program Management 4 3 2 1 N/A
1. Activities and sessions are placed correctly, appropriately, and /
sequenced efficiently, executing the identified time schedules.
2. Facilitators properly managed the learning sessions. /
3. The learning sessions promote learning collaboration and integrate /
technical assistance for the participants.
4. The learning sessions provide meaningful learning experiences to the /
participants.
5. In general, the activity (e.g., PLC, workshop, SLAC, training) is well- /
organized and implemented.

Office Address: Don Emilio Salumbides ES, San Vicente St.

Brgy. Magsaysay, Lopez, Quezon 4316
Contact No.: 0943-128-2229
Facebook: DepEd Tayo Lopez East – Quezon; Lopez East District Quezon
Email Address: [email protected]
 Republic of the Philippines
Department of Education
REGION IV-A CALABARZON
SCHOOLS DIVISION OF QUEZON
LOPEZ EAST DISTRICT
Lopez, Quezon

Activity Resources (Presentation Materials, Workshop Materials, 4 3 2 1 N/A

Handouts)
1. The presentations are aesthetically and properly designed and /
prepared.
2. Workshop activities are provided with enough learning resources for /
learning and collaboration.
3. Access or submission links are correctly and properly working. /
4. Speakers and/or trainers provide meaningful activities and learning /
resources for the participants during and/or after the learning session.
5. Activity resources supported the presentations, workshops, and overall /
conduct of the learning session.

Technical Assistance (TA) Quality 4 3 2 1 N/A

1. The technical assistance, learning inputs, and general learning intakes /
apply to school practice.
2. Different perspectives and ideas are presented, which provides rich /
discussion, critical dialogue, and learning inputs to the participants.
3. The technical assistance is highlighted and adequately integrated with /
the activity, particularly following the district’s IRTA principles,
frameworks, processes, and features (e.g., OLS, CLC, L&D).
4. The process involves (a) sharing of information and expertise, (b) /
inputs for instruction and skills enhancement, (c) transmission of
working knowledge, (d) consulting services (e.g., consultation,
mentoring), or (e) transfer and utilization of technical data.
5. The TA providers exhibit wit and intelligence, show constructive /
approach, pose positive values and characteristics of an instructional
leader, and are generally commendable.
Alignment to Professional Standards (e.g., PPST, PPSSH, PPSS) 4 3 2 1 N/A
1. The activity anchor’s objectives, strategies, and content discussions /
with a specific domain/strand of the required Philippine Professional
Standards for Teachers, School Heads, and/or Supervisors.
2. The discussions, presentations, and engagement foster the /
development of specific domain/strand/competency of the required
professional standards for teachers, school heads, and/or supervisors.
3. The activity (e.g., L&Ds, workshops, PLCs, LACs, webinars) provides /
opportunities for reflection of practice to further attain and develop
specific domains/strands/competencies in the professional standards
for teachers, school heads, and/or supervisors.
4. The activity (e.g., L&Ds, workshops, PLCs, LACs, webinars) /
established the need to gauge actions, measures, and efforts in
attaining competence development based on the required professional
standards.
5. The provision and quality of technical assistance anchors with specific /
domains/strands/competencies of the required professional standards.

Office Address: Don Emilio Salumbides ES, San Vicente St.

Brgy. Magsaysay, Lopez, Quezon 4316
Contact No.: 0943-128-2229
Facebook: DepEd Tayo Lopez East – Quezon; Lopez East District Quezon
Email Address: [email protected]
 Republic of the Philippines
Department of Education
REGION IV-A CALABARZON
SCHOOLS DIVISION OF QUEZON
LOPEZ EAST DISTRICT
Lopez, Quezon

IV. RECOMMENDATIONS AND FEEDBACK

Kindly share your honest response to improve our L&D practice. Use the results of this evaluation to enhance the
delivery of your PPAs.

What did you like best in our conducted learning activity (e.g., PLC, training-workshop, capacity building)?

I LIKE HOW THE SPEAKERS GIVE THEIR BEST KNOWLEDGE AND THE BEST OF WHAT THEY CAN SHARE TO
THEIR CO- WORKERS LIKE US.

What are your Key Take Away Points (KeyTAP) in this activity?
KeyTAP: Intakes KeyTAP: Reflection KeyTAP: Application
Organizers and facilitators give their
I have learned a lot especially on best to be able that this activity went Preparation for PPST RPMS.
SMEPA wherein it includes the well Knowledge in filling up the SALN
participation of the school for the past
grading period.
What are the PPST/PPSSH/PPSS competencies (domains, strands) developed in you from your participation in this learning
activity? Share all the specific domains and strands (e.g., Domain 1 – Strand 1.1; Domain 2 – Strand 2.2) to highlight
improvement of practice or competence.
PPST DOMAIN- Personal Growth and Professional Development.

How can we make this professional learning activity better next time?

n/a

Please share any thoughts or suggestions below.

n/a

V. SUBMISSION DETAILS

Submission and Compliance Clause: The undersigned confirms that all the details are correct and valid. The
leads/organizers shall strictly follow all health and safety standards, governing policies to L&D activities, and

Office Address: Don Emilio Salumbides ES, San Vicente St.

Brgy. Magsaysay, Lopez, Quezon 4316
Contact No.: 0943-128-2229
Facebook: DepEd Tayo Lopez East – Quezon; Lopez East District Quezon
Email Address: [email protected]
 Republic of the Philippines
Department of Education
REGION IV-A CALABARZON
SCHOOLS DIVISION OF QUEZON
LOPEZ EAST DISTRICT
Lopez, Quezon

data/information protection. The participant shall submit this accomplished form to the activity organizers. School
Heads need to evaluate and study the feedback to improve the practice of the school.

Participant (Optional) Reviewed/ Checked (SH) Noted

Signature: Signature: Signature:

Prepared by: JUAN DELA CRUZ Noted: VIRGINIA C. ANDAL Submitted to: REJULIOS M.
VILLENES
Position: Teacher I Position: PRINCIPAL II Position: PSDS
Date: February 02, 2022 Date: February 02, 2022 Date:

Office Address: Don Emilio Salumbides ES, San Vicente St.

Brgy. Magsaysay, Lopez, Quezon 4316
Contact No.: 0943-128-2229
Facebook: DepEd Tayo Lopez East – Quezon; Lopez East District Quezon
Email Address: [email protected]