Republic of the Philippines

Department of Education
Region VI – Western Visayas
Schools Division of Capiz
GUINBIALAN INTEGRATED SCHOOL
Guinbialan, Maayon, Capiz

MODULE DISTRIBUTION AND RETRIEVAL FORM

Q4 week 5
Grade Level & Section: _9__
Brgy: Guinbialan
Received by: Returned by: Remarks
Name of Signature of Date Contact No. Name of Signature of Date
No. Name of Learner SUBJECT AREA ()
Parents/Guardian Parents/ Received () Parents/Guardian Parents/ Returned
Guardian Guardian
1 ALICO, JOLEN D. English
Mathematics
Filipino
TLE
Science
AP
EsP
MAPEH: MUSIC
MAPEH: ARTS
MAPEH: PE
MAPEH: HEALTH
2 AYONGAO, RONNEL D. English
Mathematics
Filipino
TLE
Science
AP
EsP
MAPEH: MUSIC
MAPEH: ARTS
MAPEH: PE
MAPEH: HEALTH
 Republic of the Philippines
Department of Education
Region VI – Western Visayas
Schools Division of Capiz
GUINBIALAN INTEGRATED SCHOOL
Guinbialan, Maayon, Capiz

Received by: Returned by: Remarks

SUBJECT Name of Signature of Date Contact No. Name of Signature of Date
No. Name of Learner ()
AREA Parents/Guardian Parents/ Received () Parents/Guardian Parents/ Returned
Guardian Guardian
3 BACINSE, DANIEL B. English
Mathematics
Filipino
TLE
Science
AP
EsP
MAPEH:
MUSIC
MAPEH: ARTS
MAPEH: PE
MAPEH:
HEALTH
4 DAPECORTAR, JOSHUA B. English
Mathematics
Filipino
TLE
Science
AP
EsP
MAPEH:
MUSIC
MAPEH: ARTS
MAPEH: PE
MAPEH:
HEALTH
 Republic of the Philippines
Department of Education
Region VI – Western Visayas
Schools Division of Capiz
GUINBIALAN INTEGRATED SCHOOL
Guinbialan, Maayon, Capiz

Received by: Returned by: Remarks

Name of Signature of Date Contact No. Name of Signature of Date
No. Name of Learner SUBJECT AREA ()
Parents/Guardian Parents/ Received () Parents/Guardian Parents/ Returned
Guardian Guardian
5 DELA CRUZ, DENNIS B./ English
DELA CRUZ, DANTE B.
Mathematics
Filipino
TLE
Science
AP
EsP
MAPEH: MUSIC
MAPEH: ARTS
MAPEH: PE
MAPEH: HEALTH
6 DEOCAMPO, ROMIL E. English
Mathematics
Filipino
TLE
Science
AP
EsP
MAPEH: MUSIC
MAPEH: ARTS
MAPEH: PE
MAPEH: HEALTH

Received by: Returned by: Remarks

No. Name of Learner SUBJECT AREA () Name of Signature of Date Contact No. Name of Signature of Date
()
 Republic of the Philippines
Department of Education
Region VI – Western Visayas
Schools Division of Capiz
GUINBIALAN INTEGRATED SCHOOL
Guinbialan, Maayon, Capiz

Parents/Guardian Parents/ Received Parents/Guardian Parents/ Returned

Guardian Guardian
7 DEVELOS ALVIN D. English
Mathematics
Filipino
TLE
Science
AP
EsP
MAPEH: MUSIC
MAPEH: ARTS
MAPEH: PE
MAPEH: HEALTH
8 ICAYAN, REYNO D. English
Mathematics
Filipino
TLE
Science
AP
EsP
MAPEH: MUSIC
MAPEH: ARTS
MAPEH: PE
MAPEH: HEALTH

No. Name of Learner SUBJECT AREA () Received by: Returned by: Remarks
Name of Signature of Date Contact No. () Name of Signature of Date
Parents/Guardian Parents/ Received Parents/Guardian Parents/ Returned
 Republic of the Philippines
Department of Education
Region VI – Western Visayas
Schools Division of Capiz
GUINBIALAN INTEGRATED SCHOOL
Guinbialan, Maayon, Capiz

Guardian Guardian
9 JOMOLO, RJ D. English
Mathematics
Filipino
TLE
Science
AP
EsP
MAPEH: MUSIC
MAPEH: ARTS
MAPEH: PE
MAPEH: HEALTH
10 MARCELINO, JOHN D. English
Mathematics
Filipino
TLE
Science
AP
EsP
MAPEH: MUSIC
MAPEH: ARTS
MAPEH: PE
MAPEH: HEALTH

Received by: Returned by: Remarks

Name of Signature of Date Contact No. Name of Signature of Date
No. Name of Learner SUBJECT AREA ()
Parents/Guardian Parents/ Received () Parents/Guardian Parents/ Returned
Guardian Guardian
 Republic of the Philippines
Department of Education
Region VI – Western Visayas
Schools Division of Capiz
GUINBIALAN INTEGRATED SCHOOL
Guinbialan, Maayon, Capiz

11 SAYAT, BRIAN A. English

Mathematics
Filipino
TLE
Science
AP
EsP
MAPEH: MUSIC
MAPEH: ARTS
MAPEH: PE
MAPEH: HEALTH
12 TINGSON, ZANDRO C. English
Mathematics
Filipino
TLE
Science
AP
EsP
MAPEH: MUSIC
MAPEH: ARTS
MAPEH: PE
MAPEH: HEALTH

Received by: Returned by: Remarks

SUBJECT Name of Signature of Date Contact No. Name of Signature of Date
No. Name of Learner ()
AREA Parents/Guardian Parents/ Received () Parents/Guardian Parents/ Returned
Guardian Guardian
1 BUNDA, MARVE V. English
 Republic of the Philippines
Department of Education
Region VI – Western Visayas
Schools Division of Capiz
GUINBIALAN INTEGRATED SCHOOL
Guinbialan, Maayon, Capiz

Mathematics
Filipino
TLE
Science
AP
EsP
MAPEH:
MUSIC
MAPEH: ARTS
MAPEH: PE
MAPEH:
HEALTH
2 DICHOSA, MARIEL ANN O. English
Mathematics
Filipino
TLE
Science
AP
EsP
MAPEH:
MUSIC
MAPEH: ARTS
MAPEH: PE
MAPEH:
HEALTH

No. Name of Learner SUBJECT AREA () Received by: Returned by: Remarks
Name of Signature of Date Contact No. () Name of Signature of Date
Parents/Guardian Parents/ Received Parents/Guardian Parents/ Returned
 Republic of the Philippines
Department of Education
Region VI – Western Visayas
Schools Division of Capiz
GUINBIALAN INTEGRATED SCHOOL
Guinbialan, Maayon, Capiz

Guardian Guardian
3 DICHOSA, RUTH D. English
Mathematics
Filipino
TLE
Science
AP
EsP
MAPEH: MUSIC
MAPEH: ARTS
MAPEH: PE
MAPEH: HEALTH

Received by: Returned by: Remarks

Name of Signature of Date Contact No. Name of Signature of Date
No. Name of Learner SUBJECT AREA ()
Parents/Guardian Parents/ Received () Parents/Guardian Parents/ Returned
Guardian Guardian
4 GEVERO, CHARMIE JOY English
C.
Mathematics
Filipino
TLE
Science
AP
EsP
MAPEH: MUSIC
MAPEH: ARTS
MAPEH: PE
MAPEH:
HEALTH
 Republic of the Philippines
Department of Education
Region VI – Western Visayas
Schools Division of Capiz
GUINBIALAN INTEGRATED SCHOOL
Guinbialan, Maayon, Capiz

Received by: Returned by: Remarks

Name of Signature of Date Contact No. Name of Signature of Date
No. Name of Learner SUBJECT AREA ()
Parents/Guardian Parents/ Received () Parents/Guardian Parents/ Returned
Guardian Guardian
5 GINGCO, FLORENCE English
JOY D.
Mathematics
Filipino
TLE
Science
AP
EsP
MAPEH: MUSIC
MAPEH: ARTS
MAPEH: PE
MAPEH: HEALTH