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LESSON PLAN CHECKLIST

WEEK: ______________________
INDICATORS

QUANTITY EFFICIENCY AND TIMELINES

ALL PARTS OF THE LESSON PLAN WERE Completed and submitted one hour before
5 EVIDENT
5 the given time
a. Objectives d. Evaluation
b. Subject Matter e. Assignment
c. Procedure
Lacking 1 indicator Completed and submitted ½ hour before
4 4 the given time
Lacking 2 indicators Completed and submitted ON TIME
3 3
Lacking 3 indicators Completed and submitted after the given
2 2 time
NO LESSON PLAN AT ALL Completed and submitted after one day
1 1

SIGNATURE OF TEACHER: ___________________________


REMARKS: ___________________________________________
CHECKED BY: _________________________________________ESHT III

WEEK: ______________________
INDICATORS

QUANTITY EFFICIENCY AND TIMELINES

ALL PARTS OF THE LESSON PLAN WERE Completed and submitted one hour before
5 EVIDENT
5 the given time
a. Objectives d. Evaluation
b. Subject Matter e. Assignment
c. Procedure
Lacking 1 indicator Completed and submitted ½ hour before
4 4 the given time
Lacking 2 indicators Completed and submitted ON TIME
3 3
Lacking 3 indicators Completed and submitted after the given
2 2 time
NO LESSON PLAN AT ALL Completed and submitted after one day
1 1

SIGNATURE OF TEACHER: ___________________________


REMARKS: ___________________________________________
CHECKED BY: _________________________________________ESHT III
Date: ____________________________

THE SCHOOL PRINCIPAL/REGISTRAR


___________________________________________

___________________________________________

SIR / MADAM:

Please furnish this office with a certified TRUE copy of FORM -137-A of the following student/s who have
been temporarily enrolled in this institution upon presentation of his/her/their credentials, bearing the following
data.

Name of Pupils In our School In your School

Grade and School Grade and School Teacher


Section Year Section Year

Your prompt attention to this request is highly appreciated.

_________ First Request

_________ Second Request

_________ Urgent

_________The bearer is authorized to hand carry the said form

Very truly yours,

NECIL H. JIMENEZ
Class Adviser

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