Department of Education: Republic of The Philippines
Department of Education: Republic of The Philippines
Department of Education
REGION II – CAGAYAN VALLEY
SCHOOLS DIVISION OF QUIRINO
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School: ___________________________ Name of the Teacher ___________________________
District: ___________________________ Name of the School Head _______________________
Grade level: _____ Subject: ____________ Modality: ____________________________________
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Signature Over Printed Name of the Teacher Signature Over Printed Name of the School Head
Monitored by:
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Signature Over Printed Name of EPS/PSDS
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