Enclosure NO. 2 to DepED Order No. 1, s.

2015)
Department of Education
Division of Bohol
Form 2A - Elementary
SCHOOL PLAN TO ADDRESS NEEDS

Name of Elementary School

Division Region:
Date Accomplished

Please indicate additional inputs needed.

Tentative A. Additional Inputs Needed
Enrolment (Please indicate number)
Grade Level (Should tally with Form
1) Classroom Teachers Textbooks Seats

Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6

TOTAL 0 0 0 0 0

Tentative B. Inputs Needs

Enrolment
Learners under the ADM-MISOSA (Should tally with
Teacher-
Form 1) Modules
Facilitator
Age 9
age 10
age 11
TOTAL 0 0 0

Tentative C. Additional Inputs Needed

Enrolment (Please indicate number)
Categories of Disability (Should tally with Classroom Teachers Textbooks Seats
Form 1)

1. Visual Impairement
2. Hearing Impairement
3. Intellectual Disability
4. Speech/Language Impairement
5. Serious Emotional Disturbance
6. Autism
7. Orthopedic Impairement
8. Special Health Problems
 9. Multiple Disabilities
TOTAL 0 0 0 0 0

D. Proposed Differentiated Program Intervention E. Assistance Needed

1. Formal Delivery System

2. ADM (Alternative Delivery Mode)

3. Special Education in Inclusive Setting:

Submitted by:

Name & Signature of School Head

Designation
Cell Phone # :
E-mail Address: