Feedback and Survey Form (School)

FEEDBACK AND SURVEY FORM

(SCHOOL)

Name Date
School
Position

1. Please check one or more boxes on the learning delivery modalities that the school
implements for SY 2020-2021.
 Printed Modules
 Digital Modules (Downloadable, CDs, DVDs, USB)
 Online (Synchronous) Distance Learning
 Online (Asynchronous) Distance Learning
 TV/Radio Based Instruction
 Others __________________
2. What learning materials does your school provide to parents/students?

 Self-Learning Modules
 Activity sheets
 Textbooks
 Workplans
 Others ____________
3. How do you furnish the learning modules to the designated recipients?

 Home delivery
 Pick-up in Schools
 Pick-up in other designated points _________________
 Others ___________________
4. How often does a parent / student need to go to school for picking up /dropping off the
modules/activity sheets?
 Once a week
 Every 2 weeks
 Once a month
 Once every grading quarter
 Others ________________
5. What is the ratio of the printed module to students?

 1 module: 1 student
 1 module: 2 students
MODE OF PRINTING AND DELIVERY OF LEARNING RESOURCES
6. Does the school procure for printing and/or delivery of learning modules?
 Yes, through ___________________  No
(Mode of Procurement)
7. Does the school conduct in-house or by-administration printing and/or delivery?

 Yes, printing and collating of learning modules are being done by ___________________.
___________________________________________________________________________
 No
8. Does the school enter into a partnership agreement with LGU?

 Yes  No
9. If your answer to No. 8 is Yes, what is the support you receive from LGU in relation to the
Basic Education Learning Continuity Plan (BE-LCP)? Please explain your answer.
 Grant of actual Special Education Fund (SEF) contribution_________________________
________________________________________________________________________
 Equipment and Supplies, ____________________________________________________

________________________________________________________________________
 Others __________________________________________________________________
________________________________________________________________________
10. Does the school enter into a partnership agreement with other eligible entities?
 Yes, __________________ provides _________________________________________
(Entity)
_____________________________________________________________________________
 No
11. What are the various assistances you receive from SDO in relation to the BE-LCP?
 The SDO mainly provides the printed materials.
 SDO provides additional fund support to the school.
 Others, __________________________________________________________________
________________________________________________________________________
12. Did the school find other ways to augment the fund for the printing of learning resources? If
yes, how? __________________________________________________________________
___________________________________________________________________________
(For teachers)
LEARNING MODULES
13. Below are the errors that you might have observed in the modules. Kindly identify the
estimated number of errors you have found to date:
Errors No. of errors found
0 1 to 3 4 to 6 7 to 10 10 to 20
Factual errors     
Computational Errors (Math related)     
Format (Font / Illustration)     
Printing errors (color) / Sorting of Pages     
Spelling / Punctuation / Typographical errors     
Grammar / Syntax     
14. Was the school able to distribute the modules and other learning materials on time?
 Yes  No
15. If your answer is No in No. 14, how long was the delay in the distribution of modules?
 1 to 3 days  4 to 8 days  9 to 15 days  15 to 30 days
16. In relation to No. 15, what are the reasons for the delayed distribution of modules? Pls.
expand your answer/s.
 Shortage of resources, ______________________________________________________
___________________________________________________________________________
 Delayed release of digital copies of modules to be printed__________________________
___________________________________________________________________________
 Delayed procurement for printing, ____________________________________________
___________________________________________________________________________
 Problems encountered on the delivery of module to students ________________________
___________________________________________________________________________
 Late pick-up of module by the parents / students _________________________________
___________________________________________________________________________
 Others __________________________________________________________________
__________________________________________________________________________
Please use the following scale in your assessment of the mode of learning and learning
materials adopted by the school.
1 = Strongly Disagree; 2 = Disagree 3 = Neutral 4 = Agree 5 = Strongly Agree
No. Criteria 1 2 3 4 5 Remarks

17. On the Use and Content of the Learning Modules and Materials
17. The lessons in the Self-Learning Modules are
1 well-organized.
17. With minimal adult supervision, the module has
2 adequate information and activities that enable the
students to learn independently.
No. Criteria 1 2 3 4 5 Remarks
17. The instructions in modules are clearly stated and
3 can be well understood by the student.
17. The practice tests and activities provided are age-
4 appropriate.
17. The questions and activities are at different levels
5 of difficulty and stimulates the student’s reasoning
and creativity.
17. The number and kind of questions/activities in the
6 module can be answered by the students within the
given time frame.
17. The contents, information, and illustrations in the
7 module are consistent with moral values and
proper conduct.
17. Overall, I am satisfied with the quality of the
8 module which provides a good learning
opportunity and supports independent learning.
18. On the distribution and retrieval of Learning Modules
18. I find the mode of distribution quick and efficient.
1
18. The school’s manner of distribution and retrieval
2 of modules is acceptable and not bothersome for
the teachers.
18. Safety prevention protocols are observed during
3 the distribution and retrieval of modules.
19. Monitoring of Progress
19. I can easily and promptly give feedback on the
1 learners’ output to the students/parents.
19. I can easily reach the students/parents for learners’
2 remediation or assistance, if needed.
20. Are you overall satisfied with the effectiveness and efficiency of the implementation of
modular distance learning? Please state your reasons.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
21. Do you have any further concerns, suggestions, and feedback to improve the implementation
of BE-LCP?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

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FEEDBACK AND SURVEY FORM

2. What learning materials does your school provide to parents/students?

3. How do you furnish the learning modules to the designated recipients?

5. What is the ratio of the printed module to students?

7. Does the school conduct in-house or by-administration printing and/or delivery?

8. Does the school enter into a partnership agreement with LGU?

 Equipment and Supplies, ____________________________________________________

No. Criteria 1 2 3 4 5 Remarks

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