Form 1: Lac Profile
Form 1: Lac Profile
Form 1: Lac Profile
This form should be accomplished by the LAC Facilitator and its members at the first LAC
session.
REGION: I
LAC Members
NAME Male/ Female DESIGNATION/ DIVISION/S Contact details Preferred contact
POSITION (email, mobile mode (email,
number) phone, Skype,
Zoom, Google
Meet, Viber, FB)
Region: I
Preferred contact (Indicate all: email, phone, Skype, Viber, WhatsApp, Zoom,
mode: Googlemeet, FB, Messenger, etc.)
Part A
Please indicate the extent to which you agree with each of the following statements by
ticking the appropriate box.
Comments / Remarks
(For example, if you disagree or
strongly disagree, please indicate
SD D N A SA why.)
MEMBER PARTICIPATION
5. The members /
demonstrated
engagement in and/or
enthusiasm for the learning
tasks during the session
(including providing
feedback
on each other’s
assignment).
FACILITATION
Part B
Please provide the information requested.
NONE
Part A
Please indicate the extent to which you agree with each of the following statements by
ticking
the appropriate box. (SD = Strongly Disagree; D = Disagree; N = Neutral; A = Agree; SA =
Strongly agree)
Comments / Remarks
(For example, if you disagree
or strongly disagree, please
SD D N A SA indicate why.)
ACTION PLAN
6. I feel motivated to apply in /
my region/division/district
what I have learned in this
lesson.
Part B
Please provide the information requested.
3. Other comments/suggestions:
NONE