NON-LEGAL-INTERVENTION-PLAN - TEMPLATE

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Republic of the Philippines


Department of Education
REGION X – NORTHERN MINDANAO
SCHOOLS DIVISION OF _____________
_____________ DISTRICT
(SCHOOL)

INTERVENTION PLAN
S.Y. ___________

Name of Recipient: _______________________ Grade/Section: ________

OBJECTIVES ACTIVITY/STRATEGY TIME FRAME PERSONS RESOURCES EXPECTED


INVOLVED NEEDED OUTPUT
Prepared by:

________________________ ___________________________ ________________________ __________________________ ________________________


Class Adviser Faculty Representative PTA Representative Student Representative Barangay/Community
Representative (when
necessary)

Recommending Approval:

_________________________
Guidance Counselor/Designate
Vice-Chairperson, School CPC

Approved:

_________________________
School Head
Chairperson, School CPC

Date: __________________________

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