This form is meant to be filled out by members of a Local Area Committee (LAC) after each LAC session. The form asks the member to rate their agreement with statements about the LAC session and their learning. It also has space for comments on topics needing further clarification, any problems or challenges encountered, and additional comments or suggestions.

1. FORM 4: LAC ENGAGEMENT REPORT
This form should be accomplished by each LAC Member at the end of every LAC session.
NAME OF MEMBER: LAC SESSION ID.:
REGION: DATE OF LAC SESSION:
DIVISION: NUMBER OF LAC SESSION:
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)
SD D N A SA
Comments / Remarks
(For example, if you disagree
or stronglydisagree, please
indicate why.)
THE LAC SESSION
1. I learned a lot from my
colleagues in this LAC session.
2. The LAC session deepened
my understanding of the SLM
content.
3. My perspective on the topic/s
covered has changed as a
result of the LAC session.
4. I participated actively in the
LAC session by sharing my
assignment and insights,
asking questions, and giving
feedback on what colleagues
shared.
5. I interacted with different
people during the LAC
session.

2. ACTION PLAN
6. I feel motivated to apply in
my region/division/district
what I have learned in this
lesson.
7. I intend to apply what I have
learned from the lesson in my
region/division/district
Part B
Please provide the information requested.
1. I need further clarification and/or resources on the following topics:
2. I encountered the following problems or challenges:
3. Other comments/suggestions: