Republic of the Philippines
Department of Education
COMMITMENT AND AGREEMENT FORM
LEARNER INFORMATION
Name of Learner: Grade & Section:
Learning Area: School Year:
PURPOSE
This Commitment and Agreement Form signify the joint commitment of the teacher, parent/guardian, and
other stakeholders to support and monitor the learner’s needs, progress, and achievement throughout School Year
2026 – 2027, covering the First to Third Term.
STAKEHOLDERS’ AGREEMENT
We, the undersigned, agree to work collaboratively to ensure the learner’s continuous improvement by
maintaining open communication, providing needed interventions, and supporting school and home learning
activities.
Name Designation/Role Signature
____________________________ Teacher ____________________
____________________________ Parent/Guardian ____________________
____________________________ Co-Teacher (if applicable) ____________________
____________________________ Guidance Counselor (if applicable) ____________________
____________________________ LGU Representative (if applicable) ____________________
TIMELINE OF COMMITMENT: School Year 2026-2027
Quarter Period Covered Focus of Communication/Action
First June 16 – August Initial orientation, discussion of learner’s baseline performance and
Quarter 22,2025 learning needs.
Second August 26 – October Monitoring and feedback on learner’s midyear progress and intervention
Quarter 24,2025 adjustments.
Third November 3 – Continued follow-up and stakeholder coordination on academic or
Quarter January 23,2026 behavioral concerns.
Fourth January 26 – March Final evaluation of learner’s achievement and recognition of progress.
Quarter 20, 2026
ACKNOWLEDGEMENT
By signing, we affirm our shared responsibility to communicate, collaborate, and support the learner’s
academic growth and well-being.
Prepared by:
_____________________
Class Adviser
FEEDBACK FORM / ACKNOWLEDGMENT SLIP
LEARNER INFORMATION
Name of Learner: Grade & Section:
Learning Area: School Year:
DETAILS OF COMMUNICATION
Date Sent:
Type of Update/ ☐ Progress Report ☐ Corrected Test Paper ☐ Intervention Plan
Communication: ☐ Behavior Report ☐ Others:
Teacher’s Feedback
PARENT’S/GUARDIAN’S ACKNOWLEDGMENT
I confirm that I have received and read the report/feedback about my child and will take necessary actions.
Parent’s/Guardian’s Name: _____________________________Signature: _____________ Date: ___________
PARENT’S/GUARDIAN’S FEEDBACK CHECKLIST
Directions: Please check (✔) the column that best represents your response.
Statements Yes No Not Sure
1. I clearly understood the update or feedback sent by the teacher. ☐ ☐ ☐
2. The feedback helped me understand my child’s progress. ☐ ☐ ☐
3. I discussed the teacher’s feedback with my child at home. ☐ ☐ ☐
4. I plan to act or support based on recommendations. ☐ ☐ ☐
5. The communication is clear and timely. ☐ ☐ ☐
Additional Comments or Suggestions (if any): _____________________________________________________________________________
__________________________________________________________________________________________________________________
Prepared by:
_____________________
Class Adviser
FEEDBACK FORM / ACKNOWLEDGMENT SLIP
LEARNER INFORMATION
Name of Learner: Grade & Section:
Learning Area: School Year:
DETAILS OF COMMUNICATION
Date Sent:
Type of Update/ ☐ Progress Report ☐ Corrected Test Paper ☐ Intervention Plan
Communication: ☐ Behavior Report ☐ Others:
Teacher’s Feedback
PARENT’S/GUARDIAN’S ACKNOWLEDGMENT
I confirm that I have received and read the report/feedback about my child and will take necessary actions.
Parent’s/Guardian’s Name: _____________________________Signature: _____________ Date: ___________
PARENT’S/GUARDIAN’S FEEDBACK CHECKLIST
Directions: Please check (✔) the column that best represents your response.
Statements Yes No Not Sure
1. I clearly understood the update or feedback sent by the teacher. ☐ ☐ ☐
2. The feedback helped me understand my child’s progress. ☐ ☐ ☐
3. I discussed the teacher’s feedback with my child at home. ☐ ☐ ☐
4. I plan to act or support based on recommendations. ☐ ☐ ☐
5. The communication is clear and timely. ☐ ☐ ☐
Additional Comments or Suggestions (if any): _____________________________________________________________________________
__________________________________________________________________________________________________________________
Prepared by:
_____________________
Class Adviser