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Template Integrative Assessment Example Blank Form

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Republic of the Philippines

Department of Education
National Capital Region
Schools Division of Pasig City

SUMMATIVE ASSESSMENT

Put an X Mark on the blank where appropriate


_____Integrative Written Works Number _____
_____Integrative Performance Tasks Number _____

Grade Level: ______ Quarter: ___ Date to be given/communicated to Time (Indicate the
the learner/parents/LSA: estimated time the
activity is to be
Date/ time to be submitted: accomplished):
e.g. 1 hour

Assessment Criteria
Learning Areas Most Essential Learning Competencies: Competency Codes:

Content Standard Performance Standard

Overview of the Assessment Activity (Provide a clear and concise description of your activity)

Assessment Method/Methods (Put an X Mark on the blank where appropriate)


______ Observation _______Tests
______ Analyses of learner’s products _______ Talking to Learners

Assessment Activity

Expected Output:
Note:
Instruction and mode of submission will be communicated in the Weekly Home Learning Plan considering the
Learner’s Modality
Recording Methods (Put an x mark on the blank where appropriate)
____Checklist ____Marks
____Class Grids ____Anecdotal Record
____Grades ____Self assessment records
____Comments on Learner’s work
____Audio recording, photographs, video footages

Making Consistent Judgement (Put an x mark on the blank where appropriate)


____ Rubric link to the assessment criteria
____Marks scheme link to assessment criteria

Feedback (Put an x mark on the blank where appropriate)

_____ Oral Feedback


_____ Written Feedback

Prepared by:

________________________ _______________________
Signature above printed name Signature above printed name
MAPEH-Teacher EsP-Teacher

________________________ _________________________
Signature above printed name Signature above printed name
English Teacher Math Teacher

________________________
Signature above printed name
Science Teacher

Date: ____________________

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