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ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT

As of ______________ 2013 Region: Division School: Address: School ID: Contract Nos.: INFRASTRUCTURE, PHYSICAL FACILITIES, FURNITURE, AND REAL ESTATE DONATIONS 1. CLASSROOM New construction Rehabilitation/Repair 2. FURNITURE PARTICULARS e.g. 1 storey, 2classroom 2 classroom e.g. Teacher's Table armchair QTY. 2 2 3 10 AMOUNT 1,300,000.00 200,000.00 16,000.00 9,000.00 DONOR PRIVATE SECTOR ABC Corporation DEF Enterprises ABC Corporation ABC Corporation LGU aspsch_form 01

Email Address:

3. TOILET & WASH FACILITIES New construction Renovation/Repair 4. MAINTENANCE

Toilets Wash Facilities e.g. construction materials, Paints 2 gallons paints e.g. land

1 2 2
1 hectare

30,000.00 10,000.00 1,000.00 100,000.00

Governor Mayor

5. REAL STATE

6. OTHERS PLS SPECIFY TOTAL


*Please attach the following document 1. Deed of Donation 2. Deed of Acceptance

construction of concrete fence

6,000.00 1,672,000.00

PTA

Prepared by:

Noted by:

School Head/Principal/OIC Approved by:

ASP Division Coordinator

Schools Division Superintendent

h_form 01

DATE COMPLETED/ TURN OVER March 8, 2012 February 22, 2012 January 10, 2012 January 10, 2012

February 24, 2012 February 24, 2012 February 10, 2012 January 12, 2012

March 15, 2012

ASP Division Coordinator

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT


As of ______________ 2013 Region: Division School: Address: School ID: Contract Nos.: INFRASTRUCTURE, PHYSICAL FACILITIES, FURNITURE, AND REAL ESTATE DONATIONS 1. CLASSROOM PARTICULARS QTY. AMOUNT DONOR PRIVATE SECTOR LGU aspsch_form 01

Email Address:

2. FURNITURE

3. TOILET & WASH FACILITIES

4. MAINTENANCE

5. REAL STATE

6. OTHERS PLS SPECIFY TOTAL


*Please attach the following document 1. Deed of Donation 2. Deed of Acceptance Prepared by: Noted by:

School Head/Principal/OIC Approved by:

ASP Division Coordinator

Schools Division Superintendent

h_form 01

DATE COMPLETED/ TURN OVER

ASP Division Coordinator

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT


As of ______________ 2013 Region: Division School: Address: School ID: Contract Nos.: HEALTH AND NUTRITION DONATIONS 1. FEEDING PROGRAM PARTICULARS QTY. AMOUNT DONOR PRIVATE SECTOR LGU aspsch_form 01

Email Address:

2. MEDICAL/DENTAL MISSION/CHECK-UPS

3. DEWORMING INTERVENTION

4. HEALTH SUPPLIES

5. OTHERS PLS SPECIFY

TOTAL
*Please attach the following document 1. Deed of Donation 2. Deed of Acceptance Prepared by: Noted by:

School Head/Principal/OIC Approved by:

ASP Division Coordinator

Schools Division Superintendent

h_form 01

DATE COMPLETED/ TURN OVER

ASP Division Coordinator

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT


As of ______________ 2013 Region: Division School: Address: School ID: Contract Nos.: READING PROGRAM DONATIONS 1. BOOKS PARTICULARS QTY. AMOUNT DONOR PRIVATE SECTOR LGU aspsch_form 01

Email Address:

2. SUPPLEMENTARY READING MATERIALS

3. OTHERS PLS SPECIFY

TOTAL
*Please attach the following document 1. Deed of Donation 2. Deed of Acceptance Prepared by: Noted by:

School Head/Principal/OIC Approved by:

ASP Division Coordinator

Schools Division Superintendent

h_form 01

DATE COMPLETED/ TURN OVER

ASP Division Coordinator

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT


As of ______________ 2013 Region: Division School: Address: School ID: Contract Nos.: TRAINING AND DEVELOPMENT DONATIONS
1. TEACHERS/PRINCIPAL TRAINING

aspsch_form 01

Email Address: DONOR PRIVATE SECTOR

PARTICULARS

QTY.

AMOUNT

LGU

2. STUDENT/PUPILS TRAINING AND FIELD TRIP

3. OTHERS PLS SPECIFY

TOTAL
*Please attach the following document 1. Deed of Donation 2. Deed of Acceptance Prepared by: Noted by:

School Head/Principal/OIC Approved by:

ASP Division Coordinator

Schools Division Superintendent

h_form 01

DATE COMPLETED/ TURN OVER

ASP Division Coordinator

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT


As of ______________ 2013 Region: Division School: Address: School ID: Contract Nos.: DIRECT ASSISTANCE DONATIONS
1. DIRECT ASSISTANCE

aspsch_form 01

Email Address: DONOR PRIVATE SECTOR

PARTICULARS

QTY.

AMOUNT

LGU

2. OTHERS PLS SPECIFY

TOTAL
*Please attach the following document 1. Deed of Donation 2. Deed of Acceptance Prepared by: Noted by:

School Head/Principal/OIC Approved by:

ASP Division Coordinator

Schools Division Superintendent

h_form 01

DATE COMPLETED/ TURN OVER

ASP Division Coordinator

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT


As of ______________ 2013 Region: Division School: Address: School ID: Contract Nos.: ASSISTIVE LEARNING DEVICES FOR STUDENT WITH SPECIAL NEEDS DONATIONS
1. PENCIL GRIPS 2. SPECIAL CHAIRS 3. SPELLING CHECK DEVICES 4. HEARING AIDS 5. TALKING COMPUTERS 6. SPECIALIZED KEYBOARDS 7. TOUCH SCREEN MONITOR 8. BRAILLE (BOOKS) 9. COMPUTERIZED SYSTEMS 10. OTHERS PLS. SPECIFY

aspsch_form 01

Email Address: DONOR PRIVATE SECTOR

PARTICULARS

QTY.

AMOUNT

LGU

TOTAL
*Please attach the following document 1. Deed of Donation 2. Deed of Acceptance Prepared by: Noted by:

School Head/Principal/OIC Approved by:

ASP Division Coordinator

Schools Division Superintendent

h_form 01

DATE COMPLETED/ TURN OVER

ASP Division Coordinator

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT


As of ______________ 2013 Region: Division School: Address: School ID: Contract Nos.: LEARNING SUPPORT DONATIONS
1. AUDIO-VISUAL

aspsch_form 01

Email Address: DONOR PRIVATE SECTOR

PARTICULARS

QTY.

AMOUNT

LGU

EDUCATIONAL MATERIALS

2. SCHOOL SUPPLIES

3. EDUCATIONAL FILM/ LIBRARIES

4. OTHERS PLS. SPECIFY

TOTAL
*Please attach the following document 1. Deed of Donation 2. Deed of Acceptance Prepared by: Noted by:

School Head/Principal/OIC Approved by:

ASP Division Coordinator

Schools Division Superintendent

h_form 01

DATE COMPLETED/ TURN OVER

ASP Division Coordinator

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT


As of ______________ 2013 Region: Division School: Address: School ID: Contract Nos.: LEARNING SUPPORT DONATIONS
1. COMPUTER

aspsch_form 01

Email Address: DONOR PRIVATE SECTOR

PARTICULARS

QTY.

AMOUNT

LGU

2. ELECTRONIC LEARNING MATERIALS

3. INTERNET CONNECTIVITY

4. OTHERS PLS. SPECIFY

TOTAL
*Please attach the following document 1. Deed of Donation 2. Deed of Acceptance Prepared by: Noted by:

School Head/Principal/OIC Approved by:

ASP Division Coordinator

Schools Division Superintendent

h_form 01

DATE COMPLETED/ TURN OVER

ASP Division Coordinator