BE Form 04

DEPARTMENT OF EDUCATION

STATEMENT OF INTERESTS
Name & Signature:
Name of Company/Organizations:
Address:
Telephone/CP No.:
Contact Person
Contact of Public School/s:
UPPER PULACAN ELEMENTARY SCHOOL
Form of Intervention: (Choose any of the two or both)
A. Donation in kind for: (Please Check the desired donation)

____1. Repair of Desk/Chairs/tables

____2. Repair of HE Ceiling

____4.
Repair
of

____ 3. Repair of School Canteen

door/window jams
____5. Repainting of Roofing (back of 5 bldgs.)
____
6.
Repainting
of
concrete perimeter fence
____7. Repainting of Front Walls
____8.
Repainting
of
window/door jams
____9. Repainting of desks/chairs/tables
____10. Repainting of HE ceiling
____11. Enhancing of landscaping
____12. Cleaning the school
ground/gardens
____13. Tapping electric connection to (2) DepEd/DPWH Comfort Rooms
____14. Concreting of entrance garage
Specific Materials / donations to be given

B. Volunteer Man-days/Labor Support

Nature of Volunteer Services

Time and Date/s of Availability

Please submit filled-out form to the principal of the school that you plan to help

HON. JESUS L. DAOALA

LENIE P. MARQUEZ

Barangay Chairman Upper Pulacan

School Principal

Chairman BE Resource
Mobilization Committee

Thank you very much!