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ANNEX A

ABOT ALAM: A NATIONAL PROGRAM FOR OUT-OF-SCHOOL YOUTH

OFFICIAL REGISTRATION FROM (Revised)


Ang abot alam ang pinakamalaking programa para maibalik ang mga Out-of-School Youth (OSY) sa pag-aaral,
mabigyan ng karampatang edukasyon, skills training/ pagsasanay at oportunidad sa trabaho o livelihood. Saklaw
ng programang ito ang mga kabataang hindi nakapag-aral, hindi nakapagtapos ng pag-aaral sa gulang na 15
hanggang 30 anyos.

Survereyor's Name:

Complete Address of Surveyor:

Position/ Office/ Affiliation ng Surveyor:

Barangay:

COMPLETE NAME
/Kumpletong Pangalan (i.e.
Last Name, Given Name,
Middle Name) (Extension
name if any ex. JR, SR, III)

BIRTHDATE / Kaarawan
(MM/DD/YY)

AGE / Edad

Sex (M/F)

CONTACT DETAILS /
COMPLETE ADDRESS /
Impormasyong pwedeng Tirahan (i.e. No., Street,
Tawagan (i.e. Email
Brgy., City or Municipality,
address, Cellphone &
Province)
Landline Number)

GABAY:LEGEND: REMARKS* | ALS** Alt


Accreditation & equivalency ProgramInformal Educaation |(PWD)***Persons
Impaired; PWD-PI- Physically Impaired

City/Municipality:

PARENTS/
GUARDIAN
(Magulang /
Tagapangalaga)
Complete Name

EDUCATION/Pinakamat
aas na Antas ng
Edukasyong Naabot
(i.e Elementary Grade,
Year in High School,
College)

D: REMARKS* | ALS** Alternative Learning System|** Isulat ang ALS-BLP-ALS Basic Literacy Program; ALS-A&E elem ALS
& equivalency Program-Elementary; ALS-A & e SECOND. ALS Accreditation & equivalency Program Seonary; at ALS-Infed aation |(PWD)***Persons With Disabilities/ May Kapansanan| ***Isulat ang PWD-Hi-Hearing Impaired; PWD-VI-Visually
-PI- Physically Impaired; PWD-WSN- With Special Need

Email Address & Contact # of Surveyor:


Province/ Lalawigan:

PREFERRED TRACK/ Planong


Gawin (i.e. Education,
Employment,
Entrepreurship/ Skills
Training) (Puedeng Higit sa
Isa ang lagyan ng Ekis)

REMARKS * Isaad kung NUMBERS Indicate number


Benepisyaryo ng
of the ff if any/Isaad ang
Programa ALS**, PYAP, mga numero, kung meron:
4Ps etc. Kung May
SSS, GSIS, Philhealth,
Kapansanan/ (PWD)*** Pantawid Household, CRN,
(N/A if Not Applicable)
etc.)

Reason of becoming OSY

Enclosure No. 2-A to DepED Memo No. 41, s. 2015


Republic of the Philippines
DEPARTMENT OF EDUCATION
Region 02
Division of Nueva Vizcaya

BRIGADA ESKEWELA 2015


NUMBER OF VOLUNTEERS
Private Sector
School_ID

School_Name

TOTAL
Prepared by:

NGO (PTA, SGC,


Gawad Kalinga,
etc.)

Community

Corporation

Parents

Private
Individual/Co
Alumni
mmunity
Member

Religious
Organizations
(Youth and
Adult)

Congressional
Officials and
Staff

Provincial
Officials

ASP Division Coordinator

BE school Form 1

s
N

2015

VOLUNTEERS
Government Agencies/National & Local
City/
Municipal
Officials

Barangay
Officials

SK
Officials

0
Approved by:

Provincial/
City/
Municipal
Employees

Firement/P
NP

AFP(PA,
Marine,
Airforce,
etc.)

Barangay
Other
Workers Volunteers

Total
Number of
Volunteers

SAMUEL R. SOLIVEN, Ph.D.


OIC, Schools Division Superintendent

Enclosure No. 2-A to DepED Memo No. 41, s. 2015


Republic of the Philippines
DEPARTMENT OF EDUCATION
Region 02
Division of Nueva Vizcaya

BRIGADA ESKEWELA 2015


RESOURCES GENERATED
School_ID

School_Name

Hardware Materials for Classroom


Repairs
Qty.

TOTAL
Prepared by:

Item

Hardware Materials for Toilet Newly Construction/ Repair

Amount (in
Peso)

Qty.

Item

Religious
Amount (in Peso) Organizations (Youth
and Adult)

Hardware Materials for Wash Fa


Construction/Repair
Item

Coordinator

BE school form 1.1

ppines
UCATION

izcaya

ELA 2015

ERATED

dware Materials for Wash Facilities Newly


Construction/Repair
Religious
Amount (in Peso) Organizations (Youth
and Adult)

0
Approved by:

Other Donations
Item

Religious
Amount (in Peso) Organizations (Youth
and Adult)

Total No. of
Volunteers

Total No. of
Hours
Rendered
(Labor)

Volunteer
Man hours
(Amount in
Peso)

Total
Amount (in
Peso)

SAMUEL R. SOLIVEN, Ph.D.


OIC, Schools Division Superintendent

Enclosure No. 2-A to DepED Memo No. 41, s. 2015


Republic of the Philippines
DEPARTMENT OF EDUCATION
Region 02
Division of Nueva Vizcaya

BRIGADA ESKEWELA 2015


DIVISION CONSOLIDATED REPORT
NUMBER OF VOLUNTEERS
Private Sector
School_ID

School_Name

TOTAL

NGO (PTA, SGC,


Gawad Kalinga,
etc.)

Community

Corporation

Parents

Private
Individual/Co
Alumni
mmunity
Member

Religious
Organizations
(Youth and
Adult)

Congressional
Officials and
Staff

Provincial
Officials

Prepared by:

ASP Division Coordinator

BE school Form 1

s
N

2015

REPORT

VOLUNTEERS
Government Agencies/National & Local
City/
Municipal
Officials

Barangay
Officials

SK
Officials

Provincial/
City/
Municipal
Employees

Firement/P
NP

AFP(PA,
Marine,
Airforce,
etc.)

Barangay
Other
Workers Volunteers

Total
Number of
Volunteers

Approved by:

SAMUEL R. SOLIVEN, Ph.D.


OIC, Schools Division Superintendent

Enclosure No. 2-A to DepED Memo No. 41, s. 2015


Republic of the Philippines
DEPARTMENT OF EDUCATION
Region 02
Division of Nueva Vizcaya

BRIGADA ESKEWELA 2015

DIVISION CONSOLIDATED REPORT


RESOURCES GENERATED
School_ID

School_Name

Hardware Materials for Classroom


Repairs
Qty.

TOTAL

Item

Hardware Materials for Toilet Newly Construction/ Repair

Amount (in
Peso)

Qty.

Item

Religious
Amount (in Peso) Organizations (Youth
and Adult)

Hardware Materials for Wash Fa


Construction/Repair
Item

Prepared by:

ASP Coordinator

BE school form 1.1

ppines
UCATION

izcaya

ELA 2015

LIDATED REPORT

ERATED

dware Materials for Wash Facilities Newly


Construction/Repair
Religious
Amount (in Peso) Organizations (Youth
and Adult)

Other Donations
Item

Religious
Amount (in Peso) Organizations (Youth
and Adult)

Total No. of
Volunteers

Total No. of
Hours
Rendered
(Labor)

Volunteer
Man hours
(Amount in
Peso)

Total
Amount (in
Peso)

Approved by:

SAMUEL R. SOLIVEN, Ph.D.


OIC, Schools Division Superintendent