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ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT

aspsch_form 01

As of March 31, 2015


Region:
Division:
School:
Address:
School ID:
Contact Nos.:

LEARNING ENVIRONMENT
DONATIONS

PARTICULARS

QTY.

AMOUNT

DONOR'S NAME
PRIVATE SECTOR

LGU

GOVERNMENT AGENCY

INTERNATIONAL

DATE COMPLETED/
TURN-OVER

aspsch_form 01

TOTAL
*

Please attach the following documents:

GPTA

Prepared by:

Noted by:

1. Deed of Donation
2. Deed of Acceptance
School Head/Principal/OIC

ASP Division Coordinator


Approved by:
Schools Division Superintendent

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT

aspsch_form 02

As of March 31, 2015


Region:
Division:
School:
Address:
School ID:
Contact Nos.:

LEARNING SUPPORT
DONATIONS

PARTICULARS

QTY.

DONOR'S NAME

AMOUNT

PRIVATE SECTOR

LGU

GOVERNMENT AGENCY

INTERNATIONAL

1.

2.

3.

4.

TOTAL
*

Please attach the following documents:

Prepared by:

Noted by:

1. Deed of Donation
2. Deed of Acceptance
School Head/Principal/OIC

ASP Division Coordinator


Approved by:

DATE COMPLETED/
TURN-OVER

Schools Division Superintendent

aspsch_form 02

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT

aspsch_form 03

As of March 31, 2015


Region:
Division:
School:
Address:
School ID:
Contact Nos.:

_____________________ Email Address: _________________________

TECHNOLOGY SUPPORT
DONATIONS

PARTICULARS

QTY.

AMOUNT

DONOR'S NAME
PRIVATE SECTOR

LGU

GOVERNMENT AGENCY

1. COMPUTER

2. ELECTRONIC LEARNING
MATERIALS

3. INTERNET CONNECTIVITY

4. OTHERS PLS. SPECIFY

TOTAL
*

Please attach the following documents:

Prepared by:

Noted by:

INTERNATIONAL

DATE COMPLETED/
TURN-OVER

aspsch_form 03

1. Deed of Donation
2. Deed of Acceptance
School Head/Principal/OIC

ASP Division Coordinator


Approved by:
Schools Division Superintendent

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT

aspsch_form 04

As of March 31, 2015


Region:
Division:
School:
Address:
School ID:
Contact Nos.:

_____________________ Email Address: _________________________

HEALTH AND NUTRITION


DONATIONS

PARTICULARS

QTY.

AMOUNT

DONOR'S NAME
PRIVATE SECTOR

LGU

GOVERNMENT AGENCY

INTERNATIONAL

1. FEEDING PROGRAM

2. MEDICAL/DENTAL
MISSION/CHECK-UPS

3. DEWORMING
INTERVENTION

4. HEALTH SUPPLIES

5. OTHERS PLS. SPECIFY

TOTAL
*

Please attach the following documents:

Prepared by:

Noted by:

1. Deed of Donation
2. Deed of Acceptance
School Head/Principal/OIC

ASP Division Coordinator

DATE COMPLETED/
TURN-OVER

Approved by:
Schools Division Superintendent

aspsch_form 04

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT

aspsch_form 05

As of March 31, 2015


Region:
Division:
School:
Address:
School ID:
Contact Nos.:

_____________________ Email Address: _________________________

READING PROGRAM
DONATIONS

PARTICULARS

QTY.

DONOR'S NAME

AMOUNT

PRIVATE SECTOR

LGU

GOVERNMENT AGENCY

INTERNATIONAL

1. BOOKS

2. SUPPLEMENTARY
READING MATERIALS

3. OTHERS PLS. SPECIFY

TOTAL
*

Please attach the following documents:

Prepared by:

Noted by:

1. Deed of Donation
2. Deed of Acceptance
School Head/Principal/OIC

ASP Division Coordinator


Approved by:

DATE COMPLETED/
TURN-OVER

aspsch_form 05
Schools Division Superintendent

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT

aspsch_form 06

As of March 31, 2015


Region:
Division:
School:
Address:
School ID:
Contact Nos.:

_____________________ Email Address: _________________________

TRAINING AND DEVELOPMENT


DONATIONS

PARTICULARS

QTY.

DONOR'S NAME

AMOUNT

PRIVATE SECTOR

LGU

GOVERNMENT AGENCY

INTERNATIONAL

1. TEACHERS/PRINCIPAL TRAINING

2. STUDENT/PUPILS TRAINING
AND FIELD TRIP

3. OTHERS PLS. SPECIFY

TOTAL
*

Please attach the following documents:

Prepared by:

Noted by:

1. Deed of Donation
2. Deed of Acceptance
School Head/Principal/OIC

ASP Division Coordinator


Approved by:

DATE COMPLETED/
TURN-OVER

Schools Division Superintendent

aspsch_form 06

aspsch_form 07

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT


As of March 31, 2015
Region:
Division:
School:
Address:
School ID:
Contact Nos.:
DIRECT ASSISTANCE
DONOR'S NAME
DONATIONS

PARTICULARS

QTY.

AMOUNT

PRIVATE SECTOR

LGU

GOVERNMENT
AGENCY

INTERNATIONAL

1. STIPEND

2. OTHERS PLS. SPECIFY

TOTAL
* Please attach the following documents:
1. Deed of Donation
2. Deed of Acceptance

Noted by:
Approved by:
ASP Division Coordinator

DATE
COMPLETED/
TURN-OVER

Schools Division Superintendent

aspsch_form 07

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT

aspsch_form 08

As of March 31, 2015


Region:
Division:
School:
Address:
School ID:
Contact Nos.:

_____________________ Email Address: _________________________

ASSITIVE LEARNING DEVICES FOR STUDENT WITH SPECIAL NEEDS


DONATIONS

PARTICULARS

QTY.

DONOR'S NAME

AMOUNT

PRIVATE SECTOR

LGU

GOVERNMENT AGENCY

INTERNATIONAL

1. PENCIL GRIPS

2. SPECIAL CHAIRS
3. SPELLING CHECK DEVICES
4. HEARING AIDES
5. TALKING COMPUTERS
6. SPECIALIZED KEYBOARDS
8. BRAILLE (BOOKS)
9. COMPUTERIZED SYSTEMS
10. OTHERS PLS. SPECIFY

TOTAL
*

Please attach the following documents:

Prepared by:

Noted by:

1. Deed of Donation
2. Deed of Acceptance
School Head/Principal/OIC

ASP Division Coordinator


Approved by:

DATE COMPLETED/
TURN-OVER

Schools Division Superintendent

aspsch_form 08

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT


As of March 31, 2013

SCHOOL ID

TOTAL

SCHOOL

Learning
Environment

Learning
Support

Technology
Suppport

Health and
Nutrition

Reading
Program

Training and
Development

Direct
Assistance

Assistive
Learning
Devices

TOTAL

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT


As of March 31, 2015
Region:
Division:
School:
Address:
School ID:
Contact Nos.:

_____________________ Email Address: _________________________

LEARNING SUPPORT
DONOR'S NAME
DONATIONS

PARTICULARS

1.

AUDIO-VISUAL
EDUCATIONAL MATERIALS

2.

SCHOOL SUPPLIES

3.

EDUCATIONAL FILM/
LIBRARIES

4.

OTHERS PLS. SPECIFY

QTY.

AMOUNT

TOTAL
*

Please attach the following documents:


1. Deed of Donation
2. Deed of Acceptance

PRIVATE
SECTOR

LGU

GOVERNMENT
AGENCY

INTERNATIONAL

Prepared by:

Noted by:

School Head/Principal/OIC

ASP Division Coordinator


Approved by:
Schools Division Superintendent

DATE COMPLETED/
TURN-OVER