COMMUNITY PROFILE

Name of
Community
Complete
Address

CONTACT PERSONS
Name

Contact Number

Caretaker Team
Homeowners
Association

PHYSICAL DEVELOPMENT
Year Established _______________________
Total Land Area ________________________
Community Infrastructure
Infrastructure
Houses
Total Number:
_________
Community Center
Health Center
School/Daycare

Yes or No

Year Completed

Walkways
Chapel/Mosque
Others, please specify

Basic Necessities
Electricity

Sewerage/Septic Tanks
Roads to the Village
Cable TV
Internet

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No Electricity
To the village
To the homes
Yes
No
Yes
No
Yes
No
Yes
No

Water Source (Please check all that apply)

[ ] Tap Water

i. Main Service Provider

___________________
ii. Rate per cubic meter P______ per cu.m
iii. Average consumption per family
______ cu.m

[ ] Deep Well

i. Distance from the community

____________
ii. Year Installed ______________

[ ] Public Pump

i. Distance from the community

____________
ii. Year Installed ______________

[ ] Individual Pump

i. No. of families with individual pumps

________
i. Distance from the community
____________
i. Distance from the community
____________
ii. No. of refilling stations near the
community ______________
iii. Price per container ______________
iv. Average monthly consumption per
family ______________

[ ] River/Spring/Ocean
[ ] Water Refilling Station

Wellness Water
1. Will the community have a dedicated space for the water filtration system?
____ Yes _____ No
a. What is the floor area? _____________
b. Is it free? ____ Yes _____ No. If no, how much is the monthly rental?
____________
2. How much is the community willing to pay for every container? ____________
3. Is the community willing to be mentored in running a business? ____ Yes _____
No
4. Who will be the person dedicated to running the water filtration system?
Name at least 3 options.
Full

Gender

Age

Gender

Age

Gender

Age

Name
Previous and
Current
Employment

Role in the
Community

Full
Name
Previous and
Current
Employment

Role in the
Community

Full
Name
Previous and
Current
Employment

Role in the
Community

Accomplished by:
_____________________________________
Name: _______________________________
Date: ________________________________