APPENDIX A

Republic of the Philippines

Province of Leyte
Municipality of Abuyog
)(
Abuyog Community College

RESPONDENTS EVALUATION SHEET FOR 4PS BENEFICIARIES

Personal information
(Detalye san Kalugaringon)

Name (ngaran): ___________________________________ Age (Edad): _______

Occupation: __________________
(Trabaho)

Educational Attainment: ______________________________

(pinakahataas nga Grado)

Name of Spouse: ___________________________________ Age (Edad): ________

(Ngaran san asawa)

Occupation: __________________
(Trabaho)

Number of Dependents: ______________________

(kadamoon han anak nga na depende)

Present/Educational Dependent(D) / Employed /

Name Age
Level Independent (I) Non-Employed

Time/ Years being 4Ps beneficiary: _____________

(Katuigon tikang magin miyembro han 4Ps)
Cash Receive/ Subsidy per month: _______________
(Kantidad han kwarta nga nadadawat kada bulan)
Direction: Please be guided by the following criteria in encircling the number of your answer

as the status of your living before and during your 4Ps grant.

(Alayon pag lidongi kon anu nga numero ikaw naangay sit iyo kabutangan san kamo

diri pa miyembro ngan san miyembro na kamo han 4Ps).

5 = Very Satisfactory (Kontento nga duro)

4 = Satisfactory (Kontento)

3 = Moderately Satisfactory (Igo la nakontento)

2 = Less Satisfactory (Waray Nakontento)

1 = Not Satisfactory ( Waray gud nakontento)

A. Education
(Pag-eskwela han mga bata) BEFORE (UGSA) DURING (ADI)

1. School supplies 5 4 3 2 1 5 4 3 2 1
(Mga gamit sa eskwelahan)

2. School attendance 5 4 3 2 1 5 4 3 2 1
(Pagsulod ha Skwelahan)

3. School Uniform 5 4 3 2 1 5 4 3 2 1
(uniporme)

4. Transportation 5 4 3 2 1 5 4 3 2 1
(Pamasahe)

5. Miscellaneous Fees 5 4 3 2 1 5 4 3 2 1
(Iba pa na mga baraydan)

B. Food
(Pagkaon)

1. Rice and bread 5 4 3 2 1 5 4 3 2 1

(Bugas ngan Tinapay)

2. Viand 5 4 3 2 1 5 4 3 2 1
(Sura)
 3. Beverages 5 4 3 2 1 5 4 3 2 1
(irimnon)

4. Fruits and vegetables 5 4 3 2 1 5 4 3 2 1

(Prutas ngan Utan)

5. Vitamins and milk 5 4 3 2 1 5 4 3 2 1

C. Health
(Panlawas)

1. Pre- and Post-natal care 5 4 3 2 1 5 4 3 2 1

(pag-mangno han pagburod)

2. Vaccination 5 4 3 2 1 5 4 3 2 1
(Bakuna)

3. Periodic check-ups 5 4 3 2 1 5 4 3 2 1
(konsultsyon ha doctor)

4. Personal hygiene items 5 4 3 2 1 5 4 3 2 1

(Gamit panlimpyo ha lawas)

5. Immediate medicines 5 4 3 2 1 5 4 3 2 1
(Medisina)Ex: Paracetamol

Direction: Answer the following question by checking YES or No

(Batona an mga masunod na pakiana hin pag butang hin check ha Yes o NO.)

1. Did 4Ps support your family in your living? ( ) Yes ( ) No

(Nakasuporta ba an 4Ps ha iyo pamilya sit iyo
panginabuhi?)

2. Did 4Ps change your social status in the community? ( ) Yes ( ) No

(Nakapagpabag-o ba an 4Ps han iyo kabutangan
dinhi han iyo kumunidad?)

3. Do you think 4Ps is effective in helping the poor? ( ) Yes ( ) No

(Epektibo ba an 4Ps han pagbulig han mga pobre?)

4. If 4Ps was not been implemented, can you sustain all ( ) Yes ( ) No
your needs?
(Kun waray 4Ps, ma akos ba niyo tanan nga iyo
kinahanglanon?)

____________________________
Respondent’s Signature