Professional Documents
Culture Documents
Name: ___________________________________________________Age:______________
Address: ___________________________________________________________________
Do you collect water for drinking? ___Yes___No Do you use wood for cooking?___Yes__No
A 4Ps Beneficiary? ___Yes___No Do you have loans? ___Yes___No Amount of loan _____
Knows How to Bike? ___Yes ___No If No, Willing to be Trained? ___Yes ___No
_________________________________ _______________________________
Applicant’s Signature Over Printed Name Parent’s Signature Over Printed Name