Document Code: DEPED-LCN-SDO-AD

Document Title: ACTIVITY DESIGN

Revision: 3 Page: 1 of 2
Prepared: QMR Reviewed: ASDS
Approved: SDS Effectivity: AUG. 8, 2019

TITLE: ________________________________________________________________________________
SCHOOL/ OFFICE: _____________________________________________________________________
PROPOSED VENUE_____________________________ PROPOSED DATE___________________

PARTICIPANTS MALE FEMALE TOTAL

Teaching Related (School Head, CID & SGOD )
Teaching (Teachers)
Non-Teaching (OSDS)
PMT & TWG (SDS,ASDS, etc.)
Others (Speaker, guests, students, etc)
TOTAL

FUNDING SOURCE ☐MOOE ☐ Canteen Fund ☐ SARO No.

☐Other Funds Please (Specify)
PROPOSED BUDGET Food / Food and Accommodation
*Materials
*Others
TOTAL

FOOD
Number Unit Particulars: Unit Price Total Price
Participants

SUB-TOTAL

 For Materials and Others: Please attach Purchase Request (school) or Market Survey/
Canvass Form (division personnel proponent) as applicable

PROPONENTS DESIGNATION SIGNATURE

RATIONALE:
What are the mandates or legal (RA, Order, or Memo) basis of the activity?

Why this activity needs to be conducted? What are the situation, problems, issues you wanted to
resolve?
 Document Code: DEPED-LCN-SDO-AD
Document Title: ACTIVITY DESIGN
Revision: 3 Page: 2 of 2
Prepared: QMR Reviewed: ASDS
Approved: SDS Effectivity: AUG. 8, 2019

OBJECTIVES/ EXPECTED OUTPUT:

Who will be the What observable What support/s are needed What are the measure
beneficiary of the performance is for the achievement of the (standard) for acceptable
activity? expected? objective? performance?

Technical Working Group

Program, Invitation & Certificates
Committee:
Registration Committee:
Evaluation Committee:
Documentation Committee:
Health and Wellness Committee:
*If applicable

What are the risks considered? How will you address them?

REFERENCES:

*Please attach the matrix of activity and list of participants

REVIEWED BY:

Printed Name and Signature

Immediate Supervisor