GI Form No.

Republic of the Philippines

PROVINCE OF _____________________
MUNICIPALITY OF _______________________
BARANGAY OF _________________________

REFERRAL FOR AFTER CARE PROGRAM

Date: __________

To: _______________________________

May we respectfully endorse _________________________, _______, residing at

______________________, to avail the services for his 3-month Aftercare and Follow-up
Program. He/she was enrolled at the General Intervention (G.I.) Program on
_______________ and has successfully completed the primary program of G.I. on
_________________.

For further information, please see attached Client’s Folder and the Aftercare Referral
Checklist below for your reference.

AFTERCARE REFERRAL CHECKLIST

The client may be referred to the following services during their 3-month Aftercare
Program:

 Technical Skills Enhancement

 Livelihood Training Activities
 Educational Programs
 Civic and Environmental Awareness Activities
 Job Placement/Employment
 Faith-based Organizations
 Support Groups

Thank you and more power!

Respectfully yours, Noted:

___________________________ ___________________________
Staff/Program Facilitator Barangay Captain