LEARNING SITE FOR AGRICULTURE (LSA)

CHECKLIST OF REQUIREMENTS

Name of Farm - ___________________________________________________________________________________________

Name of Farm Owner - ___________________________________________________________________________________________
Land area (Hectare/s) - ___________________________________________________________________________________________
Address - ___________________________________________________________________________________________
Contact No. - ___________________________________________________________________________________________
E-mail Address - __________________________________________________________________________________________
Method of Farming System ______ Conventional _____ Semi-conventional
______ Natural Farming System

LS/SPA Category 1. According to Technology Practiced

_____ Farming LSA
_____ Agri-Processing Enterprise
2. According to Type of Assistance Provided
_____ With Financial Assistance
_____ Technical Assistance Only

Not
Requirements Complied Remarks
Complied
1. Letter of Intent (either of the following)
a. Letter of Intent duly signed by the
farm owner/ processor/manager
b. Letter of Endorsement/
Recommendation by the LGU and
other entities
c. Letter of Endorsement/
Recommendation by the ATI
2. Technical Requirements
a. Accomplished Farm Profile Form duly
signed by the farm owner/processor/
manager
b. LSA Acceptance Evaluation Form
c. Acceptance to Become LSA Form
d. Farm Development Plan

Validated by: Reviewed by:

_______________________________________ ________________________________________
Signature over printed name Signature over printed name
Designation Designation
Date:_________________________________ Date:__________________________________

ATI-QF/PAD-95 Rev. 00 Effectivity Date: November 16, 2019