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University Extension Services Center College/Department

 Copy of the benchmark survey of the  Copy of the benchmark survey of the Office of the President
problems, needs and resources of the problems, needs and resources of the  Copy of a Special Order granting permit to
community community faculty/department/college to conduct the
 Copy of Memorandum of Agreement or  Matrix showing portion of the extension program/activity
Memorandum of Understanding with curriculum/syllabi suggesting an extension
partner organizations and institutions program and the corresponding activity OVCRED
 Proof of Research extension conducted  OVCRED brochure/catalog/journal
Forum/Planning session ( minutes of  Memorandum of Agreement or
meetings, attendance list, photo Memorandum of Understanding with MSU-TIC
documentation) partner organizations and institutions  MSU-TIC brochure or MSU Intellectual
 List of extension program/activities reflect  Copy of a Special Order granting permit to Property Office brochure
the University’s VMGO faculty/department/college to conduct the
 Organizational Chart of the University extension program/activity Office of the BOR
Extension Services Center  Proof of Research extension  Copy of the extension manual duly
 Curriculum Vitae of Extension Forum/Planning session ( minutes of approved by the university
Director/Coordinator with his/her function meetings, attendance list, photo
and PDS documentation)
 List of Extension services personnel (name,  List of extension program/activities reflect
core functions, job description and the college/department’s VMGO
employment status)  Guidelines on the conduct of the extension
 Copy of the operational plan of the program
university on extension services  Process Documentation Report
 Individual Performance and Commitment  Event feedback sheet
Report  College Organizational Chart including the
 List of consultant/experts from various Extension Coordinator
disciplines to serve in special extension  Curriculum Vitae of College Extension
project with their curriculum vitae and PDS Coordinator with his/her function and PDS
 Photo documentation on the  Copy of the operational plan of the
implementation of planned extension college/department on extension services
program  Individual Performance and Commitment
 Process Documentation Report Report
 Workbook/worksheet  List of consultant/experts from various
 Photo documentation on the disciplines to serve in special extension
technologies/news/information project with their curriculum vitae and PDS
disseminated to the clientele  Photo documentation on the
 Copy of the extension manual duly technologies/news/information
approved by the university disseminated to the clientele
 Activity report Instrument  Activity report Instrument
 Community Entry Form/Survey  Community Entry Form/Survey
 Parental/Guardian Consent and Waiver  Parental/Guardian Consent and Waiver
Form Form
 Feedback Session Tool  Feedback Session Tool
 Evaluation Survey Result  Evaluation Survey Result
 Copy of the periodic monitoring and  Copy of the periodic monitoring and
evaluation results of the extension evaluation results of the extension
activities to provide feedback on the activities to provide feedback on the
program program
 Copy of the budgetary requirements for  Documentation on the efforts done by the
the extension program college on finding and partnering with
 Line item Budget approved by the other agencies in implementing the
Department of Budget and Management extension program (MOA/MOU and
 Financial Work Plan by the university Acknowledgement Receipt)
signed by the Finance team  Proof that the college/department sources
 Documentation on the efforts done by the out technical assistance and service inputs
university on finding and partnering with from other agencies
other agencies in implementing the  Proof of community participation in the
extension program (MOA/MOU and planning and implementation of extension
Acknowledgement Receipt) activities (minutes of meetings, photos,
 Proof that the university sources out attendance sheet) and Process
technical assistance and service inputs Documentation Report
from other agencies  Documentation on technology adoption,
 Proof of community participation in the utilization and commercialization
planning and implementation of extension  Copy of a sustainable extension
activities (minutes of meetings, photos, development plan and projects for the
attendance sheet) and Process next 5 years together with Evaluation
Documentation Report Survey Results, Extension Program Impact
 Documentation on technology adoption, Assessment, Process Documentation
utilization and commercialization Report
 Copy of a sustainable extension  Photo evidence of the meetings and
development plan and projects for the events conducted between partner
next 5 years together with Evaluation organizations/institutions
Survey Results, Extension Program Impact
Assessment, Process Documentation
Report
 Photo evidence of the meetings and
events conducted between partner
organizations/institutions

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