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EXTENSI
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CECENTER
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.(052)820-82-38/
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COMMUNI
TYNEEDSASSESSMENT
Bar
angay/Muni
cipal
it
y/Provi
nce___________________
DateConducted:_________________________________
Conductedby: _________________________________
College/
Uni
t: _________________________________

I
ns t
ructi
on:Pag-ar al
angmabut iangmganakal i
stananagl al
arawanngi nyongpangunahi ngkailangan,
prayori
dad,atmgadapati sa-alangalangngbar angaypat ungkols akaunlaran.Lagyanngt sek( /
)s apatlango
sa()kungnaaayons akal agayanngbar angayninyo.Sal amatpo.
A.Pisi
kalnaKaanyuan
kapatagan( ) bulubunduki
n( ) baybayin( )I bapa________________
______mal ayosa kabayanan ______mal akiangbahagdanngl upaingamits at i
rahan
______mal ii
tanglawakngl upangtaniman ______mgabul ubundukin/burolhi ndinagagamit
______panotnaangmgabul ubundugin/
burol ______mayl andsi
des al ugal
______nat uyoangmgai l
og/ tal
on/spr
ing ______bihiranaangmganani rahanghayops abundok
______illegalloggi
ng ______paggawangul ingngmgapunongkahoy
______Kul angs asust
ansiyaangl upangtaniman _____pagbaha
I
bapa: _____________________________________________________________________________
______________________________________________________________________________

B.KaanyuhangPangl ipunan
_______mal akiangpami lya( <4anak) ______mar amiangnas a0-1 5t aonggul ang
_______hindipant ayangdamingbabaes alal aki____mar amiangmayanak,0-6t aonggul ang
_______mal i
itangagwatngpanganganak ______isaangmayt rabahos apami l
ya
_______kabahayanyar isamagaangmat er yal/ ______hi ndipag-aar iangl upangt ini
ti
r i
kan
Barong-bar ong ______hi ndipag-aar iangbahaynat i
nitir
han
_______mat aas :drop-outr atesael ement ary ______mgaOSYhi ndinakapag-ar al
_______kul angs api nag-ar alanangmga ______kakul angans apaar alan( sili
d-aralan,mgagami t
,
magul ang/ headoff amily teacher s,ibangpas i
lidad_________)
_______Lowr eadingcompr ehens ion ______kul angs akas anayans apags alit
aatpags ulat
_______kul angs aliter acynakaal aman saEngl i
sh/Pili
pino
_______ kailanganngkar agdagangkas anayans apagt uturoangmgat eacher s
_______kul angangnagt at r
abahonas at aonggul ang1 5-60
_______kul angangpas i
li
dads akal us ugan ______kul angangt auhans as erbisyongkal usugan
_______wal angbot i
kas abar angay ______madal angangpunt angs erbisyongkal us
ugan
_______mar amiangnagkakas akitng ____________________________________________________
_______s anhingpagkamat ayngmgat aomal imitay________________________________________
_______hi ndilahatngmgabat a,0-1t aonggul angkumpl etoangbakuna___wal angher balgardening
_______madal angnapagpur gas amgabat a3-1 2t aonggul ang ___hi ndingpr aktisngf amilyplanning
_______mar amis amga0-6,7-1 2t aonggul angaypayat ,maput l
a/mababaangt i
mbang
_______maymat ang-manok _____maybos yo _______mayanemi a ___wal angheal thinsurance
_______hi ndieks klus iboangpagpas usos agat asngi nas aloobna0-6buwanggul angngbaby
_______maagaangpagwal ays apagpas usongbat a(simul a3-4buwanggul angangbaby)
_______hi ndimas ust ans i
yaangkar agdagangpagkai nbigays amgabat as imula6nabuwanggul ang
_______kul angs akaal amanngpaghandangpagkai npar as amgami yembr ongpami l
ya
_______kaunt iangal am s aiba’ti bangkl asengl utongkat ut ubong/ i
bapangpagkai n
_______maymgapamahi ins amgapagkai n ____hi ndiwas t
oangpagkai n
_______ Kul angangkaal amans apag-i mbak/ procesongmgapagkai n
I
bapa______________________________________________________________________________
_______________________________________________________________________________

C.KalagayangPangkabuhayan
_______mababangbuwanangki ta _________hi
ndipi
rmihanangtrabaho
______kulangangkasanayan( s
kil
ls)s
akabuhayankatul
adng________________________________
_______mgamaybahaywal angdagdagki
tanapwedenggawi nsabahay

BU-F-ESC-15
Rev.No.0
Eff
ecti
vit
yDate:Nov.8,201
1
 BI
COLUNI
VERSI
TY
EXTENSI
ONSERVI
CECENTER
BUREPCBui
l
ding,LegazpiCi
ty
Tel
.Nos
.(052)820-82-38/
481-1
6-21 Email
:bu_es
c@yahoo.
com

I
bapa_____________________________________________________________________________
__________________________________________________________________________________
Kulangangkaal amans at eknol ohi yangpags as aka,pag-aal aganghayop
_______kaunt iangur ingmgat inat anim nagul ayoi naalagaanghayop
_______wal angcapi tals apagt ani m os akabuhayan ________kul anganggami t/makinar yas apagt anim
________kul angangmar kets amgapr odukt o _______mahalangbi li
hin
________Kul angangpambi l
ingpagkai n _______Kul angangbi li
han/ kalakals abar angay
________hi ndis apatangpr odukt os apags asaka/ paghahayupan
________madal angangpagkakat aons apaghapbuhay ______
________Kul angangkaal amans apags imul angnegos yo/ pagl akadngpapel ess anegos yo/ pamamal akadng
negos yoohanapbuhay
________ kul angkaal amans apangi ngi sda/ fishpondes tabl i
shment
________Kul angangs er bisyos a()pagpagupi tngbuhok ()s astre/pananahingdami t
()t ubero ()kar pent ero ()el ect ri
cian ()s arisaris t
or e ( )i bangt i
ndahan_______
I
bapa______________________________________________________________________________
_______________________________________________________________________________
D.Pangl i
punangI mpr astakt ura
_______bako-bakongdaan/ foot wal k ______wal angr i
prapangkanal
_______ nas i
rangt ulay ______wal angkur yent eangi bangkabahayan
_______wal angmal i
nisnamapagkunanng ______mal ayongpag-i i
gibngt ubig
inumi ngt ubig ______s ir
aangwat err eservoi r
_______wal angBar angayHal l
/Bar angayHeal thSt ati
on/ Li
br ary ____kul angangs erbi
s yongs asakyan
_______wal ang Nut rit
ion/ DayCar eCent er
_______kul anganggami t /
pas ili
dads abar angay()t i
mbangan/ pagkuhangt aas ()bl oodpr essur e
apparat us ( )comput er()f i
lingcabi net s ( )cooki ngut ens il
sandequi pment ()mobi let r
icycle
()gami tngBgy.Tanod ()bas ket ballcour t()r i
cemi l
l()s olardr yer ibapa____________________
_______kul angs akaalamans apagkumpuningmgai mpr astakt ura
_______kul angangpar aanngkomuni kas yongal i
ngatpapunt as abar angay kat uladngr adio,t v,cellphone,
tel
epono
_______ Kakul anganngkaal amans amgapr ogr amangpangkaunl arannggobyer noatmgai ba’tibang
ahensiya,non-gover nmentor gani zat i
ons ,at bp.
I
bapa______________________________________________________________________________
_______________________________________________________________________________
F.KalagayangPangpul it
ika
_______wal angr esolusyons amgapanukal angpambar angay
_______wal angor dinans angi si
nas atupar ant ungkols a_____________________________________
_______madal angnapagpupul ongng()Bar angayCounci l ()mgaor ganisasyons abar angay
_______ hi ndibuoangmgaor gani sasyonos amahans abar angay
_______wal angBar angayI nt egr atedDevel opmentPr ogram/ Plan/ AnnualI nves tmentPl an
_______wal angor ganizat ionalchar tsaBar angayDevel opentCounci l
_______wal angmi nut esofmeet ingang ()Bar angayCounci l()Bar angayNut rit
ionCommi ttee
()I bapa ____i lan/ madal angangmgaahens i
yangpumupunt as abar angay
_______Kul angs akas anayans al eader ship/ managementofbar angaygover nance
_______ Kakul anganngkaal amans amgapr ogr amangpangkaunl arannggobyer noatmgai ba’tibang
ahensiya,non-gover nmentor gani zat i
ons ,at bp.

I
bapa______________________________________________________________________________
_______________________________________________________________________________

I
nul
at/I
nihandani
:

__________________________________ ___________________
Pangal
an/Lagda Petsa

BU-F-ESC-15
Rev.No.0
Eff
ecti
vit
yDate:Nov.8,201
1
 BI
COLUNI
VERSI
TY
EXTENSI
ONSERVI
CECENTER
BUREPCBui
l
ding,LegazpiCi
ty
Tel
.Nos
.(052)820-82-38/
481-1
6-21 Email
:bu_es
c@yahoo.
com

BU-F-ESC-15
Rev.No.0
Eff
ecti
vit
yDate:Nov.8,201
1