Value-Based

VALUE-BASED
ACTIVITY PROPOSAL
Note:
All Activity Proposals shall be submitted to the VPAA Office at least one (1) week prior to the actual date
of the activity to allow time for processing.

Department: Institute of Health Sciences Date of Filing: September 4,2019

This section is for student clubs/organizations:

Proponent (Club/Organization/):____________________________________________________
Members of the Committee:
___________________________ ___________________________
___________________________ ___________________________
___________________________ ___________________________
___________________________ ___________________________
Date/s of Meeting/s for the Activity:
___________________________ ___________________________
___________________________ ___________________________
Venue/s of the Meeting/s for the Activity:
___________________________ ___________________________
___________________________ ___________________________
Name and Signature of the Committee Head and Club/Organization Adviser

___________________________ ___________________________
Committee Head Adviser
_____________________________________________________________________________________

I. GUIDING VALUE
In this proposal, the proponents intend to promote the value of:

Name the Value Name the Skill/Attribute

Christ centeredness + Service

Guide:
Value = Gospel Value or CIC Core Value
Skill = 21st Century
Attribute = Graduate Attributes

II. MEANING OF THE VALUE

Note:
● The meaning of the selected Value and Skill/Attribute will be based from the
meaning/interpretation of values pre-determined by their department
● Each department (PSGS, JHS, SHS, College) have their own pre-determined
meaning/interpretation of values
____________________________________________________________________________

III. APPLICATION OF THE VALUE IN THE ACTIVITY

Note:
Based from the meaning of value, the proponents are to state how the value will be applied in the
proposed activity.
____________________________________________________________________________
____________________________________________________________________________

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IV. TITLE OF THE ACTIVITY

Note:
The Title of the activity must reflect or relate to the Value/Attribute/Skill and their application.

V. THIS ACTIVITY COMPLEMENTS THE FOLLOWING SUBJECTS:

Note:
The proponents are to identify the subject/s that will enhance specific competencies that will help
achieve the desired appreciation of values in the students through the proposed activity.
____________________________________________________________________________
____________________________________________________________________________

VI. OBJECTIVES
Note:
● The objectives must be aligned with the prescribed competencies and with how the value is put to
use (operationalized in the proposed activity.
● The objectives must be demonstrable and measurable.

At the end of the activity, the students can or will be able to….
_________________________________________________________________________
_________________________________________________________________________

VII. EVALUATION OF THE ACTIVITY

Note:
● The design and content of the evaluation must adhere to the key ideas of the objectives.
● The items that are to be found in the evaluation must come from the items written in the
objectives.
● A Rubric for rating the items in the evaluation must also be included to ensure validity and
reliability of evaluation results.
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________

VIII. OTHER DETAILS OF THE ACTIVITY

Note:
Shade the appropriate box/es and fill-out the details (as applicable) in the spaces provided

□ In-Campus □ Seminar/Training, Workshop/Conference

Nature of Activity
□ Off-Campus □ Contest/Competition
□ Community Extension/Outreach Program
□ to attend
□ Others_____________________________
□ to conduct
□ to host
Level □ Local □ Regional □ International
□ Provincial □ National
Department
Club/Organization
Participants
Date
Time
Venue
Proposed Budget
Source of Budget

IX. TIMELINE FOR TASK ACCOMPLISHMENT (Gantt Chart)

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 Value-Based
Note:
● Identify the major tasks required for the proposed activity.
● Fill-out the table based on the order of the tasks to be done, the person in-charge of the
task, and the timeline for accomplishing the task.
● Indicate the target date for the start and the end of each of the tasks.
● In the timeline, indicate the dates and shade according to the expected period of task
accomplishment
TASKS PERSON/S Start End TIMELINE FOR TASK COMPLETION
INCHARGE Date Date Date Date Date Date Date
Task 1
Task 2
Task 3
Task 4
Task 5

X. PROGRAM OF ACTIVITIES
Note:
● Insert the Program Outline, or Flow of Program or include the Program Sheet as an
attachment

XI. BUDGET PROPOSAL

Note:
● Liquidation of Expenses must be done and submitted within 2 weeks from the date of the
activity.
Expenses Source of Fund Amount Quantity Total Amount
Registration
Materials/Supplies
Transportation
Meals
Other Expenses
Contingency
Grand Total

Prepared by: Noted:

Name & Signature Name & Signature

of Club/Organization Officer of Club/Organization Adviser
or Faculty/Personnel or Department Chair/Head

XII. BUDGET AVAILABILITY

Note:
● Attachment as it applies:
o For student clubs/organizations:
▪ A copy of the print out of available club/organization fund from
the Accounting Office endorsed to the Activity Coordinator. The
computations of which are based on the number of students of
the organization x amount of club fee/student.

o For Department-Organized Activities:

▪ A copy of the section of the department budget that shows the
activity and the allotted budget for such.

For student clubs and organizations:

● Actual amount that is readily available based from the records from the Accounting
Office

Amount of Available Fund: Attested by:

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___________________________ ___________
(to be accomplished by the Activity Coordinator) COORDINATOR, ACTIVITY DATE SIGNED

For Activities with Proposed Budget exceeding Certification of Budget Availability:

Php 10,000.00
___________________________ ___________
ACCOUNTANT DATE SIGNED

ACTION TAKEN:

Recommendation
Note: the recommending signatory will depend on the nature of the activity
For Clubs and Organizations, Co-curricular-Related For Course-Related Seminars, Trainings, etc. and
Seminars, Trainings, etc. for Department-Organized Activities

_______________________ ______________ __________________________ ____________

HEAD, OSA DATE SIGNED DEPARTMENT HEAD/PRINCIPAL DATE SIGNED

Approval
For Activity Budget up to Php 10,000.00 For Activity Budget exceeding Php 10,000.00
□ Approved □ Disapproved □ Approved □ Disapproved
_______________________ ____________ _________________________ __________
DR. AMADO J. ESTONILO III DATE SIGNED REV. FR. MICHAEL F.I. VENERACION DATE SIGNED
VPAA/DEAN, Institute of Higher Studies CIC PRESIDENT

ATTACHMENTS FOR OFF-CAMPUS ACTIVITIES/SEMINARS:

● Letter of Invitation (if applicable)
● Parent’s Consent Form and Accomplished Waiver Form
● List of Students/Participants
● Authority to Travel and Trip Ticket

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