Pikit National High School

SENIOR HIGH SCHOOL DEPARTMENT

Community Engagement, Solidarity and Citizenship (CESC)

Name of student: ____________________________________ 12 HUMSS ___

Subject Teacher: Ronald Paz Rocha

i.

Title of Activity: ______________________________________________

Objectives: 1. _________________________________

2. ___________________________________

Nature of Activity: (at least 2 paragraphs)

_____________________________________________________________________________________

Type of Activity:

Date of Activity: (Duration) ___________________________________________

Head: ______________________________________________

Venue of the Activity: ___________________________________

Level/Age of Participants: _________________________________

Number of Participants (minimum of 3, maximum of 4 only)

ii.

Table 1: Program Design

1.1 Research Stage

Date Duration Brief Description Person in charge

(at least 2 paragraphs)

1.2 Design Stage

Date Duration Brief Description Person in charge

(at least 2 paragraphs)
1.3 Implementation Stage

Date Duration Brief Description Person in charge

(at least 2 paragraphs)

1.4 Evaluation Stage

Date Duration Brief Description Person in charge

(at least 2 paragraphs)

Table 2: Breakdown of Expenses

Materials Quantity Unit Cost Total Cost

(100-200 ONLY)

Table 3: Allocation of Funds

Source of Funds Amount

Timeline:

1. Making of Proposal – June 3-9, 2021

Output: Written/Printed documents. (i. activity, ii. Program design, budget, allocation)
To be submitted during the retrieval of modules on June 10.

2. Implementation of the Activity – June 10-18, 2021

Output: Pictures w/ description (from preparation, actual implementation and evaluation)

To be submitted on June 24, 2021.

3. Evaluation of the Activity – June 18, 2021

Output: Written/printed evaluation from the participants. Any evaluation related to your
activity.
To be submitted on June 24, 2021