Reference No.: BatStateU-FO-ESO-01 Effectivity Date: January 18, 2021 Revision No.

: 01

Title: EXTENSION PROGRAM PLAN / PROJECT PROPOSAL

Extension Service / Training is requested by clients.

Extension Service / Training is Department’s initiative.

I. Title of the Project/Activity:

II. Location:

III. Duration:

IV. Type of Community Extension Service:

V. Sustainable Development Goals (SDG):

VI. Office/s / College/s Involved:

VII. Program/s Involved (specify the programs under the college implementing the project):

VIII. Project Leader, Assistant Project Leader and Coordinators:

IX. Cooperating Agencies:

X. Beneficiaries (Type and Number of Male and Female):

XI. Total Cost of the Project and Sources of Funds:

XII. Rationale of the Project (brief description of the situation):

XIII. Objectives (General and Specific):

XIV. Description of the Project, Strategies and Methods (Activities / Schedule):

XV. Financial Plan:

XVI. Functional Relationships with the Collaborating Agencies (Duties / Tasks of the Cooperating Agencies):

XVII. Monitoring and Evaluation Mechanics / Plan:

XVIII. Plans for Ensuring the Sustainability of the Project:

Prepared by: Reviewed by:

NAME OF REQUESTING OFFICIAL/ NAME

PERSONNEL Director/Head, Extension Services/
Designation Head, Research and Extension Services
Date Signed: Date Signed:
Recommending Approval: Recommending Approval:

NAME NAME
Vice President/Vice Chancellor for Research, Vice President/Vice Chancellor for
Development and Extension Services Administration and Finance
Date Signed: Date Signed:
Approved by:

NAME
University President/Chancellor
Date Signed:

Tracking Number___________________ Page 1 of 2

Required Attachment: If Extension Service / Training is requested by clients, attach the letter of request with endorsement from the
University President.
Cc: (1) Office of the College Dean for CC/EC

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