ADOPT A CHILD PROGRAM

PROFILE OF THE CHILD

NAME: __________________________________________
AGE: ___________________________________________
SCHOOL:
________________________________________________
GRADE/YEAR LEVEL: _____________________________
RELATIONSHIP WITH YOUR TUTEE:
______________________________________
FAMILY BACKGROUND:
NAME OF FATHER: _______________________________________________
NAME OF MOTHER: ______________________________________________
OCCUPATION OF FATHER: ________________________________________
OCCUPATION OF MOTHER: ______________________________________
AVERAGE MONTHLY INCOME: _____________________________________
SIBLING ORDER: _________________________________________________
NUMBER OF INDIVIDUALS IN THE HOUSEHOLD: ______________________

SCHEDULE OF REACHING OUT TO THE KID: _______________________________

NOTE:
1. Choose at least 1 respondent only
2. For children who belong to the marginalized sector (preferably)
3. 5 to 13 years old
 LETTER OF CONSENT

Date: ______

Ako si ______________________________________________________, ama/ina ni

____________________________________________ Edad ________________ ay
pinapahintulutan na matulungan ang aking anak ni ___________________________

na may kursong ___________________________________ sa __________________

mula _____________________ hanggang ________________________ sa oras ng

________________________.

Signature of parent: ________________________________

Noted by: ________________________________________ (dean)

PROGRESS REPORT/REFLECTION GUIDE:
1. Detailed story of what had happened/transpired during your outreach program.
2. Challenge or difficulties encountered.
3. Joys/positive things that you had encountered.
4. Other observations/suggestions
(ANSWER THESE IN PARAGRAPH FORM)

Note:
1. Reports/reflections should be submitted after every sessions (12 sessions of
2 hours each)
2. With documentation (5 pictures minimum)
3. With videos – maximum of 30 minutes
4. After every 6 sessions you will submit a feedback from your respondent.
Record a 2 to 3 minute video of their feedback.

GUIDE: Anong masasabi nyo sa pagtulong ni ate/kuya sa inyo?

Anong naalala sa mga itinuro/sinasabi ni ate/kuya?
Anong nagustuhan ninyo na katangian ni ate/kuya ?
Anong parte sa mga ginagawang pagtulong ni ate/kuya ang
kailangan nya pang paghusayin o ayusin?