Enclosure No. 5 to Division Memorandum SGOD No. 022, s.

2022

Republic of the Philippines

Department of Education
Date:

AR No : N/A (Auto-generated once requested/prepared online)

FOR: NAME OF SCHOOL HEAD

Position/Designation

FROM: NAME OF PROPONENT

Position/Designation

SUBJECT: Activity Request

NAME OF
PROGRAM(S)/ Program/Project Name: Enhancement of School Improvement Plan (SIP)
PROJECT(S)
OUTPUT(S) TO BE State the “Output Code(s)” and the corresponding final output(s) to be
PRODUCED AND produced as reflected in the WFP including the physical target.
ITS CODE(S)
Output Code Output Physical Target
n/a 1. Enhanced School Improvement Plan 1
(Sample only)

ACTIVITY/IES TO Specific activities to be undertaken in order to produce the output. It may be a

BE REQUESTED series of workshops, trainings, writeshops, conferences, research initiatives,
studies, etc.

Activity Code Name of Activity/ies

001 1. Data Gathering Activities (Sample only)
002 2. Meeting with the School Planning Team (Sample only)
003 3. Workshop on the Enhancement of SIP (Sample only)
004 4. Printing of the Enhanced SIP (Sample only)

ACTIVITY/IES Write NONE if there is no request for

WITH downloading of funds.
DOWNLOADING Otherwise, indicate Specific OUs who NONE
will receive the downloaded funds,
exact amount to be downloaded, and
its purpose.
ACTIVITY/IES TO Identify activity/ies to be bumped-off, if any, to cover expenses required to
BE BUMPED-OFF certain activity/ies in case that the requested amount exceeds with the approved
AND ITS CODE(S) budget in WFP.
Activity Code Name of Activity Amount to be bumped-off
 n/a n/a n/a

Grand Total P _________________

FINANCIAL Amount being requested (must reflect the amount indicated in WFP).
REQUIREMENTS Attach the detailed computation for pre-audit, per activity, showing the grand
total.
Requirement for this transaction as follows:
Activity Code Amount in WFP Amount Requested
001 2,000.00 2,000.00
002 1,000.00 1,000.00
003 5,000.00 5,000.00
004 1,000.00 1,000.00

Grand Total 9,000.00 9,000.00

SOURCE OF Indicate Line Item per GAA and Funding Year
FUNDS Example: School MOOE

ADMINISTRATIVE Articulation of administrative arrangements (participants, inclusive dates,

ARRANGEMENTS special disbursing officer of the activity, and the other relevant information per
activity including cost-sharing arrangements, if necessary)
Activity Sub-Activities Pax Inclusive Remarks
Code Dates
1. Data Gathering Activities
001 10 Jan. 20, 2022
(Sample only)
2. Meeting with the School
002 Planning Team (Sample 10 Jan. 25, 2022
only)
3. Workshop on the
003 Enhancement of SIP (Sample 30 Feb. 1, 2022
only)
4. Printing of the Enhanced
004 n/a Feb. 15, 2022
SIP (Sample only)
ANNEXES 1. Activity Design/Program of Activities
2. List of Participants
3. Detailed Budget Estimates
4. Certification from Clearing House, if needed in the activity
5. Accomplished Purchase Request (PR), if any
6. Legal instrument or any form of directives from person in authority
7. Portion of the approved WFP where activities are stipulated

All expenses incurred in this activity is subject to usual accounting and auditing rules and regulations.