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Republic of the Philippines

SORSOGON STATE UNIVERSITY


OFFICE OF EXTENSION SERVICES
Sorsogon City
Tel. No. (056) 211-0200 Loc 111 Email: oes@sorsu.edu.ph
EXTENSION EVALUATION FORM
PROJECT TITLE: PROJECT LOTUS (Localized Tutorial Services)
DATE: April 29, 2023
Name of Extension Participant: Johnray B. Habol Barangay: TINAGO

CRITERIA Failed to Fulfilled some Fulfilled all Exceeded Highly


meet my of my of my my Exceeded my
expectation expectations expectations expectations expectations
s
2- Less 3- 4- Very 5-
1 -POOR Satisfactory Satisfactory Satisfactory Outstanding

1. My evaluation of the Extension Service provided in


terms of quality and relevance (Ebalwasyon ko sa
lebel nin dekalidad asin akma sa pangangaipuhan na /
Extension Service na nakonducir samo.)
2. Evaluation of the Extension Advisory Service
provided in terms of quality and relevance
(Ebalwasyon ko sa lebel nin dekalidad asin akma sa
pangangaipuhan na serbisyong tinao kan SSU
/
Extensionist/s )
3. Timeliness of Service Delivery (Napapanahon na
pagdeliber nin Extension Service ) /
4. Extension Request responded within 3-5 days
(Pagtugon sa kahagadan na magkonducir ki
Extension sa laog nin 3-5 aldaw)
/
Signed: ________________________ Date: April 29, 2023

Republic of the Philippines


SORSOGON STATE UNIVERSITY
OFFICE OF EXTENSION SERVICES
Sorsogon City
Tel. No. (056) 211-0200 Loc 111 Email: oes@sorsu.edu.ph

EXTENSION EVALUATION FORM


PROJECT TITLE : PROJECT LOTUS (Localized Tutorial Services)
DATE: April 29, 2023
Name of Extension Participant: Johnray B. Habol Barangay: TINAGO

CRITERIA Failed to Fulfilled some Fulfilled all Exceeded Highly


meet my of my of my my Exceeded my
expectations expectations expectations expectations expectations

1 -POOR 2- Less 3- 4- Very 5-


Satisfactory Satisfactory Satisfactory Outstanding
1. My evaluation of the Extension Service provided
in terms of quality and relevance (Ebalwasyon ko
sa lebel nin dekalidad asin akma sa
pangangaipuhan na Extension Service na
/
nakonducir samo.)
2. Evaluation of the Extension Advisory Service
provided in terms of quality and relevance
(Ebalwasyon ko sa lebel nin dekalidad asin akma
sa pangangaipuhan na serbisyong tinao kan
/
SSC Extensionist/s )
3. Timeliness of Service Delivery (Napapanahon
na pagdeliber nin Extension Service ) /
4. Extension Request responded within 3-5 days
(Pagtugon sa kahagadan na magkonducir ki
Extension sa laog nin 3-5 aldaw)
/
Signed: ________________________ Date: April 29, 2023
Extension Beneficiary

1
Republic of the Philippines
SORSOGON STATE UNIVERSITY
OFFICE OF EXTENSION SERVICES
Sorsogon City
Tel. No. (056) 211-0200 Loc 111 Email: oes@sorsu.edu.ph

EXTENSION EVALUATION FORM


PROJECT TITLE : PROJECT LOTUS (Localized Tutorial Services)
DATE: April 29, 2023
Name of Extension Participant: Johnray B. Habol Barangay: TINAGO

CRITERIA Failed to Fulfilled some Fulfilled all Exceeded Highly


meet my of my of my my Exceeded my
expectations expectations expectations expectations expectations

1 -POOR 2- Less 3- 4- Very 5-


Satisfactory Satisfactory Satisfactory Outstanding
1. My evaluation of the Extension Service provided
in terms of quality and relevance (Ebalwasyon ko
sa lebel nin dekalidad asin akma sa
pangangaipuhan na Extension Service na
/
nakonducir samo.)
2. Evaluation of the Extension Advisory Service
provided in terms of quality and relevance
(Ebalwasyon ko sa lebel nin dekalidad asin akma
sa pangangaipuhan na serbisyong tinao kan
/
SSC Extensionist/s )
3. Timeliness of Service Delivery (Napapanahon
na pagdeliber nin Extension Service ) /
4. Extension Request responded within 3-5 days
(Pagtugon sa kahagadan na magkonducir ki
Extension sa laog nin 3-5 aldaw)
/
Signed: ________________________ Date: April 29, 2023
Extension Beneficiary

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