COMMON TEMPLATE

INSERT YOUR SCHOOL HEADING HERE

COMMUNITY-BASED PROJECT PROPOSAL

I. Title of the Project:

II. A. Proponent
B. Project Venue
III. Project Description
IV. Objectives
1.
2.
3.
V. Organizational Management
VI. Budgetary Requirements
VII. Financial Resources

Prepared by:

PROPONENT’S NAME
Position

APPROVED:

SCHOOL HEAD
Position

OR

BRGY. CAPTAIN’S NAME

Barangay & Address
Indorsement Page
(p.1)
INSERT SCHOOL LOGO HERE

1st Indorsement
(Date)

Respectfully forwarded to the Schools Division Superintendent, Division of La

Union, City of San Fernando, La Union the herein request of PROPONENT’S
NAME, Position of School, School Address to conduct the Community-Based
Project entitled “Title” for the School Year (2020-2021), recommending approval.

SCHOOL HEAD
Position

_______________________________________

Request Letter
(p.2)

Insert School Logo Here

_________________
(Date)
JORGE M. REINANTE, CSEE, CEO VI, CESO V
Schools Division Superintendent
Division of La Union
City of San Fernando, La Union

SIR:

I have the honor to request from your good office to conduct the Community-Based
Project entitled “Title” to the Grade (6) of School & Address for the School Year 2020-
2021.

Your approval to this request is highly appreciated.

Very truly yours,

PROPONENT’S NAME
Position
Approval Sheet

APPROVAL SHEET

Permit to Conduct an Income Generating Project

This Income Generating Project entitled “TITLE” prepared and submitted by

NAME OF PROPONENT, of SCHOOL, SCHOOL ADDRESS .

Pertinent documents submitted/attached have been read, thoroughly evaluated and

validated by the Division Evaluation Committee and thereby recommended for approval of
the Schools Division Superintendent.

DIVISION EVALUATION COMMITTEE:

DR. MELBA N. PAZ

Education Program Supervisor
In-charge of Income Generating Project

DR. GERMAN E. FLORA

Chief Education Supervisor
Curriculum Implementation Division

RECOMMENDING APPROVAL:
DR. DOMINGO L. LAUD
Assistant Schools Division Superintendent

APPROVED:

JORGE M. REINANTE, CSEE, CEO VI, CESO V

Schools Division Superintendent

School Letter Head

 ACTION PLAN
“Title”
School Year: ________

PROGRAM/ 1. Information
PROJECT Dissemination
OBJECTIVES 1. To conduct
dialogue with
prospective groups
to assist in the
implementation of
the feeding program
2. To disseminate
information
OBJECTIVES
1. 1. Inviting the
prospective groups
of the brgy for
dialogue to assist.
2. Purok meetings
shall be held
PEOPLE 1. Brgy Officials
INVOLVED 2. BHW
3. Community
People
4. ANO Officers
TIME August
FRAME
Specific Time Frame
SUCCESS Dialogue with
INDICATOR prospective groups
to assist in the
implementation of
the feeding program
should have been
conducted.

Prepared by:

Proponent’s Name
Position

APPROVED:

School Head’s Name Name of Brgy. Captain*

Position Barangay Captain, Barangay _______

*Attachment 1
Attach approved letter to the Brgy. Captain
 Attachment 2
CURRICULUM VITAE

NAME: Recent 2x2 pic

Address:
Contact Number:
Email Address:

Personal Background:

Permanent Residence:
Birthdate:
Birthplace:
Father’s Name:
Mothers Name:
Spouse Name:

Educational Attainment:

Graduate Study:
Tertiary Level:
Secondary Education:
Elementary Education:

Government Eligibility/ies:

__________________________
__________________________

Work Experience/Teaching Position

Graduate Study: School: Address:

Tertiary: School: Address:
Secondary: School: Address:
Elementary: School: Address:

Government Eligibility/ies:
_____________________________
_____________________________

Teaching-related Work Experience:

Position: School: Year: