NATIONAL SERVICE TRAINING PROGRAM 2

COMMUNITY IMMERSION MATRIX

1. Secure a copy of the NSTP Consent Form from the NSTP Office located on the 12TH
Floor General Education Faculty Room. Communicate to your parent/guardian the
process of NSTP Community Immersion and let them sign the Consent Form provided. A
copy of the NSTP Consent Form can also be found in Appendix A of this file. You may
opt to print the consent form on your own if resources are available.
2. Attach a photocopy of your parent/guardian’s ID in your NSTP Consent Form. Submit
your consent form to your class secretary for bulk notary and compilation.
3. Submit your class’s notarized NSTP Consent Forms to the NSTP Office. The Office will
then issue a Community Immersion Approval Sheet that will signify the beginning of
your community immersion.
4. Do an ocular visit and secure contact information of community partners. Fill out the
Community Information Sheet in Appendix B to secure all vital information needed
from the community.
5. Draft a letter of communication stating your intention to conduct an outreach program in
your selected community. Address the letter to your community partner/s. Add your
NSTP Professor, NSTP Coordinator (Mr. Zoren Matthew L. Blardony), and the Dean of
School of Arts and Sciences (Dr. Conrado F. Vidal Jr.) as a signatory of the letter. Submit
the letter of communication together with your project proposal to the NSTP Office. A
sample Communication Letter can be found in Appendix C. The Project Proposal
Format is provided in Appendix D.
6. After submitting the communication letter and the project proposal, consultations will be
scheduled until the NSTP Office approves the conduction of your final output:
Community Outreach Program.
7. Lastly, the group should be able to produce an NSTP 2 Activityfolio that will consolidate
all vital files, documentation materials, and narratives/reflection. NSTP 2 Activityfolio
Format is attached in Appendix D. Student Volunteer-Reflection Sheet is found in
Appendix F. Community Partner-Reflection Sheet is available in Appendix G.
Beneficiary-Reflection Sheet is attached in Appendix H. Alternative for this will be an
online Activityfolio that could be made by using a single drive but still follows the same
format.
8. Additional Instruction: you have the freedom to enhance the format provided in terms
of its face value, but all information provided must be reflected in your modified format.
 NATIONAL SERVICE TRAINING PROGRAM 2

NSTP PARENT/GUARDIAN CONSENT FORM

NSTP 2: Community Immersion

National Training Service Program (NSTP2) is a three – unit non – academics course for students who
have taken National Training Service Program 1. It requires the actual involvement of the students in community
projects and activities designed to encourage the youth to contribute to the improvement of the general welfare and
the quality of life for local and its various institutional components, more particularly, in terms of improving health,
education, environment, entrepreneurship, safety, recreation, and moral of the citizenry (RA No.9163, Section 3,
d). In compliance with the approved Implementing Rules and Regulation (IRR) which was improved last November
13, 2009, in accordance with the provision of Republic Act No. 9163.

In line with this, NU MOA as an institution abiding to the Philippine Constitution will create opportunities
for our NSTP 2 students to immerse themselves in the community, honing learners who will embody not only the
Nationalian Identity but also Patriotism, Nationalism, and Genuine Care for the community.
Instructions
1. Accomplish all information being asked herein.
2. This form should be accomplished and submitted to the NSTP Office before the conduction of Community
Immersion Program.
3. Provide attachment of Parent’s Identification Card for verification.
Student’s Information
Student’s Name: Year and Section:
Course: Contact Number:
Parent/Guardian Information
Custodian Parent/Guardian’s Name:
Home Address:
Contact Information:
I, the undersigned parent/guardian of _________________________________ do hereby authorize my
son/daughter to participate in off – campus activities related to NSTP 2 Community Immersion. I understand that
by signing this consent form, I am allowing my son/daughter to travel within and/or outside of Metro Manila and I
have been informed of the details regarding the off-campus activity, including the destination/s, mode/s of
transportation, name/s of adult chaperone/s, and time and place of departure and return. I understand that during
this off-campus activity, my son/daughter will be under the direction and general supervision of the NSTP Office,
and adult chaperone/s selected by the school representatives. I fully understand that my son/daughter is subject to
discipline for his/her conduct during the activity.

In the event my son/daughter needs medical attention during the off-campus activity, I hereby give my
permission to the NSTP Office representatives for the trip to take my son/daughter to a physician, hospital, or other
medical institution for treatment. I expressly authorize all medical treatment which a physician may determine
necessary under the circumstances. I understand that in time that the representative may not be able to reach out, I
give them authority to take medical actions under the supervision of a medical professional. I also understand that
I am responsible for all medical expenses incurred in treating my son/daughter.

_______________________________________________________________

Signature over Printed Name of Parent/Guardian and Date of Signing

Name of Emergency Contact in case the Consenting Parent/Guardian is not available:

 NATIONAL SERVICE TRAINING PROGRAM 2
Contact Number of Emergency Contact:

Additional Medical Instructions from Parent/Guardian

Proof of Identity of Parent/Guardian

Please attached any proof of identity.

I hereby certify that all information given herein is true and correct.

_______________________________________________________________

Signature over Printed Name of Parent/Guardian and Date of Signing

 NATIONAL SERVICE TRAINING PROGRAM 2

COMMUNITY INFORMATION SHEET

Target Community
Name of Community:
Date of Ocular Visit:
Member of the visiting team:
Target Community Background:

Community Contact Person/s (Community Partner/s):

Contact Information:
Needs of the Community determined via an interview with the Community Partner/s:

Documentation (Attached evidence of visit/s here):

 NATIONAL SERVICE TRAINING PROGRAM 2

I hereby certify that all information given herein is true and correct.

_______________________________________________________________

Signature over Printed Name of Ocular Visit Team

 NATIONAL SERVICE TRAINING PROGRAM 2

SAMPLE COMMUNICATION LETTER

Hon. Virgilio D. Mabag

Punong Barangay
Barangay 178, Pasay City

Dear Sir,

Good day!

As part of our National Training Service Program 2, our class would like to conduct a community
immersion within your barangay. We were tasked to identify a community within your barangay
that will be chosen as the recipient of our Community Outreach Program.

In line with this, we would like to seek your approval and assistance in making this community
immersion possible.

Sincerely,

Ms. Joanna Mae G. Lontok

Class Representative
MED 2AA

Noted by:

Mr. Zoren Matthew L. Blardony

NSTP Professor/ NSTP Coordinator

Dr. Conrado F. Vidal Jr.

Dean, School of Arts and Sciences
 NATIONAL SERVICE TRAINING PROGRAM 2

PROJECT PROPOSAL FORMAT

PROJECT POSTER:
Showcase your creativity by designing a Publication Material/ Poster relevant to your project
proposal. Print the poster in a whole paper and use it as the cover page of your printed output.
PROJECT TITLE:
Think of a catchy name for the project
RATIONALE:
Discuss the purpose of the study and its significance. In this section, emphasize the need for
such a program.
TARGET COMMUNITY:
Select a community that needs the program being proposed. Discuss comprehensively the
situation in the chosen community and why they are worthy recipient of the program.
PROJECT OBJECTIVE:
Enumerate the aim this project is aspiring to attain within the conduction of the community
extension program. Give at least five.
PEOPLE INVOLVED:
Include significant individuals who are contributors to the project being proposed. This might
include community leaders, speakers, and guests.
PROGRAM PROPER:
Include here the comprehensive plan on the conduction of the program itself.
BUDGET AND ALLOCATION:
Itemize in this section the equipment needed for the conduction of the program and the budget
needed.
WORKING COMMITTEE
Introduce the individuals behind the project. Provide information about the volunteers.

NSTP 2 ACTIVYFOLIO FORMAT

Parts
Cover Page: NSTP 2 Activityfolio, “A Community Immersion Project of MED2AA”,
“Academic Year 2023-2024”
Table of Content
Project Proposal
Letter of Communication
Parents Consent Forms
Community Information Sheet
Student Volunteer-Reflection Sheets
Community Partner-Reflections Sheets
Beneficiary-Reflection Sheets
Photo Documentation
 NATIONAL SERVICE TRAINING PROGRAM 2

STUDENT VOLUNTEER-REFLECTION SHEET

TITLE OF COMMUNITY OUTREACH PROGRAM

LOCATION OF PROGRAM DATE OF CONDUCTION

REFLECTION:
 NATIONAL SERVICE TRAINING PROGRAM 2

COMMUNITY PARTNER-REFLECTION SHEET

TITLE OF COMMUNITY OUTREACH PROGRAM

LOCATION OF PROGRAM DATE OF CONDUCTION

REFLECTION:
 NATIONAL SERVICE TRAINING PROGRAM 2

BENEFICIARY-REFLECTION SHEET

TITLE OF COMMUNITY OUTREACH PROGRAM

LOCATION OF PROGRAM DATE OF CONDUCTION

REFLECTION:
 NATIONAL SERVICE TRAINING PROGRAM 2

TASK DISTRIBUTION: Please read and review each designation and fill out the vacant positions.

Position Tasks Output/ Evidence

Executive Committee
1.Project Leader  Spearhead the entire community
immersion.
 Coordinate with the NSTP Coordinator
 Micromanage the other members of the
committee
2. Assistant Project  Aid the project leader.
Leader  Convene the committee in times of
project leader’s absence
3. Secretary  Person-in-charge of all documentations
 Responsible for collating all files for the
Activityfolio
 Coordinates with Documentation and
Logistics Committee
4. Treasurer  In-charge of all financial matters
 In-charge of facilitating fund-generating
efforts
5. Auditor  Provides assistance to the treasurer.
 Safe keep all receipts and proof of
financial transactions.
 Liquidate funds for transparency

6. Lead Documenter  Responsible for coordination within the

Doc Committee
 Document all activities.
 Responsible for the team's efficiency
and production of content
 Will stand as the social media manager
7. Photo  Document all activities by taking quality
Documenter photos
8. Video  Document all activities by taking quality
Documenter videos
9. Vlogger  Responsible for social media posting
worthy video content
10. Blogger  Responsible for the write ups and
posting quality content worthy of
posting

11. Technical  Responsible for all tasks that require

Committee technological expertise.
 NATIONAL SERVICE TRAINING PROGRAM 2
 In charge of devices for events and
activities
12. Arts and  Coordinate with the documentation
Creatives committee and aid when the need
Committee arises.
 In charge of all creative stuff
13. Acquisition/  Responsible for making resources
Purchasing available.
 In charge of purchasing items/
equipment needed for all activities
 Coordinate with the treasurer and the
auditor
14. Food Committee  Over-all in charge in terms of managing
food and beverages if so, a need arises
15. Talents and  Provides entertainment by producing a
Education creative act (dance number/ song
Committee number)
 Provide learning opportunities if the
need arises
16. Sanitation and  Responsible for the sanitation and
Cleanliness cleanliness of all venues.
Committee  In charge of delegation of tasks and
reminding CLAYGO

Please Comment here if there is a need for a new position.