ASP Quarterly Report Forms.xls

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT__________Quarter, SY ____________

Region:

Division:

School:

Address:

School ID:

Contact Nos.: _____________________ Email Address: _________________________

LEARNING ENVIRONMENT

DONATIONS

1. CLASSROOM

2. FURNITURE

3. TOILET & WASH FACILITIES

4. MAINTENANCE

5. REAL STATE

6. OTHERS PLS. SPECIFY

* Please attach the following documents:

1. Deed of Donation

2. Deed of Acceptance

_____________________ Email Address: _________________________

PARTICULARS QTY. AMOUNT

Prepared by:

School Head/Principal/OIC

Approved by:

SOCORRO V. DELA ROSA, CESO V

Schools Division Superintendent

PRIVATE SECTOR LGUDATE COMPLETED/

TURN-OVER

Noted by:

SHIRLEY E. LEGASPI, Ed.D. Senior Education Program Specialist

SGOD-Social Mobilization & Networking

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT__________Quarter, SY __________

Region:

Division:

School:

Address:

School ID:

Contact Nos.: _____________________ Email Address: ____________________________

LEARNING SUPPORT

DONATIONS

1. AUDIO-VISUAL

EDUCATIONAL MATERIALS

2. SCHOOL SUPPLIES

3. EDUCATIONAL FILM/

LIBRARIES

school uniforms

1. Deed of Donation

_____________________ Email Address: ____________________________

PARTICULARS QTY.

Prepared by:

AMOUNTDONOR

PRIVATE SECTOR LGU

Noted by:

Approved by:

SOCORRO V. DELA ROSA, CESO VSchools Division Superintendent

DATE COMPLETED/ TURN-OVER

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT__________ Quarter, SY ____________

Region:

Division:

School:

Address:

School ID:

TECHNOLOGY SUPPORT

DONATIONS

1. COMPUTER

2. ELECTRONIC LEARNING

MATERIALS

3. INTERNET CONNECTIVITY

1. Deed of Donation

_____________________ Email Address: _________________________

Prepared by:

Approved by:

TURN-OVER

Noted by:

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT___________ Quarter, SY ___________

Region:

Division:

School:

Address:

School ID:

HEALTH AND NUTRITION

DONATIONS

1. FEEDING PROGRAM

2. MEDICAL/DENTAL

MISSION/CHECK-UPS

3. DEWORMING

INTERVENTION

4. HEALTH SUPPLIES

1. Deed of Donation2. Deed of Acceptance

_____________________ Email Address: _________________________

Prepared by:

Approved by:

TURN-OVER

Noted by:

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT___________ Quarter, SY _____________

Region:

Division:

School:

Address:

School ID:

Contact Nos.: _____________________ Email Address: ___________________________

READING PROGRAM

DONATIONS

1. BOOKS

2. SUPPLEMENTARY

READING MATERIALS

1. Deed of Donation

_____________________ Email Address: ___________________________

Prepared by:

Approved by:

TURN-OVER

Noted by:

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT__________ Quarter, SY ___________

Region:

Division:

School:

Address:

School ID:

Contact Nos.: _____________________ Email Address: _______________________________

TRAINING AND DEVELOPMENT

DONATIONS

1. TEACHERS/PRINCIPAL TRAINING

2. STUDENT/PUPILS TRAINING

AND FIELD TRIP

1. Deed of Donation

_____________________ Email Address: _______________________________

PARTICULARS QTY.

Prepared by:

AMOUNTDONOR

PRIVATE SECTOR LGU

Noted by:

SHIRLEY E. LEGASPI, Ed.D. ASP Division Coordinator

Approved by:

SHIRLEY E. LEGASPI, Ed.D. ASP Division Coordinator

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORTAs of March 31, 2012

Region:

Division:

School:

Address:

School ID:

Contact Nos.: _____________________ Email Address: ____________________________

DIRECT ASSISTANCE

DONATIONS

1. STIPEND

1. Deed of Donation

_____________________ Email Address: ____________________________

PARTICULARS QTY.

Prepared by:

AMOUNTDONOR

PRIVATE SECTOR LGU

Noted by:

Approved by:

Region:

Division:

School:

Address:

School ID:

Contact Nos.: _____________________ Email Address: _____________________________

ASSITIVE LEARNING DEVICES FOR STUDENT WITH SPECIAL NEEDS

DONATIONS

1. PENCIL GRIPS

2. SPECIAL CHAIRS

3. SPELLING CHECK DEVICES

4. HEARING AIDES

5. TALKING COMPUTERS

6. SPECIALIZED KEYBOARDS

8. BRAILLE (BOOKS)

9. COMPUTERIZED SYSTEMS

1. Deed of Donation

_____________________ Email Address: _____________________________

ASSITIVE LEARNING DEVICES FOR STUDENT WITH SPECIAL NEEDS

PARTICULARS QTY.

Prepared by:

AMOUNTDONOR

PRIVATE SECTOR LGU

Noted by:

SHIRLEY E. LEGASPI, Ed.D. Senior Education Program Specialist SGOD-Social Mobilization & Networking

Approved by:

SHIRLEY E. LEGASPI, Ed.D. Senior Education Program Specialist SGOD-Social Mobilization & Networking

ASP Quarterly Report Forms.xls

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