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ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT

As of ______________ 2013
Region:
Division
School:
Address:
School ID:
Contract Nos.:

Email Address:

INFRASTRUCTURE, PHYSICAL FACILITIES, FURNITURE, AND REAL ESTATE


DONATIONS
1. CLASSROOM
New construction
Rehabilitation/Repair
2. FURNITURE

3. TOILET & WASH FACILITIES


New construction
Renovation/Repair
4. MAINTENANCE

PARTICULARS
e.g. 1 storey, 2classroom
2 classroom
e.g. Teacher's Table
armchair

Toilets
Wash Facilities
e.g. construction materials, Paints
2 gallons paints

5. REAL STATE

e.g. land

6. OTHERS PLS SPECIFY

construction of concrete fence

2
2
3
10

AMOUNT
1,300,000.00
200,000.00
16,000.00
9,000.00

1
2

30,000.00
10,000.00

1,000.00

1 hectare

TOTAL
*Please attach the following document
1. Deed of Donation
2. Deed of Acceptance

QTY.

100,000.00

6,000.00
1,672,000.00

Prepared by:

School Head/Principal/OIC
Approved by:

DONOR
PRIVATE SECTOR
ABC Corporation
DEF Enterprises
ABC Corporation
ABC Corporation

Schools Division Superintendent

T
aspsch_form 01

DONOR
LGU

DATE COMPLETED/
TURN OVER
March 8,
February 22,
January 10,
January 10,

Governor
Mayor

2012
2012
2012
2012

February 24, 2012


February 24, 2012
February 10, 2012
January 12, 2012

PTA

March 15, 2012

Noted by:

ASP Division Coordinator

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT


As of ______________ 2013
Region:
Division
School:
Address:
School ID:
Contract Nos.:

I
ILOCOS SUR
SAN VICENTE INTEGRATED SCHOOL
POB., SAN VICENTE, ILOCOS SUR
320905
09178702519

Email Address:

svis_deped@yahoo.com

LEARNING ENVIRONMENT
DONATIONS

PARTICULARS

QTY.

AMOUNT

DONOR
PRIVATE SECTOR

1. CLASSROOM

2. FURNITURE

3. TOILET & WASH FACILITIES

4. MAINTENANCE

5. REAL STATE

6. OTHERS PLS SPECIFY


TOTAL
*Please attach the following document
1. Deed of Donation
2. Deed of Acceptance

Prepared by:

BEATRIZ R. RIOTOC
Principal I
Approved by:

MARINO S. BAYTEC, Ed.,D.,CSEE

Schools Division Superintendent

T
aspsch_form 01

yahoo.com

DONOR
LGU

DATE COMPLETED/
TURN OVER

Noted by:

SAMUEL R. LAZO, Ed. D.


EPS I-TLE/EPP
ASP Division Coordinator

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT


As of ______________ 2013
Region:
Division
School:
Address:
School ID:
Contract Nos.:

I
ILOCOS SUR
SAN VICENTE INTEGRATED SCHOOL
POB., SAN VICENTE, ILOCOS SUR
320905
09178702519

Email Address:

svis_deped@yahoo.com

LEARNING SUPPORT
DONATIONS

PARTICULARS

QTY.

AMOUNT

DONOR
PRIVATE SECTOR

1. AUDIO-VISUAL

EDUCATIONAL MATERIALS

2. SCHOOL SUPPLIES

3. EDUCATIONAL FILM/
LIBRARIES

4. OTHERS PLS. SPECIFY

TOTAL
*Please attach the following document
1. Deed of Donation
2. Deed of Acceptance

Prepared by:

BEATRIZ R. RIOTOC
Principal I
Approved by:

MARINO S. BAYTEC, Ed.,D.,CSEE

Schools Division Superintendent

T
aspsch_form 02

yahoo.com

DONOR
LGU

DATE COMPLETED/
TURN OVER

Noted by:

SAMUEL R. LAZO, Ed. D.


EPS I-TLE/EPP
ASP Division Coordinator

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT


As of ______________ 2013
Region:
Division
School:
Address:
School ID:
Contract Nos.:

I
ILOCOS SUR
SAN VICENTE INTEGRATED SCHOOL
POB., SAN VICENTE, ILOCOS SUR
320905
09178702519

Email Address:

svis_deped@yahoo.com

LEARNING SUPPORT
DONATIONS

PARTICULARS

QTY.

AMOUNT

DONOR
PRIVATE SECTOR

1. COMPUTER

2. ELECTRONIC LEARNING
MATERIALS

3. INTERNET CONNECTIVITY

4. OTHERS PLS. SPECIFY

TOTAL
*Please attach the following document
1. Deed of Donation
2. Deed of Acceptance

Prepared by:

BEATRIZ R. RIOTOC
Principal I
Approved by:

MARINO S. BAYTEC, Ed.,D.,CSEE

Schools Division Superintendent

T
aspsch_form 03

yahoo.com

DONOR
LGU

DATE COMPLETED/
TURN OVER

Noted by:

SAMUEL R. LAZO, Ed. D.


EPS I-TLE/EPP
ASP Division Coordinator

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT


As of ______________ 2013
Region:
Division
School:
Address:
School ID:
Contract Nos.:

I
ILOCOS SUR
SAN VICENTE INTEGRATED SCHOOL
POB., SAN VICENTE, ILOCOS SUR
320905
09178702519

Email Address:

svis_deped@yahoo.com

HEALTH AND NUTRITION


DONATIONS

PARTICULARS

QTY.

AMOUNT

DONOR
PRIVATE SECTOR

1. FEEDING PROGRAM

2. MEDICAL/DENTAL
MISSION/CHECK-UPS

3. DEWORMING
INTERVENTION

4. HEALTH SUPPLIES

5. OTHERS PLS SPECIFY

TOTAL
*Please attach the following document
1. Deed of Donation
2. Deed of Acceptance

Prepared by:

BEATRIZ R. RIOTOC
Principal I
Approved by:

MARINO S. BAYTEC, Ed.,D.,CSEE

Schools Division Superintendent

T
aspsch_form 04

yahoo.com

DONOR
LGU

DATE COMPLETED/
TURN OVER

Noted by:

SAMUEL R. LAZO, Ed. D.


EPS I-TLE/EPP
ASP Division Coordinator

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT


As of ______________ 2013
Region:
Division
School:
Address:
School ID:
Contract Nos.:

I
ILOCOS SUR
SAN VICENTE INTEGRATED SCHOOL
POB., SAN VICENTE, ILOCOS SUR
320905
09178702519

Email Address:

svis_deped@yahoo.com

READING PROGRAM
DONATIONS

PARTICULARS

QTY.

AMOUNT

DONOR
PRIVATE SECTOR

1. BOOKS

2. SUPPLEMENTARY
READING MATERIALS

3. OTHERS PLS SPECIFY

TOTAL
*Please attach the following document
1. Deed of Donation
2. Deed of Acceptance

Prepared by:

BEATRIZ R. RIOTOC
Principal I
Approved by:

MARINO S. BAYTEC, Ed.,D.,CSEE

Schools Division Superintendent

T
aspsch_form 05

yahoo.com

DONOR
LGU

DATE COMPLETED/
TURN OVER

Noted by:

SAMUEL R. LAZO, Ed. D.


EPS I-TLE/EPP
ASP Division Coordinator

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT


As of ______________ 2013
Region:
Division
School:
Address:
School ID:
Contract Nos.:

I
ILOCOS SUR
SAN VICENTE INTEGRATED SCHOOL
POB., SAN VICENTE, ILOCOS SUR
320905
09178702519

Email Address:

svis_deped@yahoo.com

TRAINING AND DEVELOPMENT


DONATIONS

PARTICULARS

QTY.

AMOUNT

DONOR
PRIVATE SECTOR

1. TEACHERS/PRINCIPAL TRAINING

2. STUDENT/PUPILS TRAINING
AND FIELD TRIP

3. OTHERS PLS SPECIFY

TOTAL
*Please attach the following document
1. Deed of Donation
2. Deed of Acceptance

Prepared by:

BEATRIZ R. RIOTOC
Principal I
Approved by:

MARINO S. BAYTEC, Ed.,D.,CSEE

Schools Division Superintendent

T
aspsch_form 06

yahoo.com

DONOR
LGU

DATE COMPLETED/
TURN OVER

Noted by:

SAMUEL R. LAZO, Ed. D.


EPS I-TLE/EPP
ASP Division Coordinator

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT


As of ______________ 2013
Region:
Division
School:
Address:
School ID:
Contract Nos.:

I
ILOCOS SUR
SAN VICENTE INTEGRATED SCHOOL
POB., SAN VICENTE, ILOCOS SUR
320905
09178702519

Email Address:

svis_deped@yahoo.com

DIRECT ASSISTANCE
DONATIONS

DONOR
PRIVATE SECTOR
N/A

PARTICULARS

QTY.

AMOUNT

1. DIRECT ASSISTANCE

N/A

N/A

N/A

2. OTHERS PLS SPECIFY

N/A

N/A

N/A

N/A

TOTAL

N/A

N/A

N/A

N/A

*Please attach the following document


1. Deed of Donation
2. Deed of Acceptance

Prepared by:

BEATRIZ R. RIOTOC
Principal I
Approved by:

MARINO S. BAYTEC, Ed.,D.,CSEE

Schools Division Superintendent

T
aspsch_form 07

yahoo.com

DONOR
LGU
N/A

DATE COMPLETED/
TURN OVER
N/A

N/A

N/A

N/A

N/A

Noted by:

SAMUEL R. LAZO, Ed. D.


EPS I-TLE/EPP
ASP Division Coordinator

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT


As of ______________ 2013
Region:
Division
School:
Address:
School ID:
Contract Nos.:

I
ILOCOS SUR
SAN VICENTE INTEGRATED SCHOOL
POB., SAN VICENTE, ILOCOS SUR
320905
09178702519

Email Address:

svis_deped@yahoo.com

ASSISTIVE LEARNING DEVICES FOR STUDENT WITH SPECIAL NEEDS


DONATIONS

DONOR
PRIVATE SECTOR

PARTICULARS

QTY.

AMOUNT

1. PENCIL GRIPS

N/A

N/A

N/A

N/A

2. SPECIAL CHAIRS

N/A

N/A

N/A

N/A

3. SPELLING CHECK DEVICES

N/A

N/A

N/A

N/A

4. HEARING AIDS

N/A

N/A

N/A

N/A

5. TALKING COMPUTERS

N/A

N/A

N/A

N/A

6. SPECIALIZED KEYBOARDS

N/A

N/A

N/A

N/A

7. TOUCH SCREEN MONITOR

N/A

N/A

N/A

N/A

8. BRAILLE (BOOKS)

N/A

N/A

N/A

N/A

9. COMPUTERIZED SYSTEMS

N/A

N/A

N/A

N/A

10. OTHERS PLS. SPECIFY

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

TOTAL
*Please attach the following document
1. Deed of Donation
2. Deed of Acceptance

Prepared by:
BEATRIZ R. RIOTOC
Principal I
Approved by:

MARINO S. BAYTEC, Ed.,D.,CSEE

Schools Division Superintendent

T
aspsch_form 08

yahoo.com

DONOR
LGU

DATE COMPLETED/
TURN OVER

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

Noted by:
SAMUEL R. LAZO, Ed. D.
EPS I-TLE/EPP
ASP Division Coordinator

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