ADOPT-A-SCHOOL PRO

__________Qua
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

TOTAL

* Please attach the following documents:

1. Deed of Donation
2. Deed of Acceptance

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPOR

__________Quarter, SY ____________

_______ Email Address: _________________________

PARTICULARS

QTY.

AMOUNT

Prepared by:

School Head/Principal/OIC

Approved by:

SOCORRO V. DELA ROSA, CES

Schools Division Superinten

RTERLY REPORT

___

DONOR
PRIVATE SECTOR

LGU

DATE COMPLETED/
TURN-OVER

CORRO V. DELA ROSA, CESO V

ools Division Superintendent

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

ADOPT-A-SCHOOL PROG

__________Qua
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

4. OTHERS PLS. SPECIFY

school uniforms

TOTAL

* Please attach the following documents:

1. Deed of Donation
2. Deed of Acceptance

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT

__________Quarter, SY __________

_______ Email Address: ____________________________

PARTICULARS

QTY.

Prepared by:

School Head/Principal/OIC

OGRAM QUARTERLY REPORT

uarter, SY __________

AMOUNT

DONOR
PRIVATE SECTOR

LGU

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

Approved by:
SOCORRO V. DELA ROSA, CESO V

Schools Division Superintendent

DATE COMPLETED/
TURN-OVER

RLEY E. LEGASPI, Ed.D.

Education Program Specialist

Social Mobilization & Networking

ADOPT-A-SCHOOL PROG

__________ Quar
Region:
Division:
School:
Address:
School ID:
Contact Nos.:

_____________________ Email Address: _________________________

TECHNOLOGY SUPPORT
DONATIONS
1. COMPUTER

2. ELECTRONIC LEARNING
MATERIALS

3. INTERNET CONNECTIVITY

4. OTHERS PLS. SPECIFY

TOTAL

* Please attach the following documents:

1. Deed of Donation
2. Deed of Acceptance

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT

__________ Quarter, SY ____________

_______ Email Address: _________________________

PARTICULARS

QTY.

AMOUNT

Prepared by:

School Head/Principal/OIC

Approved by:

SOCORRO V. DELA ROSA, CES

Schools Division Superintende

TERLY REPORT

__

DONOR
PRIVATE SECTOR

LGU

DATE COMPLETED/
TURN-OVER

RRO V. DELA ROSA, CESO V

ools Division Superintendent

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

ADOPT-A-SCHOOL PRO

___________ Qu
Region:
Division:
School:
Address:
School ID:
Contact Nos.:

_____________________ Email Address: _________________________

HEALTH AND NUTRITION

DONATIONS
1. FEEDING PROGRAM

2. MEDICAL/DENTAL
MISSION/CHECK-UPS

3. DEWORMING
INTERVENTION

4. HEALTH SUPPLIES

5. OTHERS PLS. SPECIFY

TOTAL

* Please attach the following documents:

1. Deed of Donation
2. Deed of Acceptance

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPOR

___________ Quarter, SY ___________

_______ Email Address: _________________________

PARTICULARS

QTY.

AMOUNT

Prepared by:

School Head/Principal/OIC
Approved by:

SOCORRO V. DELA ROSA, CE

Schools Division Superinten

TERLY REPORT

___

DONOR
PRIVATE SECTOR

LGU

DATE COMPLETED/
TURN-OVER

ORRO V. DELA ROSA, CESO V

ools Division Superintendent

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

ADOPT-A-SCHOOL PRO

___________ Qua
Region:
Division:
School:
Address:
School ID:
Contact Nos.:

_____________________ Email Address: ___________________________

READING PROGRAM
DONATIONS
1. BOOKS

2. SUPPLEMENTARY
READING MATERIALS

3. OTHERS PLS. SPECIFY

TOTAL

* Please attach the following documents:

1. Deed of Donation
2. Deed of Acceptance

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPOR

___________ Quarter, SY _____________

_______ Email Address: ___________________________

PARTICULARS

QTY.

AMOUNT

Prepared by:

School Head/Principal/OIC

Approved by:

SOCORRO V. DELA ROSA, C

Schools Division Superint

ERLY REPORT

__

DONOR
PRIVATE SECTOR

LGU

DATE COMPLETED/
TURN-OVER

CORRO V. DELA ROSA, CESO V

hools Division Superintendent

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

ADOPT-A-SCHOOL PRO

__________ Qu
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

3. OTHERS PLS. SPECIFY

TOTAL

* Please attach the following documents:

1. Deed of Donation
2. Deed of Acceptance

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPOR

__________ Quarter, SY ___________

_______ Email Address: _______________________________

PARTICULARS

QTY.

Prepared by:

School Head/Principal/OIC

GRAM QUARTERLY REPORT

rter, SY ___________

AMOUNT

DONOR
PRIVATE SECTOR

LGU

Noted by:
SHIRLEY E. LEGASPI, Ed.D.
ASP Division Coordinator
SGOD-Social Mobilization & Networking

Approved by:
SOCORRO V. DELA ROSA, CESO V
Schools Division Superintendent

DATE COMPLETED/
TURN-OVER

IRLEY E. LEGASPI, Ed.D.

ASP Division Coordinator

-Social Mobilization & Networking

ADOPT-A-SCHOOL PRO

As of M
Region:
Division:
School:
Address:
School ID:
Contact Nos.:

_____________________ Email Address: ____________________________

DIRECT ASSISTANCE
DONATIONS
1. STIPEND

2. OTHERS PLS. SPECIFY

TOTAL
* Please attach the following documents:
1. Deed of Donation

2. Deed of Acceptance

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPOR

As of March 31, 2012

_______ Email Address: ____________________________

PARTICULARS

Prepared by:

QTY.

School Head/Principal/OIC

OGRAM QUARTERLY REPORT

March 31, 2012

AMOUNT

DONOR
PRIVATE SECTOR

LGU

Noted by:

SHIRLEY E. LEGASPI, Ed.D.

Senior Education Program Specialist
SGOD-Social Mobilization & Networking

Approved by:
SOCORRO V. DELA ROSA, CESO V

Schools Division Superintendent

DATE COMPLETED/
TURN-OVER

RLEY E. LEGASPI, Ed.D.

Education Program Specialist

-Social Mobilization & Networking

ADOPT-A-SCHOOL PRO

__________ Qu
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
10. OTHERS PLS. SPECIFY

TOTAL

* Please attach the following documents:

1. Deed of Donation
2. Deed of Acceptance

ADOPT-A-SCHOOL PROGRAM QUARTERLY REPOR

__________ Quarter, SY ___________

_______ Email Address: _____________________________

FOR STUDENT WITH SPECIAL NEEDS

PARTICULARS

QTY.

Prepared by:

School Head/Principal/OIC

GRAM QUARTERLY REPORT

arter, SY ___________

AMOUNT

DONOR
PRIVATE SECTOR

LGU

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

Approved by:
SOCORRO V. DELA ROSA, CESO V

Schools Division Superintendent

DATE COMPLETED/
TURN-OVER

RLEY E. LEGASPI, Ed.D.

Education Program Specialist

Social Mobilization & Networking