ILIGAN MEDICAL CENTER COLLEGE San Miguel Village, Pala-o, Iligan City Mindanao, Philippines Tel. No.

221-4661 local 1111 ______________________________________________________________________________ APPLICATION FORM FOR ACCREDITATION

Name of Organization: Acronym : Office Address : Contact Information : Landline No: Fax No E-mail Address: Date Organized Date Registered Contact Person Designation Contact No. Registering Agency ILIGAN MEDICAL CENTER COLLEGE IMCC San Miguel Village, Pala-o, Iligan City Dr. Royce S. Torres President, IMCC (063) 221-4661 Local 1111 221-6584 rstorres@yahoo.com 1975 August 22, 1985 Dr. Royce S. Torres President 09177160658 Securities and Exchange Commission (SEC) with Registration No. 128187 Academic Institution based in Iligan City (please see attached document)

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Organizational level : Purposes/Objectives :

Projects and Beneficiaries: Period Project Construction and fabrication of BioSand Filters Construction and fabrication of BioSand Filters Costs (Approximate) Php36,000.00 (for steel molds and construction materials) 6.000.00 (for construction materials only) Beneficiaries 378 Inmates and BJMP personnel at the Iligan Reformatory Jail, Brgy. Tipanoy, Iligan City 24 household beneficiaries of the Tomas Cabili Village Housing Association, Inc., Brgy Tomas Cabili, Iligan City Critical river communities in Brgys. Pugaan and Hinaplanon (more than 6000 tree/mangrove species planted in collaboration with DENR, NPC, Phil. Army, Brgy. Status

2009

Completed

2010

Completed

2007- up to present

Tree/MangroveGrowing

5,000.00

Completed and On-Going

2007- up to present

Community-Based Medical and Health Services Program Cherubim Day Care Center and Nursery

5,500.00 (per month for transportation

2007- up to present

2013

Bio-Sand Filter Project

Fil-Lux Village Resettlement Project (includes social preparation, community organizing and construction of BioSand Filters (in partnership with LIHUK, Inc.) Alternative Literacy Program (ALS) for the Bajaus (in partnership with MSU-IIT and Friends of Bajaus)

1,000/month honorarium for full-time day-care personnel Php30,000 for communitybased BSF trainings

Councils, Free and Accepted Masons of the Phils., LIHUK, Inc., CEMO and students of other academic institutions in Iligan City. Women, mothers and children in all sitios in Brgy. Pugaan (daily medical and health services extended by nursing students) Pupils and parents of Brgy. Saray availing of the nursery services of Cherubim Day Care and Nursery School 200 households of Sendong survivors in Brgy. Hinaplanon and 75 households of Brgy. Tomas Cabili

Completed and On-Going

Completed and On-Going

To be implemented In 2013 (MOU has already been signed by respective Punong Barangay)

2013

Funds coming from the Government of Luxemburg

105 household beneficiaries affected by TS Sendong

To be implemented in September 2013

2010-up to present

Funds are coming from individual donors and benefactors

Approximately, 80 children, young adults and adults attending ALS during weekend classes

On-going program

Project Financing: At the moment, fund sources that finance the projects are mostly coming from IMCC, with other financing scheme (sweat equity and local counterpart) arranged locally through MOU with the project beneficiaries. However, partnership building with local and national NGOs (Lig-ong Hiniusang Kusog sa Kabus, Inc. and the Partnership of Philippine Support Service Agencies, Inc. ) are being initiated by IMCC to further solicit support on projects especially those that address Climate Change and DRRM, Water, Health and Sanitation and those that respond the housing needs of survivors of TS Sendong. Services the Organization Provides or Can Participate in: 1. Water, Sanitation and Hygiene;

2. Bio-Sand Filter Technology; 3. Health and Medical Services; 4. Training and Workshops on Disaster Risk Reduction Management (DRRM) and Climate Change Adaptation (CCA); 5. Health Research and Development; 6. Community Development Organizing; 7. Environmental Advocacy through Lecture-Concerts (Songs and Dances); 8. Community Mortgage Program and Housing Development. Name of Officers and Members of the Board of Directors, including contact information: 1. Mrs. MARIA CONCEPCION T. LAGTAPON - Chairperson of the Board 2. Mr. JOSEPH ANTHONY B. PICARDAL - Director 3. Dr. DANIEL P. U. RIGOR - Director 4. Mr. STEPHEN T. MONTERROYO - Treasurer/Director 5. Dr. ROYCE S. TORRES - Director/IMCC President Contact Information: 221-4661

List of Partner Agencies/NGOs/POs: LGU: 1. Lig-ong Hiniusang Kusog sa Kabus, Inc. (LIHUK); 2. Tomas Cabili Village Homeowners Association, Inc. (TCVHOAI) ; 3. Barangay Councils of Tomas Cabili and Hinaplanon; Regional Partnership: 1. Northern Mindanao Consortium on Health Research and Development (NorMinCoHRD); 2. Northern Mindanao Consortium on Industry, Energy and Emerging Research and Development (NorMinCIEERD); 3. NSTP Educators Association in Region-10, Inc. (NEAR-10); National: 1. Philippine Association of Institutions for Research, Inc. (PAIR, Inc); 2. Philippine Association of Extension Program Implementers, Inc. (PAEP, Inc.); 3. International Association of Multi-Disciplinary Research (IAMURE, Inc.); 4. Partnership of Philippine Support Services Agencies, Inc. (PHILSSA, Inc.); 5. Philippine Health Social Science Association. Inc. (PHISSA, Inc.) I HEREBY CERTIFY to the correctness of the above information.

_____________________________ Dr. ROYCE S. TORRES President