Note: This is just a( SAMPLE OF EXTENSION SERVICES)

Republic of the Philippines

UNIVERSITY OF SOUTHEASTERN PHILIPPINES
College of Education –Community Extension for Pre-Service Teachers
Obrero Campus
Obrero,Davao City

ACTION PLAN
Campus/College Unit : CED
Calendar Year : 2017
Title of the Extension Activity : Feeding Program for Malnourished Children
General Objectives : Improve the nutritional status of the identified Grade 5 malnourished pupils of Sto. Nino ES.

Target No. & Budgetary Requirements

PROJECT/ ACTIVITIES Persons Target Date/ Expected
Objectives Classification Venue
Responsible Duration Particular Source Amount (PhP) Outcome
of Participants
1.Seek approval of the
designed action plan. 1. Improve
(Signatories below should the Group 1-BEED February 6,2017 Sto. Nino ES
be strictly followed). nutritional 4E
status of
2. Identify malnourished Grade 5 5 pupils 1. Genlyn
children through the help of malnouris Rico
an adviser hed 2. Joan Biel
pupils. 3. Leslie
Gan
. 4. Rose
2.Asking permission to Bino
conduct the feeding activity 5. Loida February 7,2017
address to the school Beniflor
principal through a formal
letter.
 3.Conduct a feeding Improved the
program to identified 1st Week Food Personal 1,000.00 nutritional status
malnourished grade 5 Feb.13,2017 Fund of grade 5
pupils for at least twice a Feb. 15,2017 selected
week for 2 weeks. malnourished
2nd Week pupils of Sto. Nino
March 1,2017 ES
MARCH 4,2017

4. Monitor and evaluate your To monitor and 5 members March 8,2016 Monitored and
respondent/sparticipants. evaluate nutritional evaluated
status of the nutritional status.
identified Grade 5
malnourished
pupils.

Prepared by: Noted by: Approved:

GENLYN RICO MRS. LILIA AMANO DR. EMMIE CABANLIT DR. JEAN L. BEJANO DR. LENNY ROJO
Group Leader Cooperating Teacher Practicum Supervisor CED Extension Head School Principal

REQUIREMENTS : EXTENSION SERVICES FOR PRE-SERVICE TEACHERS + Attachments: (To be attached to your portfolio for extension activities).

1. Approved ACTION PLAN –to be checked and submitted before the conduct of extension activity.
2. LETTER OF APPROVAL from the Principal-before the activity started.
3. Conduct of activities with documentation and pictorials.