SUMMARY OF COMMUNITY BASED PROGRAM

DATE PROJECT TITLE PROJECT TYPE PROJECT PROPONENT/S PROJECT BENEFICIARIES OBJECTIVES
I. PROJECT DESCRIPTION

PROJECT TITLE
PROJECT TYPE
(Education-training/health-medical mission/arts-
exhibit, etc.)
PROJECT PROPONENT/S
(Name of Organization/College)
PRIMARY CONTACT PERSON, TITLE, CONTACT
NUMBER
PROJECT BENEFICIARIES
(Urban poor, Women, Youth, etc.)
NUMBER OF BENEFICIARIES
(Number of Households and Individuals)
LOCATION OF BENEFICIARIES
DATE OF IMPLEMENTATION/DURATION
AREA OF PROJECT IMPLEMENTATION
BUDGET REQUIREMENT
(Overall Amount of Budget Requirement)

II. BACKGROUND/SITUATION ANALYSIS

1. What prompted the project?

2. What existing concern or potential problem that you want to address?

III. PROJECT OBJECTIVES

OBJECTIVES

a) What are the expected short term results of the

project?

b) What are the expected long term results of the

project?

IV. RISK MANAGEMENT PLAN

What are the risk and factors that may hamper or

hinder the successful implementation of project
activities and achievement of project outputs
 COMMUNITY BASED PROGRAM PROPOSAL FORM

em that you want to address?

 STRATEGIES

What are the strategies that must be done to meet the

objectives?

What are the measures that would mitigate the adverse

effects resulting from such risks?
V. PROJECT ORGANIZATION AND STAFFING

Office/Staff Designated Responsibilities Contact Person Contact Details

VI. PROJECT WORK PLAN

Phases of the Project Key Activities Person - In - Charge Resources Needed

(Date)

VII. PARTNERSHIPS AND COLLABORATIONS

Indicate the name of the

partners if any you will Person - In - Charge Contact Details Role and Contributions
work with during the
project

VIII. DETAILED BUDGET REQUIREMENT

ITEM SUPPLIER QUANTITY UNIT PRICE

Grand Total :
IX. OTHER RELEVANT INFORMATION

May include any other information that will support the request for funding, such as:
• brief enumeration of other stakeholders who pledged support to the project
• other projects tha are lined - up to complement the current initiative

X. ATTACHMENTS
• Profile/brochure of the organization
• Endorsement and recommendation letters
• Other documents to support the request
• Letters of support demonstrating partnership commitment to the project
• Evaluation plan and tool for your project

XI. FOLLOW - UP

How do you plan to follow - up?

Prepared by : _____________________

Date Submitted : _____________________

Checked and Verified by : _____________________

Date Submitted : _____________________

Approved by : _____________________

Date : _____________________
TOTAL