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Republic of the Philippines

DEPARTMENT OF EDUCATION
Region I
DIVISION OF PANGASINAN II
WEST CENTRAL SCHOOL
San Guillermo, San Jacinto, Pangasinan

BRIGADA ESKWELA
National Schools Maintenance Week

STATEMENT OF INTEREST FORM

I am interested to be part of the National Schools Maintenance Week.

NAME:

NAME OF COMPANY/ ORGANIZATION:

ADDRESS OF COMPANY/ ORGANIZATION:

TELEPHONE NO.
CONTACT PERSON :DANIEL C. ABAOAG – 09238632838/540-7188

NAME OF PUBLIC SCHOOL: WEST CENTRAL SCHOOL

ADDRESS OF SCHOOL: SAN GUILLERMO, SAN JACINTO PANGASINAN

FORM OF INTERVENTION: (Choose any of the two or you can choose both.)

a. Donations-in-kind for:
(please check desired donation)
____Painting the roofs (adds two or more years to the life of the roof)
____Cementing existing footpaths and drains
____Repairing leaking water pipes
____Repairing comfort rooms and toilets
____Painting exterior walls of classrooms
____Repairing or replacing ceiling boards
____Repairing, refinishing or repainting chairs, desks and furniture
____Cleaning-up the gardens
____Repairing or replacing broken windows, jalousies, doors
____Replacing school signs
____Any other types of repairs needed to be done
____ Monetary Donation

Specific material/donation to be given:

___________________________________________________________________

___________________________________________________________________

b. Volunteer man-days/labor support:

Nature of volunteer services ___________
Time and date/s of availability ___________

Please submit filled-out form to the principal of the school of your plan to help. Thank
you so much!