RD:02-00-FO-80

Departmental Community Extension Service Project Report A.Y. _________________________

Department: ___________________________________________
CES Project Title: ________________________________________________ Timeframe: _____________________
Partner Community: ___________________________________________
Address and Contact Number: _________________________________________________________________
I.

Objectives

A. General Objectives:
1.
2.
B. Specific Objectives:
1.
2.
3.
III.

Terminal Report Matrix

Activities

Inclusive Dates
of
Implementation

Output/s

Outcome/s
(State the observable
impact of each activity)

Implementers
Admin

Faculty

Student

Cost

Participants

Staff

Alumni

Others

Personnel/
Partner
Reps

Learner/
Recipient

Charge to
Extension
Fee

Remarks

Counterpart
of Partner
Community

TOTAL:

Prepared by:

Noted by immediate superior:

Noted by community representative:

Designation:
Signature:
Date:

Designation:
Signature:
Date:

Designation:
Signature:
Date:

Recommended for Approval by:

Endorsed by:

Approved by:

_________________________________________ ______________
CES Director
Date

______________________________________________ __________________
Assistant Vice President, REMI Division
Date

____________________________________________ _______________
Vice President for REMI Division
Date
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