ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT aspsch_form 01

Region:
As of March 31, 2015
SAMPLE
Division:
School:
Address:
School ID:
Contact Nos.: _____________________ Email Address: _________________________

LEARNING ENVIRONMENT
DONOR DATE COMPLETED/
DONATIONS PARTICULARS QTY. AMOUNT
PRIVATE SECTOR LGU TURN-OVER

1. CLASSROOM

- New Construction e.g. 1 storey, 2 classroom 2 1,300,000.00 ABC Corporation March 8, 2012
- Rehabilitation/Repair 2 classroom 2 200,000.00 DEF Enterprises February 22, 2012
2. FURNITURE
e.g. Teacher's Table 3 16,000.00 ABC Corporation January 10, 2012
armchair 10 9,000.00 ABC Corporation January 10, 2012
3. TOILET & WASH FACILITIES
- New Construction Toilets 1 30,000.00 Governor February 24, 2012
- Renovation/Repair Wash Facilities 2 10,000.00 Mayor February 24, 2012

4. MAINTENANCE
e.g. Construction materials, Paints
2 gallons paints 2 1,000.00 ABC Corporation February 10, 2012
5. REAL STATE
e.g. Land 1 hectare 100,000.00 Alumni January 12, 2012

6. OTHERS PLS. SPECIFY Construction of concrete fence 1 span 6,000.00 PTA March 15, 2012

TOTAL 1,672,000.00

* Please attach the following documents: Prepared by: Noted by:

1. Deed of Donation
2. Deed of Acceptance __________________________________________
School Head/Principal/OIC ASP Division Coordinator
Approved by:
_________________________________________________
aspsch_form 01
Schools Division Superintendent
 ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT aspsch_form 02
As of March 31, 2015
Region:
Division:
School:
Address:
School ID:
Contact Nos.: _____________________ Email Address: ____________________________

LEARNING SUPPORT
DONOR DATE COMPLETED/
DONATIONS PARTICULARS QTY. AMOUNT
PRIVATE SECTOR LGU TURN-OVER

1. AUDIO-VISUAL
EDUCATIONAL MATERIALS

2. SCHOOL SUPPLIES

3. EDUCATIONAL FILM/
LIBRARIES

4. OTHERS PLS. SPECIFY

school uniforms

TOTAL -

* Please attach the following documents: Prepared by: Noted by:

1. Deed of Donation
2. Deed of Acceptance __________________________________________
School Head/Principal/OIC ASP Division Coordinator
Approved by: aspsch_form 02
_________________________________________________
Schools Division Superintendent
 ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT aspsch_form 03
As of March 31, 2015
Region:
Division:
School:
Address:
School ID:
Contact Nos.: _____________________ Email Address: _________________________

TECHNOLOGY SUPPORT
DONOR DATE COMPLETED/
DONATIONS PARTICULARS QTY. AMOUNT
PRIVATE SECTOR LGU TURN-OVER

1. COMPUTER

2. ELECTRONIC LEARNING
MATERIALS

3. INTERNET CONNECTIVITY

4. OTHERS PLS. SPECIFY

TOTAL -

* Please attach the following documents: Prepared by: Noted by:

1. Deed of Donation
2. Deed of Acceptance __________________________________________
School Head/Principal/OIC ASP Division Coordinator
Approved by:
_________________________________________________ aspsch_form 03
Schools Division Superintendent
 ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT aspsch_form 04
As of March 31, 2015
Region:
Division:
School:
Address:
School ID:
Contact Nos.: _____________________ Email Address: _________________________

HEALTH AND NUTRITION

DONOR DATE COMPLETED/
DONATIONS PARTICULARS QTY. AMOUNT
PRIVATE SECTOR LGU TURN-OVER

1. FEEDING PROGRAM

2. MEDICAL/DENTAL
MISSION/CHECK-UPS

3. DEWORMING
INTERVENTION

4. HEALTH SUPPLIES

5. OTHERS PLS. SPECIFY

TOTAL -

* Please attach the following documents: Prepared by: Noted by:

1. Deed of Donation
2. Deed of Acceptance __________________________________________
School Head/Principal/OIC ASP Division Coordinator
Approved by:
_________________________________________________
aspsch_form 04
Schools Division Superintendent
 ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT aspsch_form 05
As of March 31, 2015
Region:
Division:
School:
Address:
School ID:
Contact Nos.: _____________________ Email Address: ___________________________

READING PROGRAM
DONOR DATE COMPLETED/
DONATIONS PARTICULARS QTY. AMOUNT
PRIVATE SECTOR LGU TURN-OVER

1. BOOKS

2. SUPPLEMENTARY
READING MATERIALS

3. OTHERS PLS. SPECIFY

TOTAL -

* Please attach the following documents: Prepared by: Noted by:

1. Deed of Donation
2. Deed of Acceptance __________________________________________
School Head/Principal/OIC ASP Division Coordinator
Approved by:
_________________________________________________ aspsch_form 05
Schools Division Superintendent
 ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT aspsch_form 06
As of March 31, 2015
Region:
Division:
School:
Address:
School ID:
Contact Nos.: _____________________ Email Address: _______________________________

TRAINING AND DEVELOPMENT

DONOR DATE COMPLETED/
DONATIONS PARTICULARS QTY. AMOUNT
PRIVATE SECTOR LGU TURN-OVER
1. TEACHERS/PRINCIPAL TRAINING

2. STUDENT/PUPILS TRAINING
AND FIELD TRIP

3. OTHERS PLS. SPECIFY

TOTAL -

* Please attach the following documents: Prepared by: Noted by:

1. Deed of Donation
2. Deed of Acceptance __________________________________________
School Head/Principal/OIC ASP Division Coordinator
Approved by:
_________________________________________________
aspsch_form 06
Schools Division Superintendent
 ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT aspsch_form 07
As of March 31, 2015
Region:
Division:
School:
Address:
School ID:
Contact Nos.: _____________________ Email Address: ____________________________

DIRECT ASSISTANCE
DONOR DATE COMPLETED/
DONATIONS PARTICULARS QTY. AMOUNT
PRIVATE SECTOR LGU TURN-OVER

1. STIPEND

2. OTHERS PLS. SPECIFY

TOTAL -

* Please attach the following documents: Prepared by: Noted by:

1. Deed of Donation
2. Deed of Acceptance __________________________________________
School Head/Principal/OIC ASP Division Coordinator
Approved by:
_________________________________________________
aspsch_form 07
Schools Division Superintendent
 ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT aspsch_form 08
As of March 31, 2015
Region:
Division:
School:
Address:
School ID:
Contact Nos.: _____________________ Email Address: _____________________________

ASSITIVE LEARNING DEVICES FOR STUDENT WITH SPECIAL NEEDS

DONOR DATE COMPLETED/
DONATIONS PARTICULARS QTY. AMOUNT
PRIVATE SECTOR LGU TURN-OVER

1. PENCIL GRIPS

2. SPECIAL CHAIRS

3. SPELLING CHECK DEVICES

4. HEARING AIDES

5. TALKING COMPUTERS

6. SPECIALIZED KEYBOARDS

8. BRAILLE (BOOKS)

9. COMPUTERIZED SYSTEMS

10. OTHERS PLS. SPECIFY

TOTAL -

* Please attach the following documents: Prepared by: Noted by:

1. Deed of Donation
2. Deed of Acceptance __________________________________________
School Head/Principal/OIC ASP Division Coordinator
Approved by: aspsch_form 08
________________________________________________
_
Schools Division Superintendent