NAME: SCORE:

SUBJECT AND COURSE: YEAR AND SECTION:

INSTRUCTOR: DATE:

COMMUNITY NEEDS ASSESSMENT FORM

1. Name of Community/ Institution being assessed

Mae Kalingang Montalbano

2. Venue or description of the location.

Brgy. San Isidro

3. Names of company Leaders and representatives.

Hon. Mayor Dennis Tom Hernandez , Kap Karen Mae Hernandez

4. Description of the community and Basic Community Statistics

Scholar of the Korean missionary group with 30 population 15 male and 15 female

I. COMMUNITY LEADER’S AND MEMBER’S OPINIONS

1. What activities are usually/currently conducted?

Social Educational

Spiritual Recreational

Livelihood All of the above

Others, please specify

2. How frequent are the activities being conducted?

Weekly Semi-monthly

Monthly Semi-annually

Annually

Others, please specify

 3. Who conducts the activities?

Barangay Council Non-Government Organizations

MAE KALINGANG MONTALBENO
Combination Community/Civic Groups

Youth/Students

Others, Please Specify

4. What is the rating of the community leaders and members for the following community current
programs? Encircle your rating for each question using the scale below:

1 - Not in a position to evaluate/No idea at all

2 - Poor/Never

3 - Needs improvement/very seldom

4 - Satisfactory/Seldom

5 - Very Satisfactory/Oftentimes

6 - Excellent/Always

Social Activities (parties, singing/dancing contests, feast 0 1 2 3 4 5

day celebration, swimming, etc.)
Spiritual activities (recollection, retreat, mass, etc.) 0 1 2 3 4 5
Recreational activities (sports fest, league, etc.) 0 1 2 3 4 5
Educational Activities (Seminars, training, workshops, etc.) 0 1 2 3 4 5
Livelihood Activities (microfinancing, subsidies, etc.) 0 1 2 3 4 5
Environmental Activities (cleaning, waste management, 0 1 2 3 4 5
garbage, collection, etc.)

5. who are the active participants of the community activities being conducted?

Parents Mothers

Fathers Youth

Students Out-of-school youth

Kids

Others, please specify

b
INVOLVEMENT OF THE MEMBERS OF THE COMMUNITY IN THE PROJECT

1 - Not in a position to evaluate/No idea at all

2 - Poor/Never

3 - Needs improvement/very seldom

4 - Satisfactory/Seldom

5 - Very Satisfactory/Oftentimes

6 - Excellent/Always

Rate the following constituents in terms of involvement or participation in community activities.

Encircle your rating for each question using the scale below.

Mothers 0 1 2 3 4 5
Fathers 0 1 2 3 4 5
Students 0 1 2 3 4 5
Out-of-school Youth 0 1 2 3 4 5
Kids 0 1 2 3 4 5

1. Who benefits from the activities?

Barangay constituents

NGOs

Others, please specify

2. What are the facilities available in the community?

Library Plaza

Sports center Social Hall

Day-care center Health Center

Others, please specify

c
3. What activities are perceived to be most needed by the community?

Livelihood Jobs Fair

Spiritual Activities Feeding Program

Social Mobilization

Others, please specify

4. Issues, problems, and opportunities present in the community

Family Problem Lack of support for activities

Drug Addiction Education

Vices Garbage

Health Peace and order

Sanitation

Others, please specify

5. Issues/concerns that the community leaders/members think should be prioritized.

Cleanliness Livelihood

Peace and order Sports

Others, please specify

II. EVALUATION BY THE TEAM CONDUCTING THE NEEDS ASSESSMENT.

1. Needs identified by community leaders and members

Livelihood for the unemployed. Proper healthcare for the mass. Additional budget for the
development and growth of the community namely education, trainings and programs.
2. Current action being taken to meet community needs.

Programs conducted like trainings such as baking, sewing, and welding to help citizens to
have a livelihood. Free medical attention for dental, eye, and other medical assistance to aid people.

3. Local resources available to help meet community needs.

Human Resources – people with necessary skills

Those who successfully finished the programs conducted can start to conduct their business
in small scale business. They can also apply as a apprentice or helper to local businesses in the
community to nurture their skills.

Financial Resources – Financial assets available

Seeking financial assistance to local government unit can address the needs of the
community for those who wants to start a business.

Equipment and materials – all equipment, materials, and supplies that will be
available to support the activities.

Equipments and materials are provided by the local government unit that conduct training
programs for their livelihood.

Community Organizations/Groups – agencies, organizations, firms, and institutions

within the community that can be considered assets to the community in the same way.

Volunteer groups is considered as an asset that helps to address the needs of the community,
such as medical missions from doctors and nurses and local church organizations.

4. Name/s of Assessor/Evaluator: