ALS Community Champion Agreement Form

ALS Community Champion Name (please print): ____________________________________________

Barangay/Community/Institution: __________________________________________________________

By signing this form, I acknowledge that I wholeheartedly accept the role of an ALS Community Champion whose
undertakings are to support the implementation of the ALS Program, to lead in promoting it through different
communication channel that can reach potential learners. Specifically, I accept the following duties and
responsibilities:
1. Disseminate ALS information
2. Persuade OSCYA to enroll in ALS
3. Install posters and tarpaulins, and distribute brochures
4. Participate in community activities that could promote ALS program
5. Post updates regarding ALS to local newsletters/magazines (barangay level) and online platforms (FB page)
6. Coordinate with barangay officials for the promotion and implementation of ALS program
7. Actively engage in all programs such as conference calls, workshops, consultations and other assessment
projects.

I acknowledge that I have read and understood the above undertakings in its entirety and agree to carry them out to
fulfill my role as an ALS Community Champion.

Date: ____________________ ALS Community Champion: _______________________________________

Date: ____________________ Education Program Specialist: _____________________________________