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Enable Communities For Inclusion Program for Children and Youth with Disabilities

   
Name of Activity: LGU   Date: Venue:  
Families    
Communitie
s    
Children    
DPO  
 

PAKISULAT NANG MALINAW AT NABABASA ANG INYONG PANGALAN AT MGA DETALYE.


Ag Se Gende Designatio Contact
Name Disability Barangay Municipality Day 1 Day 2
e x r n Number

1                    

2                    

3                    

4                    

5                    

6                    

7                    

9
1
0
Gender: S - Straight L - Lesbian G - Gay B - Bisexual T - Transgender Sex: M - Male F - Female I - Intersex

Attested by:___________________________
Province of Northern Samar Signature over printed name
In Partnership with

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