Lutos Na e Copy - C

KRISTEL FAYE J.
YOUNG
BTVTED-FSM 3A (Bachelor of Technical Vocational
Teacher Education major in Food Service Management)
1003
1
Republic of the Philippines
SORSOGON STATE UNIVERSITY
Sorsogon City Campus
Sorsogon City
Office of Research and Development Services
Tel. No. (056) 211-0200 E-mail Address: ords@sorsogonstatecollege.edu.ph
TABLE OF CONTENTS
Parental Consent Form and Learners Profile ----------- 3
Attendance Sheet ------------------------------------- 5
Summary List of the Target Beneficiaries
for the Project Lotus -------------------------------- 6
Evaluation Form -------------------------------------- 7
2
Research, Extension and Training Office
Extension and Training Services Unit
Magsaysay St., Sorsogon City
E-mail Add.: ssc@sorsu.edu.ph
PARENTAL CONSENT FORM and LEARNERS PROFILE
I confirm that I, Ferdinand O. Young am the parent/guardian of Ferna Kaye J. Young .
I hereby consent to my child participating in the Project LOTUS (Localized Tutorial Services), an
extension project of Sorsogon State College, Teacher Education Department. I understand that this
activity will be of help to my child’s educational needs.
Name: FERDINAND O. YOUNG Contact No. 09462940611

Signature: ______________________ Date signed: SEPTEMBER 29, 2022
CONTACT DETAILS
Child’s Name: FERNA KAYE J. YOUNG

Date of Birth: SEPTEMBER 23, 2014 Place of Birth: SORSOGON CITY Age: 8 Sex:
FEMALE
Year/Grade level: GRADE II School: SORSOGON EAST CENTRAL SCHOOL
Address: GUINLAJON SORSOGON CITY
Name of Tutor: KRISTEL FAYE J. YOUNG Contact No. 09203463904

I confirm that I, Divina J. Young am the parent/guardian of Princess Jewel J. Young .
Name: DIVINA J. YOUNG Contact No. 09468877434

CONTACT DETAILS
Child’s Name: PRINCESS JEWEL J. YOUNG

Date of Birth: JUNE 28, 2010 Place of Birth: SORSOGON CITY Age: 12 Sex: FEMALE
Year/Grade level: GRADE VII School: SORSOGON NATIONAL HIGH SCHOOL
Address: GUINLAJON, SORSOGON CITY

3
I confirm that I, Sheryl P. Andaya am the parent/guardian of Angel P. Andaya .
Name: SHERYL P. ANDAYA Contact No. 09101036466

CONTACT DETAILS
Child’s Name: ANGEL P. ANDAYA

Date of Birth: AUGUST 8, 2014 Place of Birth: SORSOGON CITY Age: 8 Sex:
FEMALE
Year/Grade level: GRADE III School: SORSOGON EAST CENTRAL SCHOOL
Address: GUINLAJON SORSOGON CITY

4
ATTENDANCE SHEET
DATE NAME OF TUTEE Time Time Signature

Started Ended
10-12-2022 Ferna Kaye J. Young 2:00pm 3:00pm
Angel P. Andaya
10-15-2022 Princess Jewel J. 9:00am 10:00am
Young
Angel P. Andaya
Young
Angel P. Andaya
Young
Angel P. Andaya
Young
Angel P. Andaya
Young
Angel P. Andaya
Young
Angel P. Andaya
Young
Angel P. Andaya
Young
Angel P. Andaya
Young
Angel P. Andaya
Young
NAME OF TUTOR: KRISTEL FAYE J. YOUNG

Year/Major: BTVTED-FSM 3A
Signature: _______________________________

5
SUMMARY LIST OF THE TARGET BENEFICIARIES FOR THE

PROJECT LOTUS – BEED(CITY)
Name of the Course Name of Target

Grade School of the
TED Student- Yr & Address Beneficiary
Level Tutee
Tutor (SSC) Section (Tutee)

6
EXTENSION EVALUATION FORM

PROJECT TITLE: PROJECT LOTUS (Localized Tutorial Services)
DATE: December 23, 2022
_________________________________________________________________________________
Name of Extension Participant: FERNA KAYE J. YOUNG
Barangay: GUINLAJON, SORSOGON CITY
Failed to Fulfilled some Fulfilled all of Exceeded my Highly

meet my of my my expectations Exceeded my
expectations expectations expectations expectations
CRITERIA 4- Very
1 -POOR 2- Less 3- Satisfactory 5- Outstanding
Satisfactory Satisfactory
1. My evaluation of the Extension Service provided in

terms of quality and relevance (Ebalwasyon ko sa ✓
lebel nin dekalidad asin akma sa pangangaipuhan na
Extension Service na nakonducir samo.)
2. Evaluation of the Extension Advisory Service
provided in terms of quality and relevance
(Ebalwasyon ko sa lebel nin dekalidad asin akma sa
✓
pangangaipuhan na serbisyong tinao kan SSU
Extensionist/s )
3. Timeliness of Service Delivery (Napapanahon na ✓
pagdeliber nin Extension Service )
4. Extension Request responded within 3-5 days ✓
(Pagtugon sa kahagadan na magkonducir ki
Extension sa laog nin 3-5 aldaw)
Signed: ________________________ Date: December 23, 2022

Extension Beneficiary
SSC-EXT-14-F-013B Rev. 01 Effective August 01, 2019


PROJECT TITLE : PROJECT LOTUS (Localized Tutorial Services)
_________________________________________________________________________________
Name of Extension Participant: ANGEL P. ANDAYA
Failed to Fulfilled Fulfilled all of Exceeded my Highly

meet my some of my my expectations Exceeded my
CRITERIA 4- Very
1 -POOR 2- Less 3- Satisfactory Satisfactory 5- Outstanding
Satisfactory

✓
pangangaipuhan na serbisyong tinao kan SSC
Extensionist/s )
4. Extension Request responded within 3-5 days ✓
(Pagtugon sa kahagadan na magkonducir ki

7

PROJECT TITLE: PROJECT LOTUS (Localized Tutorial Services)
_________________________________________________________________________________
Name of Extension Participant: PRINCESS JEWEL J. YOUNG
Failed to Fulfilled some Fulfilled all of Exceeded my Highly

meet my of my my expectations Exceeded my
CRITERIA 4- Very
1 -POOR 2- Less 3- Satisfactory 5- Outstanding
Satisfactory Satisfactory

✓
pangangaipuhan na serbisyong tinao kan SSU
Extensionist/s )
4. Extension Request responded within 3-5 days
(Pagtugon sa kahagadan na magkonducir ki ✓


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KRISTEL FAYE J.

Parental Consent Form and Learners Profile ----------- 3

Attendance Sheet ------------------------------------- 5

Summary List of the Target Beneficiaries

for the Project Lotus -------------------------------- 6

Evaluation Form -------------------------------------- 7

PARENTAL CONSENT FORM and LEARNERS PROFILE

I confirm that I, Ferdinand O. Young am the parent/guardian of Ferna Kaye J. Young .

Name: FERDINAND O. YOUNG Contact No. 09462940611

Child’s Name: FERNA KAYE J. YOUNG

Name of Tutor: KRISTEL FAYE J. YOUNG Contact No. 09203463904

Republic of the Philippines

PARENTAL CONSENT FORM and LEARNERS PROFILE

I confirm that I, Divina J. Young am the parent/guardian of Princess Jewel J. Young .

Name: DIVINA J. YOUNG Contact No. 09468877434

Child’s Name: PRINCESS JEWEL J. YOUNG

Name of Tutor: KRISTEL FAYE J. YOUNG Contact No. 09203463904

Republic of the Philippines

PARENTAL CONSENT FORM and LEARNERS PROFILE

I confirm that I, Sheryl P. Andaya am the parent/guardian of Angel P. Andaya .

Name: SHERYL P. ANDAYA Contact No. 09101036466

Child’s Name: ANGEL P. ANDAYA

Name of Tutor: KRISTEL FAYE J. YOUNG Contact No. 09203463904

Republic of the Philippines

DATE NAME OF TUTEE Time Time Signature

NAME OF TUTOR: KRISTEL FAYE J. YOUNG

Republic of the Philippines

SUMMARY LIST OF THE TARGET BENEFICIARIES FOR THE

Name of the Course Name of Target

Republic of the Philippines

EXTENSION EVALUATION FORM

Failed to Fulfilled some Fulfilled all of Exceeded my Highly

1. My evaluation of the Extension Service provided in

Signed: ________________________ Date: December 23, 2022

SSC-EXT-14-F-013B Rev. 01 Effective August 01, 2019

Republic of the Philippines

EXTENSION EVALUATION FORM

Failed to Fulfilled Fulfilled all of Exceeded my Highly

1. My evaluation of the Extension Service provided in

Signed: ________________________ Date: December 23, 2022

Republic of the Philippines

EXTENSION EVALUATION FORM

Failed to Fulfilled some Fulfilled all of Exceeded my Highly

1. My evaluation of the Extension Service provided in

Signed: ________________________ Date: December 23, 2022

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