Healthy Pilipinas Awards for Partners 2023

APPLICATION FORM

Organization Name

Type of Organization Development Partner Civil Society Organization

National Government Private Corporation
Agency Others _____________

Name of Project(s) /
Intervention(s) /
Advocacy or
Advocacies

Inclusive Dates of From: To:

Implementation

Area of Strategic Check all Areas that apply to your intervention/initiative/activity. For
Implementation each checked Area, please complete the corresponding Questionnaire
Sheet.

Health Literacy
Healthy Settings
Healthy Governance
Citizenship

Completed by Approved by

Signature over Printed Name Signature over Printed Name

Contact number: Contact number:

Email: Email:

Date: Date: