Activity Design CESC

Republic of the Philippines
Department of Education
REGION XII
SCHOOLS DIVISION OF SOUTH COTABATO
POLOMOLOK NATIONAL HIGH SCHOOL
January 17, 2024
School Principal II
National High School
Thru:
School Academic Head
Ma’am/Sir:
Greetings of peace!
In National High School, Grade 12 Humss Freud will be having a Feeding Activity this
Tuesday, January 23, 2024. In line with this I am asking your humble heart to allow the Grade 12
Department to hold the said activity. By doing this, the Grade 12 HUMMS students will be able to
cook and share foods to the children and parents of Asuncion Village. Rest assure that we will
observe proper health protocols during the said activity. May this request be granted with your
blessing and consent. Thanks, and God bless.Sincerely Yours,
Grade 12 Humss Leader
Noted:
CESC Subject Teacher
APPROVED:
MURDY F. BAUTISTA PhDEd

School Principal II
ACTIVITY DESIGN
Address: Octavio Village, Brgy. Cannery Site, Polomolok, South Cotabato 9504
Telephone Number: (083) 878-8996
Email Address: 304560@deped.gov.ph
REGION XII
I. Program/Project/Activity Title:
“Have Heart, lend a Heart, and Make a Difference: A Grade 12 HUMSS
students Outreach Program”
II. Proponent/s:
KENNETH A. JOCSON
Grade 12 Teacher
All Grade 12 HUMSS students
III. Implementing Office/School:
Polomolok National High School
IV. Location:
Octavio Village, Brgy. Cannery Site, Polomolok, South Cotabato
V. Target Number of Participants:

5 constituents in different purok in Brgy. Cannery Site
VI. Total Project Cost:

NONE
VII. Implementation Schedule:

January 23, 2024
VIII. Duration:
3hrs – 8am to 11am
IX. Venue:
Asuncion Village, Barangay Cannery Site, Polomolok, South
Cotabato
X. Rationale:
Many young people are struggling with health issues, which in
some cases became more drastic during the surge of the pandemic due
to the major adjustments they experienced. Even today, most youth
lack the knowledge and understanding of how to properly manage and
care for their mental health.
One of the activities of HUMSS Strand in their subject of

Community Engagement, Solidarity and Citizenship is Outreach
Activity. This type of activity encourages grade 12 HUMSS students
REGION XII
to be advocates and help raise important community issues that need to

be addressed, such as youth mental health. Furthermore, this activity
will help those students who lack knowledge and understanding of
how essential good mental health is, especially in youth, because the
facilitators of the program will be giving lectures and sharing lessons
in the most fun and engaging way possible.
XI. Terminal Objective:

To provide nutritious food and help share knowledge and raise
awareness on mental health to the community of Brgy. Cannery Site.
XII. Enabling Objectives:

- To improve the nutritional health of the community
- To provide knowledge and lesson on proper mental health
management
- To increase awareness on the importance of mental health among
youth
XIII. Expected Outputs:

At least 25constituents in the community will benefit the activity
XIV. Activity Description:

Grade 12 HUMSS Outreach Activity
XV. Performance Indicators:

Attendance and list of Participants
XVI. List of Participants:

Attendance and list of Participants
REGION XII
XVII. List of Participants:
Grade 12 HUMSS students
XVIII. Budgetary Requirements

Donation
XIX. Source of Funds
Donation, Utensils and ingredients from the facilitators of the program
XX. Matrix of Activities
Date Time Min. Topic / Activities Persons Responsible /

Facilitators
January 23, Attendance/ Giving of Student/s
2024 Program /Registration
8:00 - 8:10 am. 10 Prayer John Paul Mamigo
8:10 -8:30 am. 20 Singing of National Student

Anthem/South Cotabato
Hymn / Regional Hymn
8:30 -8:45 am 15 Opening Remarks Purok Chairman
8:45 - 9:00 am. 15 Message Gleiry Mae C. Dela Pena
9:00- 9:45 am. 45 Short Lecture/Giving of Kurt Jhune Camilo

Fliers
9:45-10:30am 45 Games Jeshiny Quenn Asas
Glaicca Hingpit
REGION XII
10:30 -10:50am. 20 Snacks/ Giving of gift All HUMSS Freud Student
10:50- 11:00am. 10 Closing Message/ Closing Prayer Clark Laurence Bolivar
Prepared by:
Gleiry Mae C. Dela Pena

Grade 12 Freud Leader
Noted:
Kenneth A. Jocson
CESC Subject Teacher
APPROVED:
MURDY F. BAUTISTA PhDEd

School Principal II
REGION XII
EVALUATION FORM
Venue:
Date:
Time:
Direction: In relation to the activity you have participated in, please check the appropriate box to indicate
your honest and objective assessment of the following:
Criteria System of Evaluation
I. Program of Activities Poor Fair Good Very Good Excellent
1. Planning
2. Scheduling (adequacy of time allotted
for each activity)
3. Sequencing of topics and activities
(topic/ activity
sequenced according to importance/
difficulty or other criteria)
4. Implementation
5. Relevance of topics/ activities to
objectives
6. Adequacy of treatment
II. Exhibits and Film Showing Poor Fair Good Very Good Excellent
1. Relevant information offered.
2. Personal enrichment gained.
III. Materials Poor Fair Good Very Good Excellent
1. Quality
2. Content
3. Packaging
4. Adequacy
5. Relevance to the needs of
participants
6. Updated
IV. Secretariat Poor Fair Good Very Good Excellent
1. Responsiveness of staff to
participants' needs
2. Adequacy of services of staff
3. Professional behavior of staff.
V. Program Objectives Poor Fair Good Very Good Excellent
1. Objectives are understood well.
2. Objectives are attained.
VI. Meals/ Refreshments Poor Fair Good Very Good Excellent
1. Quality
REGION XII
2. Schedule of meals
3. Manner of serving
4. Adequacy
VII. Conference Venue
Poor Fair Good Very Good Excellent
Accommodation
1. Services
2. Facilities (light, water, ventilation,
noise, rest rooms)
3. Accommodation
VIII. Impact of Activities Poor Fair Good Very Good Excellent
1. To what extent were interaction,
sharing and socialization gained?
IX. Speakers and Resource Persons: Indicate your assessment of the speaker and resource
person by encircling one of the five numbers that comprise the qualities scale.
4- Very
5- Excellent 3- Good 2- Fair 1- Poor
Good
Relevance to
Quality of Content of Materials
Name of Resource Person the
Presentation Presentation Used
Assigned
Topic
12345 12345 12345 12345

12345 12345 12345 12345
Workshop Facilitator
12345 12345 12345 12345
12345 12345 12345 12345
COMMENTS:
REGION XII
COMMUNITY FIELD WORK REPORT

POST- COMMUNITY OUTREACH NARRATIVE REPORT
I. Title/ Name of Community Outreach

________________________________________________________________________
( ) Progress ( ) Project ( )Activities ( ) Services
II. Nature/ Description of the Outreach

_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
III. Date
IV. Travel Time
Mode of Travel Travel

Departure from school
Arrival at venue
Departure from venue

V. Name of Venue/ Community
_______________________________________________________________________
_______________________________________________________________________
VI. Respondents/
Clients A. Number of
Respondents :
B. Genders :
C. Age Level :
REGION XII
VII. Project Input

A. Faculty/ Staff/ Student as (1) Lecturer (2) Facilitator
(3) Coordinator (4) Volunteers
Name Department Job Designation
B. Student Implementors
Name Department Job Designation
VIII. Narrative/ Descriptive Report (in 100 words)
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
________________________________________________________________________________
_________________________________________________________________________________
IX. Problems Encountered: Enumerate the significant problems encountered during the
implementation proper.
REGION XII
Rubrics for Immersion

Group Participation
Excellent Above Average Average Poor Teacher

5 pts. 4 pts. 3 pts. 2pts. Score
Student constantly Student is a
engaged in the Student participates passive Student is not
activity. Students in the participant involved with
Involvement show awareness activity as needed through the the activities
of the issues, asks and but could use more most of the around the
answered questions. enthusiasm. immersion immersion trips.
experience.
Student completed Student completed
Student did not
assigned task/ assigned task/role and
Student has complete
role and is ready with ready with
completed required
required required materials for
some of the tasks/ roles.
materials for the the immersion
assigned Student
Preparedness immersion. activities. Student
tasks/roles contributed little
Student has done all has done the basic
and ready for the or
assignments with required
immersion nothing at all to
best effort assignments and
and ready for the activities. the overall
ready for the most
activities. activities.
activities.
Student is
neutral about the
immersion Student has a
Student is positive
activities. negative
about the
Student attitude.
immersion Student is positive
spreads mixed Student makes
Attitude activities being set the about the
feelings the
example for immersion activities.
around the experience
students around him/
group both bad for others
her.
positive and around him/ her.
negative.
Student Student
Body and/or verbal sometimes frequently
responses indicate pay attention to interrupt
Student respects and active the group and/or put
Social
encourages the listening/participati discussion. down the views
Interaction
views of others. on. Student asks Student of others.
questions and build sometimes ask Student do not
on other comments. questions
REGION XII
and build on participate.

others comment. Does not mix
with the group.
TOTAL
REGION XII
Rubrics for Immersion (Individual)

Individual Performance
Needs Competent
Developing Exemplary
Development (GOAL)
Student wants Student realizes that
earnestly to she/ he can Student has grasped a
Student can "help", but shows learn from those deep knowledge of
articulate Student no knowledge of she/ he serves. solidarity and
systematic demonstrates little to the larger historical, Recognizes that actively engaged in
causes of social no engagement. economic, and poverty linked to living out her/ his
problems. socio- political larger systematic commitment to the
problems at play. issues occurring in poor.
the world.
Evidence
Student is
Student frequently
cognizant of the Student connected donates his/ her time
importance of to (either through
Student recognizes to social
meeting the awareness of or
the importance of causes in his/ her
needs of people dedication to act
meeting the Shows little community and
and the
needs of "the engagement. on behalf of) social sees connection
environment
other" through the causes and issues between what he/
through service ,
service. surrounding the she can do at home
but fails or
people he/ she and how the
unaware of how to
serves. impacts those
get involved with a
overseas.
specific cause.
Evidence
Can clearly articulate

Has religious or what faith and
spiritual spirituality
Student prays with conversations with mean in his/ her life.
the group but has faculty/ staff or Lives in a
Student explores Disinterested or not other students. manner that aligns
the role of faith unengaged with shown any signs Knows that faith and with his/ her faith.
and spirituality in spiritual topics that he/ she is spirituality Clearly connects faith,
service.
grappling with his/ play an important justice, and
her faith. role in his/ her life spirituality. Can
and in quest for articulate why his/
justice. her faith compels
her/ him to act for
justice.
REGION XII
Evidence
Student expresses Student engages

Students engages in Student articulate
knowledge of, actively with social
social justice some knowledge of
Is disengaged with interest in, and justice issues and
efforts with the social justice
social efforts. efforts, yet does concern for social seeks to eliminate
goal of eliminating
justice efforts is injustice in
injustice for all. not see how what is
moved to the plight whatever realm he/
relevant.
of the poor. she can.
Student can
Student built good articulate the Student can articulate
relationships with importance of the
Student building
individuals from importance of
understands the Student does not sustainable
the host while on building sustainable
importance of understand the
the trip, yet could relationships with relationships with
building concept of
not articulate the "the other", but "the other" and lives
sustainable "relationships"
importance of might not grasp his/her life in
relationships with holistically and
life-giving and the importance of accordance with
"the other" broadly.
sustainable these relationships these principles.
(community)
relationships with at the community, He/she embodies
"the other" institutional, or solidarity.
environmental level.
REGION XII
STUDENT WAIVER
I, ______________________________presently enrolled in ____________________

(Track/Strand) present myself to participate in a GRADE 12 HUMSS: OUTREACH
PROGRAM as part of our school activity and do hereby pledge that:
1. I will obey and abide the rules and regulations promulgated, enforced by the school,
carried by the teacher-in-charge for the protection and safety of all;
2. I hereby waive and renounce my rights to all damages, hospitalization, and the like.
I will not hold the school, staff and the teacher concerned responsible for any misfortune,
injury, or accident be slight or serious, that may happen in connection with the activities or
requirements. The cause of which will be attributable to my acts of disobedience,
negligence, and the offense of my heading to advice, warning, precaution, and safety rules
that were discussed to me the subject-teacher in charge before the start of the activity.
The content of this waiver was read and explained to me before I affix my name and
signature this _____th day of _____________, 20___ freely and voluntarily.
Thank you very much!
Yours truly,
______________________________ _____________________________
Name of Student Name of Parent/ Guardian
(Signature over Printed Name) (Signature over Printed Name)
REGION XII
PARENTAL/ GUARDIAN CONSENT

Date:_________________
TO WHOM IT MAY CONCERN:
This is to certify that I allowed my son/ daughter to participate in a GRADE 12

HUMSS: OUTREACH PROGRAM as requirement in Community Engagement,
Solidarity, and Citizenship (CESC).
Name of Son/ Daughter

Name of Activity
Inclusive Date/s
Place(s) to Visit
Thank you very much!
_____________________________
Parent/ Guardian
(Signature over Printed Name)

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Republic of the Philippines

January 17, 2024

Grade 12 Humss Leader

CESC Subject Teacher

MURDY F. BAUTISTA PhDEd

All Grade 12 HUMSS students

III. Implementing Office/School:

Polomolok National High School

V. Target Number of Participants:

VI. Total Project Cost:

VII. Implementation Schedule:

One of the activities of HUMSS Strand in their subject of

to be advocates and help raise important community issues that need to

XI. Terminal Objective:

XII. Enabling Objectives:

XIII. Expected Outputs:

XIV. Activity Description:

XV. Performance Indicators:

XVI. List of Participants:

XVII. List of Participants:

Grade 12 HUMSS students

XVIII. Budgetary Requirements

XIX. Source of Funds

Donation, Utensils and ingredients from the facilitators of the program

XX. Matrix of Activities

Date Time Min. Topic / Activities Persons Responsible /

8:00 - 8:10 am. 10 Prayer John Paul Mamigo

8:10 -8:30 am. 20 Singing of National Student

8:45 - 9:00 am. 15 Message Gleiry Mae C. Dela Pena

9:00- 9:45 am. 45 Short Lecture/Giving of Kurt Jhune Camilo

9:45-10:30am 45 Games Jeshiny Quenn Asas

10:30 -10:50am. 20 Snacks/ Giving of gift All HUMSS Freud Student

10:50- 11:00am. 10 Closing Message/ Closing Prayer Clark Laurence Bolivar

Gleiry Mae C. Dela Pena

MURDY F. BAUTISTA PhDEd

12345 12345 12345 12345

COMMUNITY FIELD WORK REPORT

I. Title/ Name of Community Outreach

II. Nature/ Description of the Outreach

IV. Travel Time

Mode of Travel Travel

Departure from venue

VII. Project Input

Name Department Job Designation

VIII. Narrative/ Descriptive Report (in 100 words)

Rubrics for Immersion

Excellent Above Average Average Poor Teacher

and build on participate.

Rubrics for Immersion (Individual)

Can clearly articulate

Student expresses Student engages

I, ______________________________presently enrolled in ____________________

Thank you very much!

PARENTAL/ GUARDIAN CONSENT

TO WHOM IT MAY CONCERN:

This is to certify that I allowed my son/ daughter to participate in a GRADE 12

Name of Son/ Daughter

I, __________presently enrolled in