DATE RECEIVED BY ALS: _______________ ______

APPLICATION FORM (RAF)

Please indicate (mark with an x) the organization initiating the set-up of an eSkwela Center: DepED LGU NGO Civic Org Other If other, please specify: Name Position Office / Organization Telephone Email

If DepED initiated, please indicate the following:

If Non-DepED initiated, please indicate the following: Target Date of eSkwela Operations:

Region ALS Division, District Location of potential site (please indicate exact address Name of Organization Location of proposed site (please indicate exact address)

Contact Person (for eSkwela setup and this form)

AVAILABILITY OF INFRASTRUCTURE REQUIREMENTS

Space/Room
*Please provide pictures of the proposed site (interior and exterior), computers and equipment (if already available) by attaching it to this form (if RAF will be sent via courier) or via email ( alscaloocandiv@yahoo.com ) AirTables and Specifications Room Size Electricity conditioning Chairs Units
electric outlets should be enough for number of computers and Center equipment; separate circuit breakers for computers and aircon units 3-10 computers: 1 aircon (2 horsepower) 11 computers or more: 2 aircon units (2 horsepower) one set (computer table and chair) per computer, plus 2 additional sets for Center Manager and Learning Facilitator

Target Number of OSYAs for first batch of eSkwela learners:

Schedule of eSkwela sessions (Please mark planned operating hours and days with an X) AM 8:00 9:00 9:00 10:00 10:00 11:00 11:00 12:00 PM 1:00 2:00 2:00 3:00 3:00 4:00 4:00 5:00 5:00 6:00 6:00 7:00 7:00 8:00 8:00 9:00
M T W Th F Sat Sun

Required

At least 1.5 sqm per computer, with provision for work area

Actual (please indicate actual specs)

Computers

Yes

No

Internet
If yes, indicate service provider:

Yes

No

If yes, what type (mark x) If Broadband, What speed?

Dial-up

DSL / Broadban d

How many? Computer Specs - General

DSL (wifi zone)

Yes
Do the computers run on Windows? (if yes, please indicate version Windows 98, 2000, XP or Vista) Can you play audio (CDs, mp3s) in the computers? Can you play video (VCDs, DVDs) in the computers? Are the computer units networked? (with LAN cables or wireless)

No

Computer Specs - Detailed

You may ask the resident IT/computer expert in your office (Network Administrator, MIS, programmer):

Technical Specs

How many computer units?

Performance Processo r
2.4 GHZ & higher

Multimedia Capability Hard Disk

160 GB (w/ <10 GB free space) 80 GB (w/ <10 GB free space) 80 GB (w/ 10 GB free space) 40 GB (w/ 10 GB free space)

Internet / Network - Ready LAN Card

10/100 Mbps

Software* Operatin g System

Any licensed / open source operating system Any licensed / open source operating system Any licensed / open source operating system Any licensed / open source operating system

Memor y
2 GB

Soun d Card
Any, workin g

Video Card
Higher than 1024 x 768 resolution

Monito r

Headset
Any, working

Applicatio ns licensed / open souce application s licensed / open souce application s licensed / open souce application s licensed / open souce application s

1 server PC Recommended 20 workstation PCs

LCD

900 MHZ or equivalent

512 MB

Any, workin g

Higher than 1024 x 768 resolution

LCD

Any, working (1 headset per computer)

10/100 Mbps

1 server PC Minimum 4 computer units (including server)

900 MHZ or equivalent

1 GB

Any, workin g

1024 x 768 resolution

CRT

Any, working

10/100 Mbps

500 MHZ or equivalent

256 MB

Any, workin g

1024 x 768 resolution

CRT

Any, working (1 headset per computer)

10/100 Mbps

Actual (please indicate actual computer specs here; use extra rows if needed)

1 server PC

workstation PCs (indicate how many)

AVAILABILITY OF STAFF REQUIREMENTS Center Manager

Name Office / Organization Please indicate relevant experience (educational background, work experience, training)

Network Administrator

Learning Facilitators
How Many? Name Relevant Experience (yes or no) Position / Designation
Trained in ALS? (If Yes, please indicate date of training) Computer user? / Does he make use of the computer for routinary tasks (e.g. reports, letters, etc)? Does he/she make use of the Internet (e.g. e-mail, browsing, chat)?

1. 2.

How can eSkwela, as a project, serve your organization, your community and its out-of-school youth and adults?

Community Involvement

Please indicate (mark with an X) the involvement of your community in the implementation of eSkwela (please specify for NGO, Civic Org, or Other):

DepE D Provision of Space/Room for eSkwela Renovation of space/room (if needed) Electricity Internet Airconditioning Units Headsets

LGU

NGO

Civic Org

Other

Computer Tables and Chairs Supplies (print modules for modules where eSkwela e-modules are not yet available; materials for learner portfolio) Computers License for OS (if proprietary; i.e. Windows) Repair and Maintenance of computers Center Manager, salary Network Administrator, salary Learning Facilitators, salary Accomplished by: (Name & Signature) Position/ Designation: Contact Number/s: E-mail Address:

Noted by:
(Name & Signature of Immediate Superior / Head of Organization)

Localized as of August 2011

Position/ Designation: Contact Number/s: E-mail Address:

ANNEX: Photos
Photos of the exterior/interior of the proposed site (building/room)

Photos of the computer units

Photo of the Center Manager, Network Administrator and Learning Facilitator (Kindly identify the personnel from left to right)