COMMUNITY MAPPING TOOL (per Household)

Household No.:
Purok No.:

Father: Type of Dwelling: With Toilet:

Mother: Extended Family: ____ yes ____ no With Gulayan:
No. of Children: Enrolled at PIS: Enrolled at other School: ____________ OSY:

Name of Child (Pls refer to Birth Certificate) With B- With With ECCD Currently Planning 4Ps SBFP
Birthday Age Gender
First Name Middle Name Surname Extension Certificate Disability ECCD facility Studying? to Enroll? Beneficiary Beneficiary

Interviewed by: Interviewee:

ROMEO V. RAMIREZ JR. LORIANE SG. FRIAS

Teacher I Teacher I Head of Household
 COMMUNITY MAPPING TALLY SHEET
Purok : No. of Household w/o School-aged Children: _________
No. of Households: With Toilet:
With Gulayan:
Dwellings: Concrete: ______ Semi: _______ Made from Light Materials: _________

Number of Children Enrolled at PIS Enrolled at Other School Out-of-School Youth With ECCD 4 Ps Beneficiary Studying Planning to Enroll (for OSY only) SBFP Benificiary With Valid Birth Certificate Under Custody of a Guardian
Age
Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total
4
5
6
7
8
9
10
11
12
13
14
15
16
17

Total

Surveyed by:

ROMEO V. RAMIREZ JR. LORIANE SG. FRIAS

Teacher i Teacher i