ANNEX A

NOMINASYON
BayanIKa! Awards

PARA SA DSWD KALAHI-CIDSS STAFF:

Inihandani: (Pangalan ng ACT/RPMO staff, posisyon)

Lugar kung saannakatalaga:

Bayan, lalawigan, at rehiyon

Telepono: E-mail address:

Pangalan ng
Nominado:

Tirahan/lokasyon:

Telepono:

Kategorya: Gender and Development Volunteerism

Pumililang ng isa. Disaster Risk Reduction or
Environment Protection
Improved Local Governance
Indigenous Peoples’ Welfare
Operations and Maintenance
(O&M) Group
Special Awards
Exceptional Youth Volunteer
Exceptional Senior Citizen
Volunteer
Exceptional Person with
Disability Volunteer

PANUTO: Sagutin ang mga tanong sa ibaba. Maglahad ng sapat na detalye upang
maipakita kung bakit karapat-dapat na hiranging BayanI Ka! Awardee ang nominadong
indibidwal, grupo, o organisasyon. Magdagdag ng papel kung kulangang puwang para
sa mga sagot.

1. Ang pakikiisa sa pamayanan ay isa sa mga katangian na ating binibigyang halaga, sa

paanong paraan ipinaliwanag o ipinaintindi ng nominado ang kahalagahan at layunin
ng DSWD KALAHI-CIDSS sa pamamagitan ng Community-Driven Development
(CDD) Approach?

2. Bukod sa pagtataguyod ng Community-Driven Development, ilarawan ang naging

tungkulin ng nominado sa kanyang pamayanan at kung bakit ito ang dahilan upang
hirangin siyang BayanI Ka! Awardee

3. Ano ang natatanging ambag ng indibidwal, grupo, o organisasyon sa (a)

pagpapatupad ng Community-Driven Development (CDD) sa pamayanan, at (b)
pagpapaunlad lalo ng local na pamamahala at buhay ng mga residente matapos
nilang lumahok sa DSWD KALAHI-CIDSS? Magbigay ng mga halimbawa (mga
epektibong solusyon o strategy, paraan para tiyakin na naging kapaki-pakinabang sa
lahat ang ginawang pagkilos sa pamayanan).
 Ambag/ Kailan Mga nakinabang Mga natapos at Katuwang na
gawing ipinalakad sa aktibidad o naisakatuparan grupo (NGA, LGU,
pinatupad ang gawain gawain (Outputs at CSO, atbp.)
(Target outcomes) Isama ang
beneficiaries) contact details

Mahalaga: Magbigay ng tatlong (3) taong magpapatotoo (character references) sa pagiging

kwalipikado ng nominadong indibidwal, grupo, o organisasyon. Ilakip ang kanilang likha at iba
pang mga dokumentong magpapatunay na karapat-dapat maging BayanI Ka! Awardee ang
nominado.

Ipadalaangnominasyonsa:

DSWD FIELD OFFICE __– KALAHI-CIDSS RPMO

Address: ___________________________
Telepono: __________________________
Email: _____________________________
 ANNEX B

NAME OF NOMINEE/S :___________________________________

REGION :___________________________________
CATEGORY : Operations and Maintenance (O&M) Group

DESCRIPTION MEANS OF GRADING SYSTEM / WEIGHT RATING

VERIFICATION INDICATOR

The nominee/s ● Updated and Bisyon - 20%

help/s in sustaining Approved ● Updated Vision, 20pts
the operations and Maintenance Mission, Goals, and
maintenance of the Program Objective, set of
● Monthly / Annual officers and CBL-
sub-project.
Investment Plan Reflective of the
(M/AIP) allocation of vision, mission and
Operation and purpose of the
Maintenance cost organization
● Documents for
Registration and Aksyon - 20%
Accreditation of O&M ● O&M Program 5pts
Group Complete
● Minutes and ● On-time conduct of 10pts
attendance of the O&M activities
meeting reflected in the O&M
● Resolution Program (SE,
recognizing the O&M Meetings,
group as official Participation to BDC)
member of the ● Operationalization of 5pts
expanded Barangay the O&M Program
Development Council
(BDC) Yakag - 15%
● Result of the ● Frequency of the 8pts
sustainability Meetings conducted
by the O&M group to
promote community
development
● Percentage of 7pts
attendees

Abilidad - 15%
● Number of trainings 15pts
that enhances skills
of the O&M groups
and members of the
community

Nakikiisa - 15%
● Recognized and 8pts
 participated in the
BDC
meetings/dialogues
● Promote activities 5pts
that leads to keep
the community
united (at least 80%
of community
participated in the
activities)
● Participation of 2pts
different sectors
from the community
(senior, persons with
disability, youth,
women, etc)

Integridad at Inspirasyon -
15%
● Adherence to the 10pts
O&M policies and
guidelines (measure:
Sustainability
Evaluation report,
zero complaints/
grievance)
● Has received awards 5pts
and recognition;

NOTE: Other MOV’s are dependent on the write-up that will prove the veracity an
authenticity of the details of the nomination.

Rated by:

(signature)__________
Name
Position

ANNEX B
 NAME OF NOMINEE/S :___________________________________
REGION :___________________________________
CATEGORY : Gender and Development

DESCRIPTION MEANS OF GRADING SYSTEM / WEIGHT RATING

VERIFICATION INDICATOR

● Gender and Bisyon - 20%

The nominee/s Development ● Was able to pursue 20pts
actively promote/s quarterly a gender-sensitive
gender equality and accomplishment subproject in the
equity in the report community
community, from ● Sex Disaggregated
participation to Data Aksyon - 20%
decision-making. ● Minutes and ● Was able to utilize 10pts
attendance of the disaggregated data
meeting as basis of planning
● Gender and and in the
Development (GAD) identification of
Plan; projects and
programs
● Was able to 10pts
implement their
plans, strategies,
and resources that
address gender-
related issues and
concerns
Yakag - 15%
● Involvement and 8pts
participation of
women in leadership
positions in the
implementation.
● Involvement and 7pts
participation of
women in SP
Implementation

Abilidad - 15%
● Number of skills more than 3
based trainings/ trainings
programs for women attended -
that the nominee 8pts
attended
1-3 trainings
attended -
5pts
 more than 3
orientations
● Number of GAD- attended -
related orientations, 7pts
info dissemination
etc. conducted 1-3
orientations
attended -
4pts

Nakikiisa - 15%
● Was able to create a
proposal/plan (e.g.
GAD Budget) that
was able to cater the
specific need of a 8pts
marginalized sector
which further
strengthened the
community spirit and
women inclusion
towards social
development;
● Actively participate
in the development
gender related
activities that
strengthen women 7pts
engagement in
planning, budgeting,
and implementation

Integridad at Inspirasyon -
15%
● Has received awards
and recognition;

more than 3
awards/
recognition
received - 8pts

● Actively involved in 1-3 awards/

the various recognition
community activities received - 5pts
that increase social
awareness and 7pts
participation of the
 women

NOTE: Other MOV’s are dependent on the write-up that will prove the veracity and
authenticity of the details of the nomination.

Rated by:

(signature)__________
Name
Position

ANNEX B
 NAME OF NOMINEE/S :___________________________________
REGION :___________________________________
CATEGORY : Disaster Risk Reduction Management or Environmental
Protection

DESCRIPTION MEANS OF GRADING SYSTEM / WEIGHT RATING

VERIFICATION INDICATOR

● Disaster Risk Bisyon - 20%

Management and ● Able to identify 20pts
The nominee/s Treatment Plan interventions to their
actively promote/s ● Environmental and community needs
environmental Social Safeguard designed to avoid or
protection for the Checklist minimize negative
benefit of everyone. ● Risk Damage environmental impacts
Assessment and and able to implement
Needs Analysis / appropriate mitigations
Participatory to address
Situational Analysis environmental issues.
(PSA)
● Subproject Concept Aksyon - 20%
Form and SP ● Prepared/Assisted in 20pts
Proposal the preparation of
● Environmental and detailed proposal,
Social Safeguards Subproject Completion
Checklist (ESSC), the Form (SPCF), and
● ESMP, the Initial documents under the
Environmental Environmental and
Examination (IEE) or Social Management
● List of BSPMC/ BDC- Framework (ESMF).
TWG Members;
Yakag - 15%
● Frequency of the 15pts
Meetings conducted/
attended by the
nominee to discuss the
ESMF plans

Abilidad - 15%
● Number of safeguards more than 3
trainings attended by trainings
the nominee attended -
15pts

1-3 trainings
attended -
10pts
 Nakikiisa - 15%
● Discussed experiences 15pts
in implementation of
safeguards measures
during Accountability
Reporting sessions

Integridad at Inspirasyon -
15%
● Has received awards more than 3
and recognition related awards/
to DRRM, Safeguards, recognition
and other related fields. received -
15pts

1-3 awards/
recognition
received -
10pts

NOTE: Other MOV’s are dependent on the write-up that will prove the veracity and
authenticity of the details of the nomination.

Rated by:

(signature)__________
Name
Position

ANNEX B
 NAME OF NOMINEE/S :___________________________________
REGION :___________________________________
CATEGORY : Indigenous Peoples’ Welfare

DESCRIPTION MEANS OF GRADING SYSTEM / WEIGHT RATING

VERIFICATION INDICATOR

Bisyon - 20%
The nominee takes ● SP proposal ● The nominee ensures 20pts
active steps to ● HH beneficiary list that the projected
ensure that the rights ● Minutes and benefits and potential
of Indigenous documentation of risks to IP communities
Peoples are fulfilled, meetings are considered in
respected, and ● Certificates/ identifying and selecting
promoted in their Recognition Awards community subprojects
community so they on trainings
can exercise their ● Barangay Aksyon - 20%
right to self- Development Plan ● Was able to identify and 20pts
determination. (BDP) / Annual implement subproject
Investment Plan that will benefit a 10pts - able to
(AIP) minority group; identify
● Documentations subproject
● Harmonized only
Ancestral Domain
Sustainability Yakag - 15%
Development ● The nominee regularly 15pts
Protection Plan to consulted the opinions,
BDP/AIP insights, and
recommendations of
the IP community to be
used in the design of
community subprojects,
and development of
community proposal

Abilidad - 15%
● Number of skill based more than 3
trainings and programs trainings
for the IP Community attended -
15pts

1-3 trainings
attended -
10pts

Nakikiisa - 15%
 ● Was able to influence 15pts
the LGU to fund PPAs
specific to the welfare
of the IP Communities

Integridad at Inspirasyon -
15%
● Promotion of 15pts
Indigenous Knowledge
Systems and Practices
(IKSP)

NOTE: Other MOV’s are dependent on the write-up that will prove the veracity and
authenticity of the details of the nomination.

Rated by:

(signature)__________
Name
Position
 ANNEX B

NAME OF NOMINEE/S :___________________________________

REGION :___________________________________
CATEGORY : Volunteerism

DESCRIPTION MEANS OF GRADING SYSTEM / WEIGHT RATING

VERIFICATION INDICATOR

Bisyon - 20%
The nominee actively ● Process
demonstrates and Documentation report
promotes ● Written testimonials,
compassionate, documentation from
collective action in colleagues;
and beyond DSWD ● Initiated action points/
KALAHI-CIDSS to plans and presented
sustain the gains these to the LGUs/
made through the agencies for funding.
program. (i.e. proposals, plans,
etc) Aksyon - 20%
● Training
certificates/awards
received
● Program
Implementation
Timeframe
● Attendance of the
meeting
● Minutes of the
meeting
● Grievance Redress
System (GRS)
Resolution
● Was able to manifest 20pts
excellent interpersonal
relationships with other
community members
leading to the
realization of
community visions that
benefits the general
public
● Actively involved in 6 pts
volunteer services
outside and beyond
KALAHI CIDSS
Program;
● Performed assigned 6 pts
tasks on time and with
exemplary
performance;
● Participated in various 8pts
development forums
and/ or recognized as
official member of the
council and represent
the general welfare of
the community,
showing extraordinary
action that leads to a
more responsive
solution of the
community needs

Yakag - 15%
● Able to influence other 8pts
community members
through sharing of
experiences during
meetings, events, etc.
● Uses every opportunity 7pts
 to encourage the
community to be more
participative in
Government
programs, activities,
and projects.

Abilidad - 15%
● Pursue self-
development through more than 3
training programs and trainings
able to master new attended -
technical knowledge 8pts
and use it for the
benefit of the 1-3 trainings
community; attended -
5pts
● Exert effort in
accessing Programs,
Project and Activities 7pts
that helps to benefit
the general welfare of
the community (i.e. #
of proposal prepared
and implemented, # of
SPs recognized and
pipelined for funding
support etc)

Nakikiisa - 15%
● Able to thwart divisive
actions and tendencies
through resolutions 8pts
● Able to organize and
mobilize the people
into a collective action
that further 7pts
strengthened the unity
within the community

Integridad at Inspirasyon -
15%
● Has received
recognition/ awards/
commendations from 8pts
the different
stakeholders
● Was able to manifest
selfless actions for the
sake of community; 7pts
NOTE: Other MOV’s are dependent on the write-up that will prove the veracity and
authenticity of the details of the nomination.

Rated by:

(signature)__________
Name
Position

ANNEX B

NAME OF NOMINEE/S :___________________________________

 REGION :___________________________________
CATEGORY : Improved Local Governance

DESCRIPTION MEANS OF GRADING SYSTEM / WEIGHT RATING

VERIFICATION INDICATOR

The nominee/s ● Resolutions/ Bisyon - 20%

showed clear ordinances passed in ● Was able to promote 10pts
initiative to promote support of and for the program
improved local institutionalization advocacies
governance within CDD Principles ● The nominee envisions 10pts
the community by ● Minutes of the BDC a community where the
lobbying for meetings poor, oppressed, and
community ● Number of meetings marginalize are given
participation, conducted opportunities through
transparency, and ● Attendance of the the submission of policy
accountability in the meetings recommendation in the
funds use and ● Certificates on LGU
implementation of trainings/ seminars
community projects attended Aksyon - 20%
at the local level ● Involvement of the 10pts
nominee in community
consultations and
community planning
activities
● The nominee was able 10pts
to provide policy
recommendations,
enhancements, and/or
changes that further
promotes PTA in local
governance

Yakag - 15%
● The nominee was able 15pts
to influence the people
to join community
consultations,
meetings, and/or
planning activities

Abilidad - 15%
● Acquire new set of 15pts
skill/s learned through
training program/s that
was/were instrumental
to the crafting of
policy
recommendation that
promotes PTA in local
 governance.

Nakikiisa - 15%
● Able to recommend 15pts
and/or push for a
policy that promotes
unity within the
community

Integridad at Inspirasyon -
15%

● The nominee ‘s policy 15pts

recommendation/s
promoting CDD
advocacies were
approved and
executed by the LGU
through an ordinance,
resolution, and the
like.

NOTE: Other MOV’s are dependent on the write-up that will prove the veracity and
authenticity of the details of the nomination.

Rated by:

(signature)__________
Name
Position

ANNEX B

NAME OF NOMINEE/S :___________________________________

 REGION :___________________________________
CATEGORY : Exceptional Youth Volunteer

DESCRIPTION MEANS OF GRADING SYSTEM / WEIGHT RATING

VERIFICATION INDICATOR

Community volunteer ● Process Bisyon - 20%

aged 15 to 24, Documentation ● Was able to manifest 20pts
eagerly promotes report excellent interpersonal
and participates in ● Written relationships with other
compassionate and testimonials, community members
collective action in documentation leading to the
the community. from colleagues; realization of
● Initiated action community visions that
points/ plans and benefits the general
presented these public
to the LGUs/
agencies for Aksyon - 20%
funding. (i.e. ● Actively involved in 6 pts
proposals, plans, volunteer services
etc) outside and beyond
● Training KALAHI CIDSS
certificates/award Program;
s received ● Performed assigned 6 pts
● Program tasks on time and with
Implementation exemplary
Timeframe performance;
● Attendance of the ● Participated in various 8pts
meeting development forums
● Minutes of the and/ or recognized as
meeting official member of the
● Grievance council and represent
Redress System the general welfare of
(GRS) Resolution the community,
showing extraordinary
action that leads to a
more responsive
solution of the
community needs

Yakag - 15%
● Able to influence other 8pts
community members
through sharing of
experiences during
meetings, events, etc.
● Uses every opportunity
to encourage the 7pts
community to be more
participative in
 Government
programs, activities,
and projects.

Abilidad - 15%
● Pursue self-
development through more than 3
training programs and trainings
able to master new attended -
technical knowledge 8pts
and use it for the
benefit of the 1-3 trainings
community; attended -
5pts
● Exert effort in
accessing Programs,
Project and Activities
that helps to benefit 7pts
the general welfare of
the community (i.e. #
of proposal prepared
and implemented, # of
SPs recognized and
pipelined for funding
support etc)

Nakikiisa - 15%
● Able to thwart divisive
actions and tendencies
through resolutions
● Able to organize and 8pts
mobilize the people
into a collective action
that further 7pts
strengthened the unity
within the community

Integridad at Inspirasyon -
15%
● Has received
recognition/ awards/
commendations from
the different 8pts
stakeholders
● Was able to manifest
selfless actions for
the sake of
community; 7pts
NOTE: Other MOV’s are dependent on the write-up that will prove the veracity and
authenticity of the details of the nomination.

Rated by:

(signature)__________
Name
Position

ANNEX B

NAME OF NOMINEE/S :___________________________________

 REGION :___________________________________
CATEGORY : Exceptional Senior Citizen Volunteer

DESCRIPTION MEANS OF GRADING SYSTEM / WEIGHT RATING

VERIFICATION INDICATOR

Community volunteer ● Process Bisyon - 20%

aged 60 or above Documentation ● Was able to manifest 20pts
who participates in report excellent interpersonal
compassionate and ● Written relationships with other
collective action in testimonials, community members
the community. documentation leading to the
from colleagues; realization of
● Initiated action community visions that
points/ plans and benefits the general
presented these public
to the LGUs/
agencies for Aksyon - 20%
funding. (i.e. ● Actively involved in 6 pts
proposals, plans, volunteer services
etc) outside and beyond
● Training KALAHI CIDSS
certificates/award Program;
s received ● Performed assigned 6 pts
● Program tasks on time and with
Implementation exemplary
Timeframe performance;
● Attendance of the ● Participated in various 8pts
meeting development forums
● Minutes of the and/ or recognized as
meeting official member of the
● Grievance council and represent
Redress System the general welfare of
(GRS) Resolution the community,
showing extraordinary
action that leads to a
more responsive
solution of the
community needs

Yakag - 15%
● Able to influence other 8pts
community members
through sharing of
experiences during
meetings, events, etc.
● Uses every opportunity 7pts
to encourage the
community to be more
participative in
 Government
programs, activities,
and projects.

Abilidad - 15%
● Pursue self- more than 3
development through trainings
training programs and attended -
able to master new 8pts
technical knowledge
and use it for the 1-3 trainings
benefit of the attended -
community; 5pts

● Exert effort in
accessing Programs,
Project and Activities 7pts
that helps to benefit
the general welfare of
the community (i.e. #
of proposal prepared
and implemented, # of
SPs recognized and
pipelined for funding
support etc)

Nakikiisa - 15%
● Able to thwart divisive
actions and tendencies
through resolutions 8pts
● Able to organize and
mobilize the people
into a collective action 7pts
that further
strengthened the unity
within the community

Integridad at Inspirasyon -
15%
● Has received
recognition/ awards/
commendations from 8pts
the different
stakeholders
● Was able to manifest
selfless actions for
the sake of 7pts
community;
NOTE: Other MOV’s are dependent on the write-up that will prove the veracity and
authenticity of the details of the nomination.

Rated by:

(signature)__________
Name
Position

ANNEX B

NAME OF NOMINEE/S :___________________________________

REGION :___________________________________
 CATEGORY : Exceptional Person with Disability Volunteer

DESCRIPTION MEANS OF GRADING SYSTEM / WEIGHT RATING

VERIFICATION INDICATOR

Actively participate ● Process Bisyon - 20%

in compassionate Documentation ● Was able to manifest 20pts
and collective report excellent interpersonal
action in the ● Written relationships with other
testimonials, community members
community.
documentation leading to the
from colleagues; realization of
● Initiated action community visions that
points/ plans and benefits the general
presented these public
to the LGUs/
agencies for Aksyon - 20%
funding. (i.e. ● Actively involved in 6 pts
proposals, plans, volunteer services
etc) outside and beyond
● Training KALAHI CIDSS
certificates/award Program;
s received ● Performed assigned 6 pts
● Program tasks on time and with
Implementation exemplary
Timeframe performance;
● Attendance of the ● Participated in various 8pts
meeting development forums
● Minutes of the and/ or recognized as
meeting official member of the
● Grievance council and represent
Redress System the general welfare of
(GRS) Resolution the community,
showing extraordinary
action that leads to a
more responsive
solution of the
community needs

Yakag - 15%
● Able to influence other 8pts
community members
through sharing of
experiences during
meetings, events, etc.
● Uses every opportunity
to encourage the 7pts
community to be more
participative in
Government
 programs, activities,
and projects.

Abilidad - 15%
● Pursue self-
development through more than 3
training programs and trainings
able to master new attended -
technical knowledge 8pts
and use it for the
benefit of the 1-3 trainings
community; attended -
5pts
● Exert effort in
accessing Programs,
Project and Activities
that helps to benefit 7pts
the general welfare of
the community (i.e. #
of proposal prepared
and implemented, # of
SPs recognized and
pipelined for funding
support etc)

Nakikiisa - 15%
● Able to thwart divisive
actions and tendencies
through resolutions
● Able to organize and 8pts
mobilize the people
into a collective action
that further
strengthened the unity 7pts
within the community

Integridad at Inspirasyon -
15%
● Has received
recognition/ awards/
commendations from
the different 8pts
stakeholders
● Was able to manifest
selfless actions for
the sake of
community; 7pts

NOTE: Other MOV’s are dependent on the write-up that will prove the veracity and
authenticity of the details of the nomination.
Rated by:

(signature)__________
Name
Position