Republic of the Philippines

Department of Education
Region I
SCHOOLS DIVISION OFFICE I PANGASINAN

Enclosure No. 1

SCHOOL FORM
Prospect Participants to the POLICE COMMUNITY ACADEMY

School: _______________________________________________ District: __________________

Total Number of Prospect Participants: ___________

NOTE: The identified learners with ages from 12-20 years-old (preferably in junior high school) will undergo 30
days of lecture, training and peace-building activities which will be conducted every Saturday in an identified
locality (15-day academic phase, and 15-day tactics phase (return demo/community engagement activities)

No. Name Age Address

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
Add/Delete Column when needed

Prepared By:

____________________________________
School Head
Contact No. ________________________

Enclosure No. 2

DISTRICT CONSOLIDATION FORM

Prospect Participants to the POLICE COMMUNITY ACADEMY

Address: Alvear St. Lingayen, Pangasinan 1

Telephone No.: (075)-522-2202
Email: pangasinan1@deped.gov.ph
 Republic of the Philippines
Department of Education
Region I
SCHOOLS DIVISION OFFICE I PANGASINAN

District: _____________________ Total Number of Prospect Participants: ___________

NOTE: The identified learners with ages from 12-20 years-old (preferably in junior high school) will undergo 30
days of lecture, training and peace-building activities which will be conducted every Saturday in an identified
locality (15-day academic phase, and 15-day tactics phase (return demo/community engagement activities)

No. of Prospect
No. School Participants

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Total
Add/Delete Column when needed

Consolidated By:

____________________________________
District School Head In-Charge of Learner-Formation
Contact No. ________________________

Noted By:

____________________________________
Public Schools District Supervisor
Contact No. ________________________

Address: Alvear St. Lingayen, Pangasinan 2

Telephone No.: (075)-522-2202
Email: pangasinan1@deped.gov.ph