ANNEX A

ABOT ALAM: A NATIONAL PROGRAM FOR OUT-OF-SCHOOL YOUTH

OFFICIAL REGISTRATION FROM (Revised)
Ang abot alam ang pinakamalaking programa para maibalik ang mga Out-of-School Youth (OSY) sa pag-aaral,
mabigyan ng karampatang edukasyon, skills training/ pagsasanay at oportunidad sa trabaho o livelihood. Saklaw
ng programang ito ang mga kabataang hindi nakapag-aral, hindi nakapagtapos ng pag-aaral sa gulang na 15
hanggang 30 anyos.

Survereyor's Name:

Complete Address of Surveyor:

Position/ Office/ Affiliation ng Surveyor:

Barangay:

COMPLETE NAME
/Kumpletong Pangalan (i.e.
Last Name, Given Name,
Middle Name) (Extension
name if any ex. JR, SR, III)

BIRTHDATE / Kaarawan
(MM/DD/YY)

AGE / Edad

Sex (M/F)

CONTACT DETAILS /
COMPLETE ADDRESS /
Impormasyong pwedeng Tirahan (i.e. No., Street,
Tawagan (i.e. Email
Brgy., City or Municipality,
address, Cellphone &
Province)
Landline Number)

GABAY:LEGEND: REMARKS* | ALS** Alt
Accreditation & equivalency ProgramInformal Educaation |(PWD)***Persons
Impaired; PWD-PI- Physically Impaired

City/Municipality:

PARENTS/
GUARDIAN
(Magulang /
Tagapangalaga)
Complete Name

EDUCATION/Pinakamat
aas na Antas ng
Edukasyong Naabot
(i.e Elementary Grade,
Year in High School,
College)

(N/A if Not Applicable) etc. ALS-A & e SECOND. ALS Accreditation & equivalency Program Seonary. at ALS-Infed aation |(PWD)***Persons With Disabilities/ May Kapansanan| ***Isulat ang PWD-Hi-Hearing Impaired. Kung May SSS.e. PYAP.With Special Need Email Address & Contact # of Surveyor: Province/ Lalawigan: PREFERRED TRACK/ Planong Gawin (i. CRN. ALS-A&E elem ALS & equivalency Program-Elementary. GSIS. Philhealth.D: REMARKS* | ALS** Alternative Learning System|** Isulat ang ALS-BLP-ALS Basic Literacy Program. Employment. PWD-VI-Visually -PI.Physically Impaired.) Reason of becoming OSY . mga numero. Entrepreurship/ Skills Training) (Puedeng Higit sa Isa ang lagyan ng Ekis) REMARKS * Isaad kung NUMBERS Indicate number Benepisyaryo ng of the ff if any/Isaad ang Programa ALS**. PWD-WSN. Education. Kapansanan/ (PWD)*** Pantawid Household. kung meron: 4Ps etc.

.

) 0 Community Corporation 0 Parents 0 Private Individual/Co Alumni mmunity Member 0 0 Religious Organizations (Youth and Adult) Congressional Officials and Staff 0 0 Provincial Officials 0 . 2015 Republic of the Philippines DEPARTMENT OF EDUCATION Region 02 Division of Nueva Vizcaya BRIGADA ESKEWELA 2015 NUMBER OF VOLUNTEERS Private Sector School_ID School_Name TOTAL Prepared by: NGO (PTA. 41.Enclosure No. 2-A to DepED Memo No. SGC. etc. Gawad Kalinga. s.

ASP Division Coordinator .

Marine. Airforce.) Barangay Other Workers Volunteers 0 0 0 Total Number of Volunteers 0 . etc.BE school Form 1 s N 2015 VOLUNTEERS Government Agencies/National & Local City/ Municipal Officials 0 Barangay Officials SK Officials 0 Approved by: 0 Provincial/ City/ Municipal Employees 0 Firement/P NP 0 AFP(PA.

SAMUEL R. SOLIVEN. Schools Division Superintendent . OIC. Ph.D.

s.Enclosure No. 2015 Republic of the Philippines DEPARTMENT OF EDUCATION Region 02 Division of Nueva Vizcaya BRIGADA ESKEWELA 2015 RESOURCES GENERATED School_ID School_Name Hardware Materials for Classroom Repairs Qty. 2-A to DepED Memo No. TOTAL Prepared by: Item Hardware Materials for Toilet Newly Construction/ Repair Amount (in Peso) Qty. 41. 0 Item Religious Amount (in Peso) Organizations (Youth and Adult) 0 Hardware Materials for Wash Fa Construction/Repair Item .

Coordinator .

of Volunteers 0 Total No. of Hours Rendered (Labor) 0 Volunteer Man hours (Amount in Peso) 0 Total Amount (in Peso) 0 .1 ppines UCATION izcaya ELA 2015 ERATED dware Materials for Wash Facilities Newly Construction/Repair Religious Amount (in Peso) Organizations (Youth and Adult) 0 Approved by: Other Donations Item Religious Amount (in Peso) Organizations (Youth and Adult) 0 Total No.BE school form 1.

SAMUEL R. OIC. Schools Division Superintendent . Ph. SOLIVEN.D.

2015 Republic of the Philippines DEPARTMENT OF EDUCATION Region 02 Division of Nueva Vizcaya BRIGADA ESKEWELA 2015 DIVISION CONSOLIDATED REPORT NUMBER OF VOLUNTEERS Private Sector School_ID School_Name TOTAL NGO (PTA.Enclosure No. Gawad Kalinga. SGC. etc. 2-A to DepED Memo No.) 0 Community Corporation 0 Parents 0 Private Individual/Co Alumni mmunity Member 0 0 Religious Organizations (Youth and Adult) Congressional Officials and Staff 0 0 Provincial Officials 0 . s. 41.

Prepared by: ASP Division Coordinator .

Marine.BE school Form 1 s N 2015 REPORT VOLUNTEERS Government Agencies/National & Local City/ Municipal Officials 0 Barangay Officials 0 SK Officials 0 Provincial/ City/ Municipal Employees 0 Firement/P NP 0 AFP(PA.) Barangay Other Workers Volunteers 0 0 0 Total Number of Volunteers 0 . etc. Airforce.

SOLIVEN.Approved by: SAMUEL R. Schools Division Superintendent .D. Ph. OIC.

0 Item Religious Amount (in Peso) Organizations (Youth and Adult) 0 Hardware Materials for Wash Fa Construction/Repair Item . 2-A to DepED Memo No. 2015 Republic of the Philippines DEPARTMENT OF EDUCATION Region 02 Division of Nueva Vizcaya BRIGADA ESKEWELA 2015 DIVISION CONSOLIDATED REPORT RESOURCES GENERATED School_ID School_Name Hardware Materials for Classroom Repairs Qty. TOTAL Item Hardware Materials for Toilet Newly Construction/ Repair Amount (in Peso) Qty.Enclosure No. s. 41.

Prepared by: ASP Coordinator .

of Hours Rendered (Labor) 0 Volunteer Man hours (Amount in Peso) 0 Total Amount (in Peso) 0 . of Volunteers 0 Total No.BE school form 1.1 ppines UCATION izcaya ELA 2015 LIDATED REPORT ERATED dware Materials for Wash Facilities Newly Construction/Repair Religious Amount (in Peso) Organizations (Youth and Adult) 0 Other Donations Item Religious Amount (in Peso) Organizations (Youth and Adult) 0 0 Total No.

Ph. SOLIVEN. OIC.D. Schools Division Superintendent .Approved by: SAMUEL R.