PHILIPPINE COUNCIL FOR NGO CERTIFICATION (PCNC)
SURVEY FORM
for newly established organization
PROFILE OF ORGANIZATION
I.
IDENTIFYING INFORMATION
Name of Organization _____________________________________________________
Address
_____________________________________________________
Telephone Number(s) __________________ Fax _______________E- mail _________
Year Established
____________________
Chief Executive Officer / President __________________________________________
Chief Operating Officer / VP/ Manager _______________________________________
I.
DESCRIPTION OF ORGANIZATION
A.
TYPE OF ORGANIZATION (Please check all types that apply. You may refer to the
accompanying sheet entitled Definition of Organization Types; others not defined in the sheet may be
self-explanatory, or you may also wish to describe the type of your organization. Use a separate sheet, if
necessary.)
_______Corporate Foundation
_______Networking
_______Cooperative
_______Service Delivery
_______Social Development
_______Education
_______Arts and Culture
B.
_______Social Welfare
_______Religious / Charitable
_______Science and Technology
_______Memorial
_______Coalition
_______Economic
_______Special Purpose
NATURE OF OPERATION
_______Funding/Grant-Making
_______Operating
I.
PERSONNEL (Current Year)
______Total Number of Regular Staff
______Total Number of Projected-Based Staff
______Total Number of Part-Time Staff
______Total Number of Volunteers
I.
SCOPE AND GEOGRAPHIC COVERAGE
A. SCOPE OF OPERATION
_______Barangay
_______Municipality
_______Province
_______City
_______Nationwide
_______International
B. LOCATION OF COVERAGE
AREA
LUZON
PROVINCE/CITY
MUNICIPALITY
BARANGAY
VISAYAS
MINDANAO
I.
PROGRAM AREAS (Please check all that apply)
______Education and Training
_______Research
______Skills Training
_______Employment
______Health and Nutrition
_______Housing
______Physical Infrastructure
_______Disaster and Relief
______Environment
______Enterprise Development / Economic Projects / Livelihood
______Youth and Family Welfare
_______Special Advocacies
______Community Development
_______Institution Building
______Art and Culture
_______Others
I.
TARGET CLIENTELE BY BASIC SECTOR (Please check all that apply)
I.
______Fisherfolk
______Peasants
______Women
______Disabled
______Urban Poor
______Indigenous People
HISTORY OF ORGANIZATION
_______Youth and Welfare
_______Children
_______Elderly
_______Victims of Calamities
_______Family
_______Others
Please provide a brief description of the history of the organization. (Attach additional sheets, if necessary).
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I.
ORGANIZATION'S VISION / MISSION / GOALS
VISION:______________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
MISSION:_____________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
GOALS:______________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
I.
PROPOSED PROJECTS / ACTIVITIES
List of proposed projects / activities for the first two (2) years.
X
TARGET FUND SOURCES
Indicate your target sources of funds and amounts estimated to be accessed.
XI.
ADMINISTRATIVE
1.
Describe the staff development program of your organization
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________
2.
List facilities and equipment that you own which you use to implement programs and
services. Please use additional sheet, if necessary
FACILITIES
XII.
EQUIPMENT
PROGRAM MANAGEMENT
1.
How are your programs and services conceptualized and implemented?
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
1.
2.
Do you use a Monitoring and Evaluation scheme/tool? ______YES______NO
Do you conduct an impact assessment of your programs and services being
provided to beneficiaries? _________YES __________NO
How does the organization ensure program assistance even after funding has
ceased?__________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
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3.
I.
PLANNING FOR THE FUTURE
1.
2.
3.
Do you have 3-5 year plan for your organization? _____YES_____NO
How often do you have strategic planning?______________________________
Who are involved in the formulation of the plans?________________________
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