TANZA NATIONAL TRADE SCHOOL
SENIOR HIGH DEPARTMENT
HUMANITIES AND SOCIAL SCIENCE
COMMUNITY ENGAGEMENT SOLIDARITY AND CITIZENSHIP
SY 2018 -2019
MONITORING FORM (CSC_2018-19)
Name: _____________________________
Faculty Coordinator: _____________________
Name of Barangay: ______________________
A. LOCATION MAP (Please Draw)
Inclusive Dates Of Service: __________________________
Total Number of Hours: ____________________________
Barangay Coordinator: _____________________________
B. DESCRIPTION OF BARANGAY
1. Demography
1.1 Approximate # of population: ______________________
1.2 Sex Distribution:
Male ________% Female _______%
1.3 Ethnic Composition (by mother tongue of households
Tagalog - ________%
Ilocano ________%
Bicolano ________%
Ilokano ________% Pampango - ________%
Pangasinense - ________%
Others - ___________%
1.4 Religious Affiliation:
Roman Catholic - ________%
Protestant - ________%
Iglesia ni Cristo - ________%
Aglipayan - _________%
Moslem ________%
Others _________%
2. Economy
2.1 Land Resources (total area in hectares) ________________
2.2 Production (please check)
•
Agricultural: _______ if yes, what type of plans/crops?__________
•
Fishing: _________
•
Livestock :_________ animal raised: ________________
•
Others: _______________________
2.3 Average Household Income/month/family (approximate)
•
Below P5,000: ________ P5.001 – 7,500: ________
•
P10,001 – 10,000: ______ P10.501 – 15,000: ________
•
15,001 and above: ________
3. Transportation and Communication
3.1 Means of transportation (Check as many items.)
•
Tricycle: _______
•
Jeepney: _______
•
Bus: _______
•
Train: _______
•
Others, please specify: ____________________
CSC FORM 1
C. Group Composition (identify your member)
3.2 Means of Communication
Available
Not Available
Daily newspaper
___________
___________
Radio
___________
__________
Television
___________
___________
Cell phone
___________
___________
Others, specify:
_________________________________________________
A short description of the communication system:
____________________________________________________________
4. Education and Health
4.1 Educational attainment (approximate)
•
No formal Education: _________%
•
With elementary education: ________%
•
With secondary education: ________%
•
With college degree: _______%
4.2 Health
•
Community hospital/clinic: _______
•
Resident physician: _______
•
Nurse: _______
•
Midwife: _______
•
Other health care professionals: _______
A short description of the education and health conditions of the
community:
5.
Nature of Community Work (Please Check)
1. Beautification projects: _______
2. Literary program : _______
3. Staging of community assemblies: _______
4. Religious Program: _______
5. Parenthood/family planning program: _______
6. Medical/dental service: _______
7. Nutrition program: _______
8. Water and energy conservation project: _______
9. Others: _______
Describe the nature of your work/task:
Team Leader: __________________________________
Asst. Team Leader: ______________________________
Team Members (with their tasks designation)
_______________________ __________________________
_______________________ __________________________
_______________________ __________________________
_______________________ __________________________
_______________________ __________________________
_______________________ __________________________
_______________________ __________________________
_______________________ __________________________
_______________________ __________________________
_______________________ __________________________
_______________________ __________________________
_______________________ __________________________
_______________________ __________________________
_______________________ __________________________
_______________________ __________________________
_______________________ __________________________
_______________________ __________________________
_______________________ __________________________
D. ACTIVITY RECORD (Weekly Report)
Date
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Day 8
Day 9
Day 10
Description of Task Done
Time
Allotted
Remarks
a. Completed
b. Partially Completed
c. No Activity
Grade equivalent
a. 5 b. 3 c. 0
Signature
(Teacher)
E. Analysis: Strength and Weaknesses
Strength
F. Evaluation
1.
Weaknesses
2.
3.
4.
5.
G. Recommendations
1.
2.
3.
4.
5.
Noted by:
Approved by:
__________________________________
Team Leader
(Signature over printed name)
_________________________________
Faculty Coordinator
(Signature over printed name)