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RECEIPT INFORMATION

(for CES Office Use Only)

Delivered/
Submitted
By
Received
By

Dat
e
Tim
e

USC-CES Form C CES Program/Project/Activity Proposal for


Requests

USE: Form C must be used for Special


Projects or those that are Requested by
your partners and were not included in your
calendar.

]
USC-CES Form C CES Program/Project/Activity
Proposal for
Requests

(Write the Title of the Program/Project/Activity)


(Indicate Department and School)
(Inclusive date and venue)

I.

Program/Project/Activity Profile
A.

Requester (please check/tick the appropriate item and include the specific name of partner or requester)

[ ] Community, please specify


[ ] Organization, please specify
[ ] Institution, please specify
[ ] Unit/s from within USC, please specify
[
[
[
[
[
B.

[
[
[
[
[

] CES Office
[ ] SAS,
] SOED,
[ ] SOE,
] SHCP,
[ ] SOLG,
] Co-Curricular Student Organization
] Extra-Curricular Student Organization

[ ] SAFAD,
[ ] SBE,
[ ] Support Unit,

Mode of request (please check/tick the appropriate item and attach said communication to this proposal)

] letter, please attach


] email, please attach
] verbal, please provide evidence
] SMS, please provide evidence
] Others, please specify

C. Nature of the Program/Project/Activity (please check/tick the appropriate item)


[ ] Training Program (non-degree and non-credited courses offered to [ ] Community Outreach (community-based and charity driven
the community)

[ ] Technical Assistance (for agencies, organizations, civic groups)


[ ] Advisory Services (for agencies, organizations, civic groups)
[ ] Information Services (dissemination of knowledge/ information

social services)

[ ] Technology transfer and utilization (process of circulating,


promoting and marketing or technologies to potential users)

[ ] Others, please specify

through various means)

D.

Program Area (please check/tick the appropriate item)

[ ] Productivity-Oriented Initiatives
[ ] Literacy, Values Formation and Life-long Learning
[ ] Social Welfare Services

[ ] Health Advocacy and Wellness Promotion


[ ] Building Christian Communities
[ ] Information Sharing

USC-CES Form C CES Program/Project/Activity Proposal for


Requests

[ ] Environmental Sustainability
[ ] Issue Advocacy and Rights Promotion

II.

[ ] Heritage Conservation
[ ] Rural and Urban Development

Rationale and Contextualization

This portion will serve as the justification for your proposal. Please provide the following minimum information for the rationale and
introduction of your program/project/activity:
a. Current condition of the community
b. Problem/need identified by the unit that you intend to address
c. Data source as well as the process underwent to generate the data
d. How will the unit respond to the condition? What expertise and competencies from the unit or in collaboration with others
will be useful to address the identified condition?

III.

Goal, Objectives, and Outcomes

This section must enumerate the following items:


a. Over-all goal of the proposed program/project/activity
b. The specific objectives that will be useful in achieving the goal (be sure they are SMART)
c. What are the expected outcomes after implementing the program/project/activity
IV.

Participants, Partners and Beneficiaries

This part must explicitly provide the specific roles/responsibilities or deliverables as well as benefits of the following:
a. Implementing team from USC/Unit
b. Internal and external partners
c. Beneficiaries and/or partner community/organization/institution

USC-CES Form C CES Program/Project/Activity Proposal for


Requests

I.

Outline of Activities
Tentative Date

Activities

Participants Needed

Person/s In-charge

Date of Report Submission


Form D must be submitted 10 working
days after the activity.

USC-CES Form C CES Program/Project/Activity Proposal for


Requests

II. Budgetary Requirements


A. Particulars
A.

Meals and Snacks

B.

Transportation

C.

Materials

Frequency

Quantity

Amount

Total

TOTAL:

Php

B. Tranches for Budget Release and Monitoring


Activity

RIS No.

TOTAL AMOUNT RELEASED:

III. Signatories

DATES

Amount

RIS Approval

Php

Budget Release

Liquidation
Report

USC-CES Form C CES Program/Project/Activity Proposal for


Requests

Prepared By:

Date:
Name and Signature of Proponent
(Faculty / Representative / Coordinator )

Noted By:

Date:
Name and Signature of Department/Unit Head
(for department/unit proposals only)

Recommending
Endorsement:

Date:
Name and Signature of School/College CES Coordinator
(for all department and college proposals)

Endorsed By:

Date:
Name and Signature of School/College Dean
(for all department and college proposals)

Recommending Approval:

Brenette L. Abrenica, MAPA, MPS

Date:

Name and Signature of CES Director


(to be affixed only after thorough review, validation, and discussion with proponents)

Approved By:

Fr. Anthony S. Salas, SVD, MM

Date:

Name and Signature of the Vice President for Academic Affairs

Received and Recorded By:

Date:
Name and Signature of USC-CES Staff