Republic of the Philippines

Department of Education
Region 02(Cagayan Valley)
SCHOOLS DIVISION OFFICE OF ISABELA
Alibagu, City of Ilagan, Isabela 3300
www.deped.isabela.com.ph (078)323-0281/323-2015 isabela.depedro2@gmail.com

Form 1
ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT
ELEMENTARY

School:_____________________________________ Address:________________________________________
School ID:__________________________________ Contact Nos.:________________________ Email Address:_____________________

LEARNING ENVIRONMENT
DONATIONS PARTICULARS QTY. AMOUNT DONOR DATE
PRIVATE LGU COMPLETED/
SECTOR TURN OVER
1. Classroom
-New Classroom
-Rehabilitation/Repair
2. Furniture
3. Toilet & Wash Facilities
4. Maintenance
5. Real Estate
6. Others (Pls Specify)
TOTAL
Please attach the following documents:
1. Deed of Donation
2. Deed of Acceptance
3. Pictures/Receipts (Xerox)

PREPARED BY:

_________________________
School Head/Principal
 Republic of the Philippines
Department of Education
Region 02(Cagayan Valley)
SCHOOLS DIVISION OFFICE OF ISABELA
Alibagu, City of Ilagan, Isabela 3300
www.deped.isabela.com.ph (078)323-0281/323-2015 isabela.depedro2@gmail.com

Form 2
ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT
ELEMENTARY

School:_____________________________________ Address:________________________________________
School ID:__________________________________ Contact Nos.:________________________ Email Address:_____________________

LEARNING SUPPORT
DONATIONS PARTICULARS QTY. AMOUNT DONOR DATE
PRIVATE LGU COMPLETED/
SECTOR TURN OVER
1. Audio-Visual Educational Materials

2. School Supplies

3. Educational Film/Libraries

4. Others (pls. Specify

TOTAL

Please attach the following documents:

4. Deed of Donation
5. Deed of Acceptance
6. Pictures/Receipts (Xerox)

PREPARED BY:

_________________________
School Head/Principal
 Republic of the Philippines
Department of Education
Region 02(Cagayan Valley)
SCHOOLS DIVISION OFFICE OF ISABELA
Alibagu, City of Ilagan, Isabela 3300
www.deped.isabela.com.ph (078)323-0281/323-2015 isabela.depedro2@gmail.com

Form 3
ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT
ELEMENTARY

School:_____________________________________ Address:________________________________________
School ID:__________________________________ Contact Nos.:________________________ Email Address:_____________________

TECHNOLOGY SUPPORT
DONATIONS PARTICULARS QTY. AMOUNT DONOR DATE
PRIVATE LGU COMPLETED/
SECTOR TURN OVER
1. Computer

2. Electronic Learning Materials

3. Internet Connectivity

TOTAL

Please attach the following documents:

7. Deed of Donation
8. Deed of Acceptance
9. Pictures/Receipts (Xerox)

PREPARED BY:

_________________________
School Head/Principal
 Republic of the Philippines
Department of Education
Region 02(Cagayan Valley)
SCHOOLS DIVISION OFFICE OF ISABELA
Alibagu, City of Ilagan, Isabela 3300
www.deped.isabela.com.ph (078)323-0281/323-2015 isabela.depedro2@gmail.com

Form 4
ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT
ELEMENTARY

School:_____________________________________ Address:________________________________________
School ID:__________________________________ Contact Nos.:________________________ Email Address:______________

HEALTH AND NUTRITION

DONATIONS PARTICULARS QTY. AMOUNT DONOR DATE
PRIVATE LGU COMPLETED/
SECTOR TURN OVER
1. Feeding Program

2. Medical/Dental Mission/Check Ups

3. Deworming Interventions

4. Health Supplies

7. Others (Pls Specify)

TOTAL
Please attach the following documents:
10. Deed of Donation
11. Deed of Acceptance
12. Pictures/Receipts (Xerox)

PREPARED BY:
_________________________
School Head/Principal
 Republic of the Philippines
Department of Education
Region 02(Cagayan Valley)
SCHOOLS DIVISION OFFICE OF ISABELA
Alibagu, City of Ilagan, Isabela 3300
www.deped.isabela.com.ph (078)323-0281/323-2015 isabela.depedro2@gmail.com

Form 5
ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT
ELEMENTARY

School:_____________________________________ Address:________________________________________
School ID:__________________________________ Contact Nos.:________________________ Email Address:_____________________

READING PROGRAM
DONATIONS PARTICULARS QTY. AMOUNT DONOR DATE
PRIVATE LGU COMPLETED/
SECTOR TURN OVER
1. Books

2. Supplementary Reading Materials

3. Others (Pls Specify)

TOTAL

Please attach the following documents:

13. Deed of Donation
14. Deed of Acceptance
15. Pictures/Receipts (Xerox)

PREPARED BY:

_________________________
School Head/Principal
 Republic of the Philippines
Department of Education
Region 02(Cagayan Valley)
SCHOOLS DIVISION OFFICE OF ISABELA
Alibagu, City of Ilagan, Isabela 3300
www.deped.isabela.com.ph (078)323-0281/323-2015 isabela.depedro2@gmail.com

Form 6
ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT
ELEMENTARY

School:_____________________________________ Address:________________________________________
School ID:__________________________________ Contact Nos.:________________________ Email Address:_____________________

TRAINING AND DEVELOPMENT

DONATIONS PARTICULARS QTY. AMOUNT DONOR DATE
PRIVATE LGU COMPLETED/
SECTOR TURN OVER
1. Teachers/ Principal’s Training

2. Students/Pupils Training
Field Trip

TOTAL

Please attach the following documents:

16. Deed of Donation
17. Deed of Acceptance
18. Pictures/Receipts (Xerox)

PREPARED BY:

_________________________
School Head/Principal
 Republic of the Philippines
Department of Education
Region 02(Cagayan Valley)
SCHOOLS DIVISION OFFICE OF ISABELA
Alibagu, City of Ilagan, Isabela 3300
www.deped.isabela.com.ph (078)323-0281/323-2015 isabela.depedro2@gmail.com

Form 7
ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT
ELEMENTARY

School:_____________________________________ Address:________________________________________
School ID:__________________________________ Contact Nos.:________________________ Email Address:_____________________

DIRECT ASSISTANCE
DONATIONS PARTICULARS QTY. AMOUNT DONOR DATE
PRIVATE LGU COMPLETED/
SECTOR TURN OVER
1. Stipend

2. Others (Pls. Specify)

TOTAL

Please attach the following documents:

19. Deed of Donation
20. Deed of Acceptance
21. Pictures/Receipts (Xerox)

PREPARED BY:

_________________________
School Head/Principal
 Republic of the Philippines
Department of Education
Region 02(Cagayan Valley)
SCHOOLS DIVISION OFFICE OF ISABELA
Alibagu, City of Ilagan, Isabela 3300
www.deped.isabela.com.ph (078)323-0281/323-2015 isabela.depedro2@gmail.com

Form 8
ADOPT-A-SCHOOL PROGRAM QUARTERLY REPORT
ELEMENTARY

School:_____________________________________ Address:________________________________________
School ID:__________________________________ Contact Nos.:________________________ Email Address:_____________________

ASSISTIVE LEARNING DEVICES FOR PUPIL/STUDENT WITH SPECIAL NEEDS

DONATIONS PARTICULARS QTY. AMOUNT DONOR DATE
PRIVATE LGU COMPLETED/
SECTOR TURN OVER
1. Pencil Grips
2. Special Chairs
3. Spelling Check devices
4. Hearing Aides
5. Talking Computers
6. Specialized keyboards
7. Braile (Books)
8. Computer Systems
9. Others (Pls Specify)
TOTAL
Please attach the following documents:
22. Deed of Donation
23. Deed of Acceptance
24. Pictures/Receipts (Xerox)

PREPARED BY:
_________________________
School Head/Principal
 Republic of the Philippines
Department of Education
Region 02(Cagayan Valley)
SCHOOLS DIVISION OFFICE OF ISABELA
ECHAGUE EAST DISTRICT
SALAY ELEMENTARY SCHOOL
Salay, Echague, Isabela 103298
 marion.tamani@gmail.com  09161077463

RESOURCE GAP/PROFILE ASSESSMENT TOOL

PROGRAM/PROJECT CURRENT STATE DESIRED STATE IDENTIFIED GAPS AND FACTORS RESPONSIBLE RESOURCES AND
ACTIVITY DESCRITION FOR THE GAPS ASSETS AVAILABLE AND
HOW IT CA BE TAPPED
TO ADDRESS THE GAPS
CONSTRUCTION OF THE SCHOOL IS HARD DURABLE IN STEEL SCHOOL MINI RAISE FUND FOR THE RAISE P121,000.00 FOR
SCHOOL MINI- UP IN PUTTING TRUSSES SCHOOL MINI AMPHITHEATER WILL SCHOOL MINI THE INITIAL
AMPHITHEATER DEMOUNTABLE AMPHITHEATER BE PUT UP AMPHITHEATER TRU CONSTRUCTION OF
SHELTER AS MINI MONEY CONTEST SCHOOL MINI
AMPHITHEATER DURING THE 2019 MR AMPHITHEATER
DURING SCHOOL & MISS VALENTINE
PROGRAMS

PREPARED AND SUBMITTED BY:

MARION B. TAMANI
Principal I