Center-Region X

LEARNING SITE FOR AGRICULTURE

FARM PROFILE

Name of Farm: ___________________________________________________________________________________________

Farm Category: 1. According to Technology Practiced
_____ Farming LSA
_____ Agri-Processing Enterprise
2. According to Type of Assistance Provided
_____ With Financial Assistance
_____ Technical Assistance Only

Owner/Institution: ______________________________________________________________________________________

THE FARM OWNER

Name of Farm-Owner: Date of Birth:

Ethnic Origin/Tribe: Religious Affiliation:

Name of Spouse: Civil Status:

Spouse educational attainment: Spouse Birthday:

No. of Children: Spouse Occupation:

Home Address:

Cellphone No.: Landline No.: E-mail Address:

Educational Background:

Level Degree Earned School

Elementary

High School

Vocational/Short Course

College

Graduate School

Membership in Organizations
Name of Organization Date Joined Position, if any

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Trainings Attended, Local & Foreign(Use additional Sheets if necessary)
Title of Training Date Attended Name of Sponsoring
Organization

Topics Delivered/Capable of Delivering as Resource Person

No. of times
Topic Audience
delivered

THE FARM
Location/Address of Farm:
Total Farm Area: Area devoted to Organic Farming:
Year started Farming: Year started Organic Farming:
No. of Workers:

THE AGRI-PROCESSING ENTERPRISE/THE INSTITUTIONAL LEVEL LSA (Agencies, SUCs,

CHED, DepEd, LGUs)
Name of Manager/Enterprise-in-charge:
Position:
Office/Address:
Telephone Number: Cellphone Number:
E-mail Address:

THE FARM

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Location/Address of Farm:

Total Farm Area:

Area Developed/Productive:

No. of Workers:

Brief History of the Farm (use additional sheets if necessary)

Physical description of the farm (terrain, soil, climate, other geographical characteristics)

Farm Operation Components

Component Area Devoted No. of Heads Remarks
(commodities/projects/enterprise) (for animals)

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Farm Operation Components
Particulars No. Cost Source
Farm facilities/building, specify below:

Farm machineries/tools, specify below:

Production Data
Component Ave. Annual No. of Production Remarks
Production Cycle per Year
(commodities/projects/enterprise)

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Cost Data
Component Ave. Annual Cost No. of Production Remarks
of Production Cycle per Year
(commodities/projects/enterprise)

Farm Management Practices

 Nursery Management

 Planting management (crop rotation, intercropping, tunneling, rain shelter/ greenhouse/

terracing, multicropping, etc.)

 Irrigation

 Fertilizer management/ composting

 Pest and Disease management

 Weed control

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  Other Practices (Specify)

 Managing, advertising and Marketing Practices

 Other farm activities (farm camps, training, etc.)

Prepared by:

____________________________________
(Farm-Owner/Farm Manager/Farm-in-charge)

I have read and understand the Institute’s Data Privacy Statement (www.ati.da.gov.ph/ati-
main/content/privacy-policy) and express my consent for ATI to collect, store, use share,
process, update and modify my personal information.

I hereby affirm my right to be informed, access, object to processing, rectify and suspend or
withdraw my personal data and claim for indemnities to the provision RA 10173 series of 2012.

_______________________________________
Signature over printed name

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