EXTENSION ACTIVITY DESIGN

I. Executive Summary
A. Title:

B. Program/Project Title:
C. Proponents:
 Implementing
College/Campus/Office:

 Cooperating Agencies:

D. Nature of the Activity:

 Community Development Assistance
 Community Outreach
 Continuing Education
 Professional Training
 Skills Training
 Student Extension Experience
 Technical Assistance
 Technical Consultancy
 Technology Packaging/Demonstration
 Training/Seminar Workshop
 Others (please specify) _____________________________

E. Participants:
F. Venue:
G. Duration:
H. Cost:
I. Source of Fund

* (This must be found only at the first page)

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Effectivity Date: October 5, 2018
 II. Brief Description/Rationale:

III. Objectives:

IV. Methodology:

V. Program of Activities:
Person responsible/I
Time/Day Specific Activity Clients/Beneficiaries
Faculty/s In-charge

VI. Activity Management Team:

Function/Role
( e.g. Guest Trainer or Resource
Name of Faculty/Staff College/Affiliation Speaker ; Trainer ; Consultant;
Facilitator

VII. Budgetary Estimates

Estimated Amount
Expense Item Day Day Day TOTAL
1 2 3

 Personal Services
- Salaries
- Honoraria of Experts
- Other Services
Subtotal
 Maintenance and Operating Expenses
- Supplies and Materials
- Training Kits
- Monitoring and Evaluation
- Communication

Subtotal
 Equipment
 Sundry/Miscellaneous
 Contingency
GRAND TOTAL:
SOURCE OF FUND:

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Effectivity Date: October 5, 2018
 VIII. Linkages and Support
Agencies/Office Expected Output/s

IX. Monitoring and Evaluation

Prepared by:
________________________
Proponent

Noted:
________________________________ _________________________
College Extension Coordinator College Dean
Date: _________________ Date: _____________________

Recommending Approval:

VICENTE A. AGDA, JR., D.M., CSEE

Director, Training and Extension Services
Date: __________________
EVA P. PALADA, Ph.D.
Vice President for Planning, Research and Extension
Date: __________________
Budget Clearance:

EVELYN T. OBINA
Director, FINMO
Date: __________________

Approved:
EDMUNDO A. CAMPOTO, DVM, Ph.D.
University President
Date: __________________

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Effectivity Date: October 5, 2018