BE Form 01 Republic of the Philippines Department of Education Region I Division of Ilocos Norte DON SALUSTIANO AQUINO MEMORIAL NATIONAL

HIGH SCHOOL School Year 2009-2010 BRIGADA ESKWELA PHYSICAL FACILITIES REPAIR AND MAINTENANCE NEEDS ASSESSMENT FORM (To be accomplished by the Resource Mobilization Committee) Instruction: Conduct an ocular inspection of the school facilities listed below. Then provide the needed information to facilitate the improvement to be done on these identified facilities. (If needed, you may use separate form for each classroom or school facility.) Condition (Check One) Satisfactory / / / / / / / / / / Weedy Dusty The weeds are to be pulled out/removed Cleaning Grass cutter 20 boxes floorwax Noted by: May 22,2009 Date of Inspection RIZALINA T. MANZANO Secondary School Principal II 10 5 Dusty Cleaning Rags, water, laundry soap, 1 pc. Plastic pail 5 Need to be repainted No water supply available. Repainting 3 Liters paint, 2 bottles thinner, 2 pcs. Paint brush, 5 pcs sand paper 15 Unsatisfactory / Remarks If unsatisfactory, describe the problem. Dusty Nature of Improvement Needed (e.g. repair, repainting, replacement, etc.) Cleaning Material Resources Needed (Indicate kind and quantity) Rags, water,1 pc. laundry soap, 1 pc. Plastic pail Manpower Needed (Indicate quantity and nature of labor services needed) 5

FACILITIES Roofs/gutters Ceilings Walls Blackboards Chairs/desks/tables Water facilities / Drainage System Lighting Windows Doors School grounds Others. Floor Prepared by: DINAH B. DUMLAO Master Teacher I

BE Form 03 Republic of the Philippines Department of Education Region I Division of Ilocos Norte DON SALUSTIANO AQUINO MEMORIAL NATIONAL HIGH SCHOOL School Year 2009-2010 BRIGADA ESKWELA RESOURCE MOBILIZATION FORM (To be accomplished by the Resource Mobilization Committee) Instruction: Using the completed BE Form 01: Physical Facilities Needs Assessment Form as basis, summarize the resources (materials and manpower) needed and list down the potential source or partners to be tapped. Add additional sheet if needed. The Status and Remarks columns should be updated regularly to determine progress in acquiring resources needed. Materials Needed Paint Paint brush Thinner Sand Paper Plastic pail Floor wax Soft broom Labor Skills/Volunteers Needed Painting of the cabinets, blackboards, chairs and bulletin boards Prepared by: DINAH B. DUMLAO Master Teacher I May 22,2009 Date of Inspection Quantity 3 gal. 4 pcs. 2 bot. 5 pcs. 2 pc 20 box. Floor wax 1 pc. Quantity Key Persons / Organizations to be Tapped I-Cherry Blossoms Fund I-Cherry Blossoms Fund I-Cherry Blossoms Fund I-Cherry Blossoms Fund I-Cherry Blossoms Fund I-Cherry Blossoms Fund Jerry Tadeo Key Persons / Organizations to be Tapped Raffy Geronimo Karl Loie Batara Ferlyn Cayaban Jerald Jhun Agustin Randell Dan B. Luna Strategies/Plan of Action Purchased Purchased Purchased Purchased Purchased Purchased Purchased Person Responsible Miss Dinah B. Dumlao Miss Dinah B. Dumlao Miss Dinah B. Dumlao Miss Dinah B. Dumlao Miss Dinah B. Dumlao Miss Dinah B. Dumlao Miss Dinah B. Dumlao Person Responsible Status Status Remarks For repainting For repainting For repainting For cleaning For cleaning, forwatering plants For cleaning For cleaning the surroundings Remarks

Strategies/Plan of Action Text the parents of these students

Miss Dinah B. Dumlao

Job well done

Noted by: RIZALINA T. MANZANO Secondary School Principal II

BE Form 06

Republic of the Philippines Department of Education Region I Division of Ilocos Norte DON SALUSTIANO AQUINO MEMORIAL NATIONAL HIGH SCHOOL School Year 2009-2010 BRIGADA ESKWELA DAILY ACCOMPLISHMENT REPORT (To be accomplished by the Program Implementation Committee) Instruction: List down all the activities that needs to be undertaken for each day of the brigade Eskwela week. At the end of each day, please mark the appropriate column that corresponds to the status of each activity. Cite reasons for non-completion. Activities Day 1 May 18,2009 Inspection of facilities and surroundings of Cherry Blossoms room. Day 2 May 19,2009 Cleaning and re-structuring the room and cleaning the window blades Day 3 May 20, 2009 repainted the chairs, tables, cabinets . Day 4 May 21,2009 Cleaning, fixing and planting at the frontage of the room. Day 5 May 22,2009 Making the report PreparPrepared by: DINAH B. DUMLAO Master Teacher I Completed / STATUS Started but not yet completed Note done REMARKS/RECOMMENDATIONS

/ / / / Noted by: May 22,2009 Date of Inspection RIZALINA T. MANZANO Secondary School Principal II

BE Form 2 Republic of the Philippines Department of Education Region I Division of Ilocos Norte DON SALUSTIANO AQUINO MEMORIAL NATIONAL HIGH SCHOOL School Year 2009-2010 BRIGADA ESKWELA SCHOOL WORK PLAN (To be accomplished by the School Head) Instruction: List down all the specific activities that you will be undertaking in relation to the conduct of Brigada Eskwela in your school and fill in the required information. Add another sheet if needed. Once completed, submit a copy to the Adopt-A-School Program coordinator or Brigada Eskwela coordinator of your school/division on or before January 31. KRA Activities Timeline Person/sResponsible Materials Needed Budget 1. Advocacy and Marketing Teacher Inform the students and parents during April-May, 2009 Parents the enrolment. Students 2. Resource Mobilization List of donated materials Make a listing of donated materials. Conduct a physical inspection of the April-May, 2009 Teacher physical facilities. 3. Implementation Conduct the Brigada Eskwela program. 4. Monitoring and Evaluation Check the outputs and account the persons involved in the program. 5. Reporting Prepared the report on the finished work. Prepared by: DINAH B. DUMLAO Master Teacher I BE Form 07 May 22,2009 Date of Inspection May 25, 2009 Teacher May 22, 2009 May 18-22,2009 Teacher Parents Students Teacher Parents Students Encoding, printing of the report P 100.00

Noted by: RIZALINA T. MANZANO Secondary School Principal II

Republic of the Philippines Department of Education Region I Division of Ilocos Norte DON SALUSTIANO AQUINO MEMORIAL NATIONAL HIGH SCHOOL School Year 2009-2010 BRIGADA ESKWELA SCHOOL ACCOMPLISHMENT REPORT (To be accomplished by the School Head) DIVISION: Ilocos Norte SCHOOL: Don Salustiano Aquino Memorial National High School School Address: Brgy. 06, Tonoton, Piddig, Ilocos Norte (Please check appropriate box) Level: ( ) Elementary ( / ) High School SCHOOL HEAD: Mrs. RIZALINA T. MANZANO PTCA PRESIDENT: Mr. Eduardo Toribio REGION: I SCHOOL I.D. Type of School: ( ) Central School ( ) Non- Central School (complete) ( ) Multigrade ( ) Primary School/ Incomplete ( ) Integrated CONTACT NUMBER: CONTACT NUMBER:

A. SCOPE OF REPAIR AND MAINTENACE WORK COMPLETED ( Please check appropriate column)
What was done? Repaired 1. Roofs 2. Ceilings 3. Walls 4.Windows and Doors 5. Chairs/Desks, Tables, and Blackboards 6.Comfort Rooms 7. Leaking Pipes 8. School Grounds/ Landscaping 9. School Signs 10. Others (Specify)
Prepared by: DINAH B. DUMLAO Master Teacher I May 22,2009 Date of Inspection

Repainted

Replaced

Others (Brief Description) Cleaned Cleaned

/ Cleaned

Noted by: RIZALINA T. MANZANO Secondary School Principal II

B. DONATIONS/ MATERIAL RESOURCES GENERATED (Use separate sheets, if needed)

Type of Donations 3 liters paint 4 paint brush 2 bots. Thinner 5 pcs. Sand Paper 2 pcs. Plastic pail 20 boxes floor wax 1 pc. Soft broom Source Donation/ I-Cherry Blossoms Students Donation/ I-Cherry Blossoms Students Donation/ I-Cherry Blossoms Students Donation/ I-Cherry Blossoms Students Donation/ I-Cherry Blossoms Students Donation/ I-Cherry Blossoms Students Donation-Jerry Tadeo Estimated Cost 390.00 150.00 60.00 100.00 80.00 100.00 50.00

Total C. VOLUNTEER SERVICES

Type of Volunteer 1. PTCA Members 2. Barangay Officials 3. Municipal/ City Government Officials 4.Provincial Govt. Officials 5. NGOs, Civic Organizations 6. Private Citizens 7. Private Companies/ Corp. 8. Other government offices 9. Parents 10. Teachers 11. Pupils/ Students 12. Others: (specify) (Family Members) 13. Prominent Volunteers TOTAL
Prepared by: DINAH B. DUMLAO Master Teacher I May 22,2009 Date of Inspection

P 930.00
Name of Individuals/ Organization Number Day 1 0 0 0 0 0 0 0 1 15 16 Day 2 0 0 0 0 0 0 0 1 5 6 of Day 3 0 0 0 0 0 0 0 1 5 6 Volunteers Day 4 0 0 0 0 0 0 0 1 5 6 Day 5 0 0 0 0 0 0 0 1 10 11 Day 6 0 0 0 0 0 0 0 1 5 6
Noted by: RIZALINA T. MANZANO Secondary School Principal II

Total
0 0 0 0 0 0 0 1 45 46

D. ESTIMATED COST OF VOLUNTEER SERVICES RENDERED G. SIGNIFICANT/ EVENTS / EXPERIENCES Type of Service Total Number of D. EVIDENCES ATTACHMENTS a. Photos happened? What (before, during, after) Who were involved? Volunteers When b. Photocopy of all completed BE Forms (check if attach) ______ Form 01 _______ Form 05 ______ Formand parents _______ Form 06 02 Students, teachers Teachers May 18-22,2009 Carpentry ______ Form 03 5 actively participated in the Parents ______ Ordinary Labor 40 implementation ofForm 04 Brigada the Students Eskwela. Prepared by: Date:

Total Number of Hours Total Estimated Cost Rendered is/are important contribution to the operation of What the school or to the existing needs of the school? The implementation of the program helped in preparing 8 1250 the school for the opening of classes. 4 2000

May 22,2009 E. ISSUES AND CONCERNS (Describe briefly problems encountered and how resolved) DINAH B. DUMLAO Master Teacher I The common problem encountered was the funding needs of the program. But through the resourcefulness of the persons involved, it was Name and Designation properly solved. Submit copy of this completed form to ADOPT-A-SCHOOL PROGRAM DISTRICT COORDINATOR or District Supervisor on or before June 15. E LESSONS LEARNED / BEST PRACTICES The practices learned were resourcefulness and the implementation of the bayanihan spirit among the people in the community. F. SUGGESTIONS TO STRENGTHEN BRIGADA ESKWELA PROJECT (Include support needed from Central, Region, and Division Office that can increase the impact of Brigada Eskwela Project in your school) There must be an allocated funds for the implementation of the program especially for major repairs of the physical facilities of the school.
Prepared by: DINAH B. DUMLAO Master Teacher I May 22,2009 Date of Inspection Noted by: RIZALINA T. MANZANO Secondary School Principal II

Form 5
Republic of the Philippines Department of Education Region I Division of Ilocos Norte DON SALUSTIANO AQUINO MEMORIAL NATIONAL HIGH SCHOOL School Year 2009-2010 BRIGADA ESKWELA

RECORD OF DONATIONS RECEIVED Items or Materials Paint Paint brush Paint thinner Sand paper Plastic pail Floor wax Soft broom Total
Prepared by: DINAH B. DUMLAO Master Teacher I May 25 ,2009 Date of Inspection Noted by: RIZALINA T. MANZANO Secondary School Principal II

Quantity 3 gal. 4 pcs 2 bottles 5 pcs. 2 pc. 20 boxes 1 pc.

Date Received May 12,2009 May 12,2009 May 12,2009 May 12,2009 May 12,2009 May 18,2009 May 18,2009

Name of Donor I-Cherry Blossoms Funds I-Cherry Blossoms Funds I-Cherry Blossoms Funds I-Cherry Blossoms Funds I-Cherry Blossoms Funds I-Cherry Blossoms Funds Jerry Tadeo

Assumed Cost Per Unit (Php) 130.00 37.50 30.00 20.00 40.00 5.00 50.00

Of Items Total(Php) 390.00 150.00 60.00 100.00 80.00 100.00 50.00 930.00

Republic of the Philippines Department of Education Region I Division of Ilocos Norte

DON SALUSTIANO AQUINO MEMORIAL NATIONAL HIGH SCHOOL School Year 2009-2010

REPORT ON BRIGADA ESKWELA May 18-22,2009

Submitted by:

DINAH B. DUMLAO Adviser, I-Cherry Blossoms

The students of I-Cherry Blossoms are busy repainting the chairs.

The chairs that need to be repainted The students are using sand paper in removing dirt and old paint of the chairs
Cleaning the window blades and doors We need to repaint the concrete bench and make signage too.

G. EVIDENCES / ATTACHMENTS a. Photos (before, during, after) b. Photocopy of all completed BE Forms (check if attach) ______ Form 01 _______ Form 05 ______ Form 02 _______ Form 06 ______ Form 03 ______ Form 04 Prepared by: DINAH B. DUMLAO Master Teacher I Name and Designation Submit copy of this completed form to ADOPT-A-SCHOOL PROGRAM DISTRICT COORDINATOR or District Supervisor on or before June 15. Date: May 22,2009