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Republic of the Philippines

DEPARTMENT OF LABOR AND EMPLOYMENT


[Region]
K to 12 DOLE Adjustment Measures Program
Initial Beneficiary Assessment Form

Good day ! The K to 12 DOLE AMP Program Management Office enjoins all program beneficiaries to
accomplish the initial assessment form. Information herein will be strictly confidential and will be used for
evaluation purposes only.

BENEFICIARY INFORMATION
Name: JOHN MARK F. DANLAG
Address: SARANAY STREET, BARANGAY ARINGAY, KABACAN, COTABATO
Mobile telephone: 0948-941-6560
Home telephone:
Email address: johnmark.danlag@gmail.com
Institutional Affiliation: UNIVERSITY OF SOUTHERN MINDANAO

Directions: Kindly put a check mark () inside the box that corresponds to your answer.
FINANCIAL
AGE GENDER MONTHLY FAMILY ASSISTANCE PROGRAM COMPONENTS AVAILED
INCOME DURATION
 20 – 25  Male  P100,000 and up  6 Months  Financial Support
 26 – 30  Female  P50,000 - P99,999  3 Months  Employment Facilitation
 31 – 35  P30,000 – P49,999  Livelihood through DILEEP
 36 – 40  P15,000 – P29,999
 41 – 45  P8,000 – P14,999
 46 – 50  Below 8,000
 51 – 55
 56 – 60
 60 Above
HEAD OF HOUSEHOLD:  Yes  No NO. OF DEPENDENTS: _________

Q1. How did you know about the K to 12 DOLE AMP?

Program Brochure
Newspaper Ad
Internet (Social Media, Website or Online News Article)
Colleagues in the Higher Education Institution
Management of the Higher Education Institution
Inter-Agency Roadshows and Information Sessions
CHED, DepEd or TESDA (Partner agencies)
Others, please specify:______________

Q2. Which program component do you think would be most beneficial for you?

Financial Support & Employment Facilitation


Livelihood through DOLE Kabuhayan
Referral to other Inter-agency Mitigation Measures

Q3. In what ways do you think the program will help you in your transition into self or full-time
employment?

K to 12 DOLE AMP Initial Beneficiary Assessment Page 1 of 2


Republic of the Philippines
DEPARTMENT OF LABOR AND EMPLOYMENT
[Region]
K to 12 DOLE Adjustment Measures Program
Initial Beneficiary Assessment Form

THE PROGRAM WILL HELP ME TO FINAN FOR A JOB AND FINANCE FOR POSSIBLE
BUSINESS PROJECT.

Q4. What are your expectations towards the Program ?

The Financial Support will be enough in order for me to transition into self or full-time
employment.
I will be able to get employment by the end of the program coverage period.
I will be able to start a business or livelihood project within the program coverage
period.
Other expectations (please specify):

Q5. What is your initial plan for the Financial Support that you’ll receive (i.e. potential livelihood projects,
etc.) ?
IT WILL BE USED TO FINANCE MYDAILY NEEDS AND TO FIND FOR A JOB

Q6. Comments / Feedback:


THANK YOU FOR THIS FINANCIAL SUPPORT. IT WILL BE A GREAT HELP.

Thank you very much for taking time to complete this initial evaluation. Your feedback is much
appreciated. Please return this form to the DOLE K to 12 Regional Program Technical Staff who assisted
you within fifteen (15) days after receipt of this form. Also, this form may be filled out online via
http://bit.ly/K12AMPIBAF.

- K to 12 DOLE Adjustment Measures Program Management Office

K to 12 DOLE AMP Initial Beneficiary Assessment Page 2 of 2

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