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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: _________
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?
Q3. In what ways do you think the program will help you in your transition into self or full-time
employment?
THE PROGRAM WILL HELP ME TO FINAN FOR A JOB AND FINANCE FOR POSSIBLE
BUSINESS PROJECT.
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
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.