USC-CES Form B CES PPA Proposal (Details)

RECEIPT INFORMATION(for CES Office Use Only)

Delivered/
Submitted
By
Received
By

Dat
e

IMPORTANT REMINDERS: Follow set

deadlines for submission.
Forms A & B: for Course-based CES and
Medium and Long term CES

Tim
e

USC-CES Form B CES Program/Project/Activity Proposal (Details)

(Write the Title of the Program/Project/Activity)
(Indicate Department and School)
(Inclusive date and venue)

I.

Program/Project/Activity Profile
A.

College/School/Department/Unit Responsible(please check/tick theappropriate item)

[ ] CES Office
[ ] SOED,
[ ] SHCP,
B.

[ ] SAFAD,
[ ] SBE,
[ ] Support Unit,

Time Frame(please check/tick theappropriate item)

[ ] Short Term
[ ] 1 semester
[ ] 2 semesters

C.

[ ] SAS,
[ X ] SOE,
[ ] SOLG,

[ ] Medium Term

[ ] Long Term

[ ] 3 semesters
[ ] 4 semesters

[ ] 5 semesters
[X] 6 semesters
[ ] Others,

Locus and Leadership (please check/tick theappropriate item)

[ ] Course-based (undergraduate)
[ ] Department-led
[ ] Support Unit-led

[ ] Course-based (graduate)
[ ] College-wide
[ ] SVD-led

[ ] Student Organization-led
[ ] Alumni-led
[ ] Others,

D. Nature of the Program/Project/Activity(please check/tick theappropriate item)

[ ] Training Program (non-degree and non-credited courses offered to [ ] Community Outreach (community-based and charity driven
the community)

[ ] Technical Assistance (for agencies, organizations, civic groups)

[ ] Advisory Services (for agencies, organizations, civic groups)
[ ] Information Services (dissemination of knowledge/ information

social services)

[ ] Technology transfer and utilization (process of circulating,

promoting and marketing or technologies to potential users)

[ ] Others, please specify

through various means)

E.

[
[
[
[
[

Program Area(please check/tick theappropriate item)

] Productivity-Oriented Initiatives
] Literacy, Values Formation and Life-long Learning
] Social Welfare Services
] Environmental Sustainability
] Issue Advocacy and Rights Promotion

[
[
[
[
[

] Health Advocacy and Wellness Promotion

] Building Christian Communities
] Information Sharing
] Heritage Conservation
] Rural and Urban Development

USC-CES Form B CES PPA Proposal (Details)

II. Significance/Relevance Matrix

Please check/tick the appropriate information per component:
A.

Contextual Dimension: establish responsive is the P/P/A to the local context:

[ ] unit have done preliminary needs assessment*

[ ] unit have not done preliminary needs assessment

Unit personnel involved in the needs assessment activity:

[
[
[
[
[

] faculty members
] class instructor
] staff
] community/org partners
] Others,

[
[
[
[

] student org./majors
] course enrollees
] student volunteers
] employed enumerators

[ ] with existing verifiable data from the field*

Data source/s:

[ ] research (faculty/student)
[ ] thesis or dissertation
[ ] CES data gathering
initiatives
[ ] community meetings
[ ] reflection notes/papers
[ ] from secondary sources

[ ] without data from the field

Enumerate bases for proposing the P/P/A:

[ ] provided/expressed by the
partner
[ ] recommended by faculty/
student/staff
[ ] from Government agency
[ ] others,

Tools used to gather data:

[
[
[
[

] survey/questionnaire
] KII/FGDs
] ocular visits
] community meetings

[
[
[
[

] exposure/immersions
] validation sessions
] documents review
] others,

Means employed to verify the data:

[
[
[
[

] survey/questionnaire
] KII/FGDs
] ocular visits
] community meetings

[
[
[
[

] exposure/immersions
] validation sessions
] documents review
] others,

What are the means employed to ensure the

responsiveness of the P/P/A to the local condition?

Who collected the data:

[
[
[
[

] faculty
] undergraduate students
] graduate students
] deloaded researcher

[ ] government agency
[ ] partner community/org.
/institution
[ ] others,

* Please provide as attachment a copy of the needs assessment report or any available data as basis for this proposal

B.

Productivity Dimension: please check/tick theappropriate item if the P/P/A involves technology:

[ ] production of new technology

[ ] utilization of existing technology
[ ] training or capacity-building for the use of technology
C.

[ ] transfer of existing technology

[ ] refinement/modification of existing technology
[ ] Others,

Economic Dimension: please check/tick theappropriate item if the P/P/A has economic implications:

USC-CES Form B CES PPA Proposal (Details)

[ ] generation of new livelihood projects/opportunities

[ ] employability of partners at
[ ] Others,

[ ] enhancement of partners current livelihood

[ ] measurable increase in the income of partners

Social Dimension: please check/tick theappropriate item if the P/P/A will lead to or benefit: PROVIDE THE

D.

ESTIMATED NUMBER OF BENEFICIARIES PER GROUP

The P/P/A will benefit:

[
[
[
[
[
[
[
E.

]
]
]
]
]
]
]

households
Local Government Units
Organizations/Associations
senior citizens (male) (at least 60 years old)
senior citizens (female) (at least 60 years old)
adults (male) (31 to 59 years old)
adults (female) (31 to 59 years old)

[
[
[
[
[

]
]
]
]
]
]
] Others,

youth (male) (13 to 30 years old)

youth (female) (13 to 30 years old)
children (boy) (6 to 12 years old)
children (girl) (6 to 12 years old)
infants (boy) (0 to 5 years old)
infants (girl) (0 to 5 years old)

Environmental Dimension: the P/P/A addresses the environmental needs of the community

[ ] River Management
[ ] Mangrove Planting
[ ] Beautification Activities
F.

[
[
[
[
[
[
[

[ ] Greening Initiatives (e.g. Tree Panting, forestation, etc.)

[ ] Clean-up Drives (coastal, river, drainage, sewage, etc.)
[ ] Others,

Governance Dimension: the program/project/activity will yield:

] networking with LGUs and community leaders
] funding support from other partners
] established counterparts from other partners
] MOA/MOU with other partners
] policy change initiatives by LGUs

[
[
[
[
[

] funding support from LGUs

] established counterparts from LGUs
] MOA/MOU with LGUs
] policy advocacy by USC faculty/students/staff
] Others,

III. Implications to Work hours, Academic Program, and Research

The following variables are identified as essentials in order to determine that your program/project/activities are aligned to your
units program offerings and research priorities. Please provide the required preliminary data. Also, do take note that these will be
verified after the completion of the program/project/activity.
[
[
[
[
[
[
[

A. Practical Counts: please provide below your estimated count per item:
] No. of man hours needed to prepare the P/P/A
[ ] No. of man hours needed to complete the P/P/A
] No. of faculty members who will be involved
[ ] No. of course-based students who will be involved
] No. of Student Organization members who will be involved
[ ] No. of staff who will be involved
] No. of Information and Education Campaign materials to be
[ ] No. of Information and Education Campaign materials to be
produced
improved/enhanced
] No. of curricular programs to be developed
[ ] No. of curricular programs to be improved/enhanced
] No. of proposals to be developed
[ ] No. of papers to be presented
] No. of papers to be published
[ ] No. of policies to be advocated

B. Human Resource Implications: please provide the specifics:

PREPARATION OF THE PPA
Faculty Members
Expertise and/or
specialization
needed

Students

IMPLEMENTATION OF THE PPA

Faculty Members

Students

USC-CES Form B CES PPA Proposal (Details)

Roles/tasks

IV. Institutional and Policy Support Needs and Counterparts

It is essential that all extension initiatives remain faithful to the mutual contributions from partners to avoid the development of the
partners dependent behavior toward the USC/unit. Thus, all CES programs/projects/ activities must be built on co-ownership of the
initiatives. Hence, please identify the various logistical support needs essential in pursuing the program/project/activity to be sourced
from both the USC system as well as from partners/beneficiaries:

A. Support from the USC system: please identify your specific needs from USC-CES:
[
[
[
[

] collaboration with other units

] provision of meals and snacks for USC manpower
] transportation for
(how many)
] materials

[
[
[
[

] resource speaker/s on
] provision of meals and snacks for partners
] venue or work station/s
] Others,

B. Support from partners/beneficiaries: please specify the contributions/counterparts from partners:

1. Partner/Beneficiaries:
[
[
[
[
[

] collaboration with other units

] provision of meals and snacks for USC manpower
] transportation for
(how many)
] venue or work station/s
] Others,

[
[
[
[
[

] collaboration with other units

] provision of meals and snacks for USC manpower
] transportation for
(how many)
] venue or work station/s
] Others,

[
[
[
[
[

] collaboration with other units

] provision of meals and snacks for USC manpower
] transportation for
(how many)
] venue or work station/s
] Others,

[
[
[
[

] resource speaker/s on
] provision of meals and snacks for partners
] registration fee/charge of
] materials

[
[
[
[

] resource speaker/s on
] provision of meals and snacks for partners
] registration fee/charge of
] materials

[
[
[
[

] resource speaker/s on
] provision of meals and snacks for partners
] registration fee/charge of
] materials

2. Partner/Beneficiaries:

3. Partner/Beneficiaries:

V. Partnership and Linkage Profile

A. Partners and Collaborators: please identify your partners/collaborators and provide their contribution/s:
WITHIN USC Partners and/or
Beneficiaries
[ ] Academic Department:
[ ] Co-Curricular SO:

What is/are the contribution/s or

counterpart of the partner?

Approval of the collaborating

unit (must be signed to be considered
official)

USC-CES Form B CES PPA Proposal (Details)

[ ] Extra-Curricular SO:
[ ] Support Unit:
[ ] Alumni:
[ ] BED:
[ ] Montessori Academy:
[ ] Others:

OUTSIDE of USC Partners and/or

Beneficiaries

What is/are the contribution/s or

counterpart of the partner?

[ ] Marginalized Community:
[ ] LGU:
[ ] Public school:
[ ] Civic Group/Association:
[ ] Professional Org.:
[ ] Govt Agency:
[ ] Church:
[ ] Advocacy Group/NGO:
[ ] Others:

B. Nature of Linkage/Partnership: please specify:

[ ] with MOU/MOA
Date Signed:
Signatories for USC:
Signatories for Partner:

[ ] without MOU/MOA
Since when is the linkage:
Who initiated the linkage:
Enumerate the activities already done:

USC-CES Form B CES PPA Proposal (Details)

Enumerate the Major duties of USC/Unit:

Enumerate the Major duties of Partner/s:

Enumerate the opportunities identified:

Enumerate the opportunities identified:

Enumerate the challenges/problems encountered:

Enumerate the challenges/problems encountered: