Form A2: COVID-19 Volunteer Form (Organization)
Please complete this form if your organization is interested in becoming a volunteer in COVID-19 response efforts. Personal information submitted will be used only for communication and monitoring purposes. Rest assured that it will be treated with utmost confidentiality.
(Maaaring sagutan ang form na ito kung ang iyong organisasyon ay interesadong maging volunteer para sa pagtugon sa COVID-19. Makasisiguro ka na iingatan at gagamitin namin ang inyong personal na impormasyon para sa pakikipag-ugnayan at pagsubaybay lamang).
* Required
GENERAL INSTRUCTIONS
Please answer N/A if the question is not applicable. If you would like to provide additional information which cannot be captured by the questions, please include these under the " Additional Information" which can be found near the end of this form.
(Maaaring sumagot ng "N/A" kung hindi naaangkop ang tanong. Kung nais mong magbigay ng karagdagang impormasyon na hindi saklaw ng tanong sa bahaging ito, maari mong ilagay ang mga ito sa " Karagdagang Impormasyon" na matatagpuan malapit sa dulo ng form na ito.)
Profile of the Organization
Name of Organization
*
Your answer
Complete Address (House No., Street, Subdivision, Barangay, City/Municipality, Province)
Block and Lot No./ Floor and Building No.
*
Your answer
Street/Subdivision
*
Your answer
Barangay
*
Your answer
City/Municipality
*
Your answer
Province (If your organization is based in NCR, please answer N/A)
Your answer
Region
*
Choose
National Capital Region (NCR)
Cordillera Administrative Region (CAR)
Region I
Region II
Region III
Region IV-A CALABARZON
MIMAROPA
Region V
Region VI
Region VII
Region VIII
Region IX
Region X
Region XI
Region XII
Region XIII (Caraga)
Bangsamoro Autonomous Region in Muslim Mindanao (BARMM)
Classification (Klase ng Organisasyon)
*
Non-Government Organization
Professional Association (Samahan ng mga Propesyonal)
Academe-based/Alumni Association (Samahan sa loob ng Paaralan/ Samahan ng mga Nagsipagtapos)
Church-based/Religious Organization (Samahan ng Kaakibat ng Relihiyon)
Employees' Association/Labor Union (Samahan ng mga Empleyado ng Manggagawa)
Private Company/Corporation (Pribadong Kompanya/Korporasyon)
Others (Iba pa)
Required
If others, please specify...
Your answer
Government Agency where your organization is registered/accredited (Ahensya ng pamahalaan kung saan rehistrado ang inyong organisasyon)
Securities and Exchange Commission (SEC)
Department of Labor and Employment-Bureau of Rural Workers (DOLE-BRW)
Cooperative Development Authority (CDA)
Department of Trade and Industry (DTI)
Department of Social Welfare and Development (DSWD)
National Youth Commission (NYC)
Local Government Unit (Lokal na Pamahalaan)
Others (Iba pa)
Not yet registered (Hindi pa rehistrado)
If others, please specify (Kung iba pa, tukuyin)
Your answer
Year Established
Your answer
Head of Organization
*
Your answer
Volunteer Focal Person/Coordinator
*
Your answer
E-mail Address
*
Your answer
Mobile/Telephone No.
*
Your answer
Website , If any
Your answer
Facebook Page (URL or username), if any
Your answer
Other Social Media Accounts, please provide organization's username
Your answer
Volunteerism-Related Information
If you would like to provide additional information which cannot be captured by the questions under this section, please include these under the " Additional Information" which can be found near the end of this form. ( Kung nais mong magbigay ng karagdagang impormasyon na hindi saklaw ng tanong sa bahaging ito, maari mong ilagay ang mga ito sa " Karagdagang Impormasyon" na matatagpuan malapit sa dulo ng form na ito.)
Type of Volunteer Assistance to be provided by the Organization (Uri ng boluntaryong gawain o serbisyong handang ibigay ng organisasyon)
*
Cooking/Preparation of meals (Pagluluto o paghahanda ng pagkain)
Preparation/Making of Personal Protective Equipment (Paghahanda o paggawa ng mga Kagamitang Pampersonal na Proteksyon)
Repacking of Goods/Donations (Pagsasaayos ng mga gamit at donasyon)
Delivery of donations and other goods (Paghahatid ng donasyon at iba pang mga gamit)
Medical Services (Serbisyong Medikal)
Online Medical Consultation (Pagbibigay ng konsultasyong medikal gamit ang internet)
Counselling (Pagpapayo at pakikinig sa nababagabag ukol sa COVID-19 gamit ang internet)
Writing (Pagsusulat)
Research (Pananaliksik)
Data Encoding (Pagtatala ng datos)
Free use of facilities or equipment (Pagpapahiram o libreng paggamit ng pasilidad at kagamitan)
Graphic arts and website design (Pagdidisenyo ng materials at paggawa ng website)
Radio Communication (Pakikipag-ugnayan gamit ang radyo)
Manning of Checkpoints (Pagbabantay sa mga checkpoint)
Coordination of volunteer activity/project (Pagsasaayos ng mga boluntaryong gawain)
Others (Iba pa)
Required
If others, please specify... (Kung iba pa, tukuyin...)
Your answer
Preferred Date (Petsa kung kailan interesadong maging volunteer)
*
MM
/
DD
/
YYYY
If your organization is willing to volunteer for more than one day, please specify other dates or duration (Kung ang iyong organisasyon ay nais maging volunteer nang higit sa isang araw, tukuyin ang iba pang petsa o kung hanggang kailan nais maging volunteer)
Your answer
Number of volunteers the organization can provide
*
Your answer
Number of hours to be rendered by volunteer organization in a day (Bilang ng oras na ibibigay ng boluntaryong organisasyon sa isang araw)
*
1-4 hours
5-8 hours
9-12 hours
Others (Iba pa)
If others, please specify... (Kung iba pa, tukuyin...)
Your answer
Number of hours in a week or month (Bilang ng oras na ibibigay ng boluntaryong organisasyon sa isang linggo o buwan)
*
5-10 hours in a week
11-40 hours in a month
Others (Iba pa)
If others, please specify... (Kung iba pa, tukuyin...)
Your answer
Preferred location where volunteer service will be rendered (Lokasyon kung saan nais magbigay ng boluntaryong serbisyo)
Barangay
Your answer
City/Municipality
*
Your answer
Province
Your answer
Region
*
Choose
National Capital Region (NCR)
Cordillera Administrative Region (CAR)
Region I
Region II
Region III
Region IV-A CALABARZON
MIMAROPA
Region V
Region VI
Region VII
Region VIII
Region IX
Region X
Region XI
Region XII
Region XIII (Caraga)
Bangsamoro Autonomous Region in Muslim Mindanao (BARMM)
Preferred Direct Recipient of Volunteer Service (Organisasyon/Grupo kung saan nais direktang magbigay ng boluntaryong serbisyo)
Your answer
Institution (Institusyon)
*
Department of Health (Kagawaran ng Kalusugan)
Government Hospital (Pampublikong Ospital/Pagamutan)
Private Hospital (Pribadong Ospital/Pagamutan)
Non-Government Organization
Company/Corporation (Kompanya/Korporasyon)
Local Government Unit (Pamahalaang Lokal)
Individual/s (Indibidwal)
Others (Iba pa)
Required
If others, please specify... (Kung iba pa, tukuyin...)
Your answer
If your target host institution does not accept volunteers anymore, is your organization willing to be referred to other institutions? (Kung ang institusyon na nais pagbigyan ng boluntaryong serbisyo ay hindi na bukas sa pagtanggap ng mga karagdagang volunteer, ang iyo bang organisasyon ay bukas na mag-volunteer sa iba pang mga imumungkahi na institusyon?)
*
Yes (Oo)
No (Hindi)
Expected Incentives/Benefits from Host Organization (Inaasahang Insentibo/Benepisyo mula sa organisasyong tatanggap ng boluntaryong serbisyo)
Personal Protective Equipment (Kagamitan para sa Personal na Proteksyon)
Meals/Snacks (Pagkain/Meryenda)
Transportation (Transportasyon/Sasakyan)
Insurance (Insyurans/Seguro)
Certificate of Attendance/Participation (Katibayan ng Pagsali/Pakikilahok)
None (Wala)
Others (Iba pa)
If others, specify... (Kung iba pa, tukuyin...)
Your answer
If the host institution cannot provide your expected incentives/benefits, is your organization still willing to render volunteering service? (Kung ang institusyong pagbibigyan ng boluntaryong serbisyo ay hindi makakapagbigay ng mga inaasahang insentibo/benepisyo, ang iyo bang organisasyon ay bukas pa ring maglaan ng boluntaryong serbisyo?
*
Yes (Oo)
No (Hindi)
Additional Information regarding volunteer assistance to be offered (Karagdagang impormasyon tungkol sa boluntaryong serbisyo na maibibigay):
Your answer
Declaration of Commitment of the Organization (Salaysay/Panunumpa ng Pangako ng Organisasyon)
By completing this form, I declare that the information herein provided are true and correct. I hereby give my permission to the Philippine National Volunteer Service Coordinating Agency (PNVSCA) to disclose this information to host organizations and the Technical Working Group for Anticipatory and Forward Planning created by the Inter-Agency Task Force for Emerging Infectious Diseases.
With full knowledge and understanding, I accept any and all risks of damage, injury, illness, or death which may result from being a volunteer. I release and discharge PNVSCA, its officers and employees, from any claims for damages or injury and all liability arising out of my participation as a volunteer.
I will also notify PNVSCA of whatever volunteer assistance I provided as a result of this initiative. Thank you.
(Sa pagsagot ko sa form na ito, pinatutunayan ko na ang mga impormasyong inilagay ko ay tama at totoo. Pinahihintulutan ko rin ang Philippine National Volunteer Service Coordinating Agency (PNVSCA) na ibigay ang aking impormasyon sa mga organisasyon kung saan kailangan ng volunteers at sa Technical Working Group for Anticipatory and Forward Planning na naitatag bilang parte ng Inter-Agency Task Force for Emerging Infectious Diseases.
Kaakibat ng buong kaalaman at pang-unawa, tinatanggap ko ang maaring panganib na maidulot ng partisipasyon ko bilang volunteer, kagaya ng pagkasira ng gamit, pinsala, sakit o kamatayan. Hindi ko rin papanagutin ang PNVSCA, kasama ng mga opisyales at empleyado nito, mula sa panganib na nabanggit.
Ipagbibigay alam ko rin sa PNVSCA ang ano mang serbisyong ibinigay ko sa organisasyon. Salamat.)
Thank you for answering this form.
Later on, we will ask you to accomplish a report form where you can provide information on the volunteer assistance you have rendered.
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