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COMMUNITY VOLUNTEERS PROFILE
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Province
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Municipality
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Barangay
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Last NameFirst NameMiddle NameExtension Name:(Jr. Sr. Etc.)
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Contact Number
Date of Filling Up
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Birth Date (mm/dd/yy)
Sex (M/F)
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Civil Status
No. of Children
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I.P. (Y/N)
I.P. Leader (Y/N)
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Head of the Household (Y/N)
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Highest Educational Attainment
Occupation
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Sectors Represented:
Current Position in BLGU
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Date of volunteer's identificaiton/appointment
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Pantawid Pamilyang Pilipino Program Beneficiary (Y/N)
Parent Leader (Y/N)
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Sustainable Livelihood Program Beneficiary (Y/N)
SLP Officer (Y/N)
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COMMITTEE MEMBERSHIP IN KALAHI - CIDSS
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Name of Committee and Position Modality Phase/CycleStart DateEnd Date
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PREVIOUS TRAINING ATTENDED (Non KALAHI - CIDSS)
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Title of TrainingTrainig ProviderYear Attended
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MEMBERSHIP IN OTHER ORGANIZATION (Non KALAHI - CIDSS)
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Organization Position
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Signature of Community VolunteerName and Signature of KC Staff
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Consent and Confidentiality Clause: The DSWD collects your name, address, sex and other information for the purpose of upcoming coordination relative to the implementation of the program
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