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7/27/2019 NSTP 12 Requirement - Community Profile
1/5
Centro Escolar University
National Service Training Program (NSTP) Department
Makati*Manila
COMMUNITY PROFILE
SURVEY FORM
I. Socio-Demographic Profile:
Name (Optional) _________________________________ Age: _________Address :
________________________________________________________________
Specific Location : _____ Near the River _____ Near the Main Road
Place of Origin : ________________________ Number of Years of Stay ___________Present Addres:______________________________ Birthdate: ____________________
Place of Birth : ___________________________ Gender : _____ Male _____ Female
Civil Status: ______ Single _____ Married ______ Widow/er
Religion : _________________ Main Source of Income : ___________________Livelihood Skills : ______________________________________________________
Training Seminars Attended :Name Name of Training Organization Date
________________________________ __________________________
______________________________________ __________________________
______
________________________________ __________________________
______________________________________ __________________________
______________________________________ ________________________________
________________________________ __________________________
______________________________________ __________________________
______
________________________________ __________________________
______
II. Family Background of Respondent (R):
Gender : Male (M) Female(F) Civil Status Single (S) Married (M)
Highest Educational Attainment: Kindergarten(0) High School (2)
Elementary (l) College (3) Vocational (4)Name Gender Age Civil Status Relation to R Education
_________________ ____ ____ ______ ___________ _____
_________________ ____ ____ ______ ___________ _____
_________________ ____ ____ ______ ___________ _____
7/27/2019 NSTP 12 Requirement - Community Profile
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_________________ ____ ____ ______ ___________ _____
_________________ ____ ____ ______ ___________ _____
_________________ ____ ____ ______ ___________ ______________________ ____ ____ ______ ___________ _____
_________________ ____ ____ ______ ___________ _____
_________________ ____ ____ ______ ___________ _____
III. Education
l. No. of Schools in the Barangay: 2. No. of Children in School
Private Public Private Public
Kindergarten ______ ______ ______ ______ Elementary ______ ______ ______ ______
High School ______ ______ ______ ______
College ______ ______ ______ ______
Vocational ______ ______ ______ ______ 2. What is your perception of education ?
Education is:_____ an opportunity to get a job
_____ an approach to address the problem of illiteracy
_____ a way of providing good future to the children_____ developing ones self-confidence and developing social responsibility
_____ Others, please specify _______________________________________
3.Dream(s) for Child(ren)
____ Finish studies____ Take a vocational course
____ Complete studies to get a job
____ Finish studies, get a job, and serve the family____ Others, pls. specify _________________________________________
IV. Livelihoodl. Means of Livelihood and System of Income
Name Means of Livelihood Income Method Used
________________ _______________ ______ _______________
________________ _______________ ______ _______________________________ _______________ ______ _______________
________________ _______________ ______ _______________
________________ _______________ ______ _______________2. Type of House
_____ Concrete _____ Made of Carton
_____ Made of Nipa _____ Made of Yero_____ Made of Wood _____ Others, pls. specify____________
3. No. of variety stores in the neighborhood _____
4. What do you perceive as personal blocks or blocks to develop yourself?
_____ lack of skills _____ lack of formal education
7/27/2019 NSTP 12 Requirement - Community Profile
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______ lack of finances _____ lack of basic needs
______ Others, pls. specify ____________________________________________
V. Lifestyle
l. Type of House
_____ Owned _____ House owned, lot rented_____ Rented _____ Others, pls. specify_________________
_____ Not rented
2. If rented, amount of monthly rental______________________________3. No. of families staying in the house______________________________
4 Home Appliances
_____ T.V. ____ Cassette Recorder
_____Radio ____ Betamax/VHS_____ Electric Fan ____ Washing Machine
_____ Karaoke ____ Others, pls. specify__________________________
5. Common Family Expenses (Rate them 1 as the lowest and 8 as the highest)
_____ Food _____ Housing_____ Transportation _____ Recreation
_____Studies/School _____ Medicine_____ Electricity _____ Clothing
_____ Others, pls. specify ______________________________
6. Common Foods Served at HomeOften Seldom
_____ Meat ______ ___________
_____ Fish ______ ___________
_____ Vegetables ______ ___________ _____ Egg ______ ___________
_____ Others, pls. specify ______ ___________
7. Meals Taken by the Family_____Once _____ Thrice _____ Five Times
_____Twice _____ Four Times _____ Six Times, and More
8. Recreation of People in the Community_____ Bingo _____ Basketball ______ Billiards ____Dominos
_____ Mahjong _____ Volleyball ______ Card Games ____ Others, ______
VI. Healthl. Common Diseases/Illnesses
_____ Fever _____ Headache _____ Stomachache _____Toothache
_____ Colds _____ Nausea_____ Cough _____ Others, please specify: ____________________
2. Methods Used to Treat Illnesses/Diseases in the Family
____________________________________________________________________________________________
______________________________________________
3. Agencies Utilized to Attend to the Health Needs of People
Private Public
7/27/2019 NSTP 12 Requirement - Community Profile
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___________________________________ _____________________________
___________________________________ _____________________________
___________________________________ ________________________________________________________________ _____________________________
4. Type of Toilet Used by the Family/Community
____________________________________________________________________5. Source of Drinking Water _______________________________________________
6. How do you dispose of your garbage?_____ Burning _____ Throwing _____ Through Garbage Collector
7. Suggestions/Recommendations to Improve the Health Condition of the People
__________________________________________________________________________________________________________________________________
_________________________________________________________________
VII. Existing Values, Beliefs, and Practices of People in the CommunityWhat are the beliefs and practices in the community in relation to the following:
A. Courtship _______________________________________________________
_______________________________________________________
B. Marriage ______________________________________________________________________________________________________________
C. Pregnancy______________________________________________________
_______________________________________________________
_______________________________________________________D. Burial _______________________________________________________
_______________________________________________________
VIII. Existing Association/Organization in the Community
1. Name of Association/Organization 2. Status
___________________________________ ___________________________________________________ ________________
___________________________________ ________________
___________________________________ ________________
IX. Problems in the Community
Problems Effects Action(s) Taken
_______________ _____________ ___________________________________________________ _____________ ____________________________________
_______________ _____________ ____________________________________
_______________ _____________ ___________________________________________________ _____________ ____________________________________
X. Suggestions/Recommendations to Resolve the Identified Problem(s)
7/27/2019 NSTP 12 Requirement - Community Profile
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_______________________________________________________________________
_______________________________________________________________________
__________________________________________________________________________