Professional Documents
Culture Documents
Dear Respondent,
Thank you.
Very truly
yours,
Middle Name:
Last Name:
Gender Preference:
3. Age:
Birthday
____________________
4. Civil Status: Single Married
Widow
Separated
5. Present Address:
6. Permanent Residence:
7. Position:
8. Designation SA
Eligibility________________________
SC/DC
ATL
ATM
9. Present Assignment:
10. Office Address:
11. Indigenous Group/ Cultural Identity/ Tribe:
12. Religion:
13. Solo Parent: Yes
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No
Others
(Specify)
Mother
Uncles/Aunts
Children
No:
No:
Others
Brothers/Sisters
(Specify)
Date of
Birth
Employed
(Y/N)
Schoolin
g
(Y/N)
With
Disability
(Pls. Indicate)
Relationship
Office
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No
No
2. Does your spouse share in the responsibility of child
caring/rearing?
Yes
No
No
2. Do you make decision/s in the management of household
affairs? Yes
No
If no, please explain
3. Do you have a household help? Yes
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No
No
No
Yes
No
b. Clean Water
Yes
c. Telephone/mobile phone
Yes
d. Television/cable
Yes
No
No
No
e. Garbage collection by the LGU
Yes
No
Yes
No
No
4. Do you attend church or religious gathering with your
family?
Yes
No
5. Do you have any regular recreation activity by yourself?
Yes
No
With your family?
No
6. Do you have enough time to rest?
Yes
No
7. Do you manage your stress well?
Yes
No
8. Do you undertake activities that will enhance your
Yes
No
capabilities or empower you as an individual?
If yes, please give examples of these activities.
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Yes
Yes
No
If no, cite reason/s:
No
Yes
No
No
12. Aside from the regular GAD Trainings undertaken by COA, what other
trainings do you still
need?
Disaster Preparedness and Risk Reduction Management
Women Empowerment and Development Towards Gender Equality
(WEDGE) by PWC
Human Rights-Based Approach (HRBA) to Development Planning
and Basic Human Rights by CHR
Harmonized Gender and Development Guidelines (HGDG) by NEDA for
Project Development, Implementation, Monitoring and Evaluation
Others, pls. specify
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
-THANK YOU-
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