Community Profile Name of Community *
Community, Tribe, Sitio or Barangay Name
Community Type *
Please select appropriate description of the community. You may select multiple types.
i.e. - Aeta, Dumagat, Ifugao, Isneg, Kankanaey, Lumad, Mangyan, Ibaloy, T'boli
Tell us how accessible the community is from the nearest city or town.
Sitio or Barangay * Municipality or City * Municipality Class * Please make a selection 2nd Class 3rd Class 4th Class 5th Class Province * Region or Islands * Population
Estimated number of residents or households.
Community Livelihood: *
General means of livelihood i.e. "Subsistence farming, fishing", "charcoal production" etc.
Getting there, best time to visit the place, travel itinerary, cellphone signal, concerns, etc.
School Profile Type of Public School: * Please make a selection Day Care School Primary School Complete Elementary School Multigrade Elementary School National High School Non-formal / IP School Name of Public School * Number of Pupils *
As a guide, estimate can be based on the total number of enrollees of Grade 1 X number of Grade Levels available in the community's public elementary school.
Example: 20 Grade 1 x 7 = 140 pupils.
Number of Classrooms * Please make a selection 1 2 3-4 5 and more
A classroom is considered as building with roof. A mango tree does not count a classroom.
Number of Teachers * Please make a selection 1 2-3 4-5 6 or more
Include teachers from Day Care, Para-teachers, ALP and volunteer teachers under the public school.
How far is the community to the public school? * Please make a selection 500 meters - 1 kilometer 2 kilometer - 4 kilometers 4 kilometers and more What is needed most by the community / school? * Tell us why the community is deserving
Share to us why are you referring the community, tell us stories, the struggles of pupils and teachers going to school.
Referrer's Information Relationship to the community * Please make a selection I am resident I am a non-Resident I work in the community I am a volunteer in the community I have been in the community I have never been in the community
Tell us how well do you know the community referred to us.
Name: * First Last Email Address: * Mobile Phone: * Contact Person
Please complete the information of the contact / point person in the community; it can be a teacher, a barangay official, community worker, or a local guide. If you are the referrer of the community and at the same time contact person, you may leave this form empty.
Name First Last Email Mobile Phone
Mobile Phone (917)XXX-XXXX
Address Street Address Address Line 2 City State / Province / Region Zip / Postal Code
How did you learn about Black Pencil Project * Please make a selection: Blogs Forums FaceBook Friends Internet Search Magazine / Newspaper Feature Mountaineering Community Photography Community Posters Propaganda Shirts Radio Seminars / Symposiums Stickers / Decals Television Travel Operators Tour Guides Website Workshops