4-B LPI Report on Volunteer Placement

PNVSCA report form for volunteer placement

Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: Form 4-B
Republic of the Philippines
National Economic & Development Authority
Philippine National Volunteer Service Coordinating Agency
G/F, Phil. Sugar Center Bldg., North Avenue, Diliman, Quezon City
Telephone No: (02)927-6847 Telefax: (02)4534726

(To be submitted by Local Partner Institution
within two months after deployment of volunteer)

Email Address: monitoring@pnvsca.gov.ph;
Email Address: monitoring@pnvsca.gov.ph

1. Name and Address of Local Partner Institution:


Have the Terms of Reference (TOR) for the volunteer been
agreed upon between the institution and volunteer
No. If yes, pls. attach a copy.
If not yet agreed, what are the concerns you and the
volunteer are encountering _________________________


Indicate living and other arrangements made for the

Email Address: ____________________________
2. Name of Volunteer/Volunteer Service Organization:

3. Name and Location Project Assisted by Volunteer:

4. Date of Assumption of Assignment:

7.1. Housing
[ ]
Provided or paid for by Local Partner Institution
[ ]
Provided or paid for by sponsoring volunteer
[ ]
Others, pls. Specify

5. Indicate the kind of social and technical/
project preparations provided to the volunteer
by your agency/organization:
5.1. Introduction of volunteer to:

7.2. Project-Related Transportation Requirements
[ ]
Vehicle provided
[ ]
Actual costs to be reimbursed
[ ]
Others, pls. Specify

Yes No

a) Agency's/Instituion's staff
b) NEDA Regional Director
c) Local Government Units
i.e. City or Municipal Mayor,
and Provincial Governor
d) Provincial Director of the
Philippine National Police

7.3. Pls. list other support facilities such as office
supplies and equipment made available to the

5.2. Briefings on local environment,
including security measures
and health situation
5.3. Briefings on project, its objectives
and role and responsibilities of
volunteer (Kindly describe briefly):

Prepared by:


Are there other matters/issues related to the volunteer
assignment that you want to be addressed?
No. If yes, kindly specify and explain

Attested by:

Name & Signature of Volunteer's Supervisor

Head of Agency/Institution

Form 4-B