SURVEY QUESTIONNAIRE

February ___, 2009

Dear _____________________________,
Community Extension (outreach) Programs in your school: does it really make a
difference? With so many demands on resources and expertise, it is worth
contributing? Dothe various extension programs impact your school or students? We
want to find answers to these and other questions in the research entitled, IMPACT
EVALUATION OF THE UNIVERSITY OF PANGASINAN’S COMMUNITY EXTENSION
PROGRAMS.
You are important to the success of this study! Please provide information and
share your experience and opinions with us. The information you provide will increase
our knowledge of effective community extension program. It will also help the University
and its collaborative partners in conceptualizing future extension programs.
Your participation in this study is voluntary and there is no loss of benefits if you
decline to respond. We will keep all responses strictly confidential and will not disclose
your name or personal answer to anyone.
Thank you for your assistance.

In Behalf of the University Extension Services,

EDWIN C. CANCINO,PhD
Director for Research and Extension Services

I. Please provide the following information pertaining to the community extension

program implemented in your locality.

What is the title of the extension project? _________________________

________________________________________________________________
________________________________________________________________
________________________________________________________________

Give a detailed description of the project along:

a. Funding/Investment mobilized
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
 ________________________________________________________
________________________________________________________
________________________________________________________

b. Participation/Social mobilization
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________

c. Number of beneficiaries reached

________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________

d. Duration
________________________________________________________
________________________________________________________
________________________________________________________
II. Given the project implemented, how do you rate:
Bad Averag Excelle Give reason for the rate
e nt given.
a. The quality of
project

b. The value of
finished
product as
compared to
the resources
invested in its
development
c. The benefits of
the students in
relation to
specific project

d. The extent of
support of the
donors in the
identification of
the project.
e. The extent of
support of the
donors in the
implementation
of the project.
f. The extent of
 support of the
donors in the
maintenance of
the project.
g. The extent and
intensity of the
activity

h. The extent of
maintenance of
project since
completed

i. The extent of
involvement of
community
residents in the
identification of
the project

Bad Averag Excelle Give reason for the rate

e nt given.
j. The extent of
involvement of
community
residents in the
implementation
of the project
k. The extent of
involvement of
community
residents in the
maintenance of
the project

l. The extent of
sharing and
 trust as a result
of the project in
the community.

III. For each of the following key areas and performance indicators, provide the
information(results or changes due to the extension) as measured before the
implementation of the extension program, immediately after the implementation
and 1 year after the implementation.
Key areas and Before Immediat 1 year
Indicators impleme e-ly after after
n-tation implemen impleme
-tation n-tation
Key areas and Indicators Before Immediately 1 year after
implemen- after implementation
tation implemen-
tation
 IV. For each of the following performance indicators, to what extent is each of the
following matters impact your communityin relation to community extension
program implemented? Indicate whether it is NOW BETTER (very much,
somewhat, little), SAME AS BEFORE, or MADE WORSE.

Key Areas and NOW BETTER SAME MADE Give reason for the
Performance AS WORSE rate given
BE-
Indicators FORE
Very some little

Much what
Thank you again for taking time to fill out this survey.