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
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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
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III. Education
l. No. of Schools in the Barangay:
2. No. of Children in School
Private
Public
Private
Public
Kindergarten
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Elementary
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High School
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College
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Vocational
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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. Livelihood
l. Means of Livelihood and System of Income
Name
Means of Livelihood Income
Method Used
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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

______ 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 Home
Often
Seldom
_____ Meat
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_____ Fish
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_____ Vegetables
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_____ Egg
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_____ Others, pls. specify ______
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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. Health
l. Common Diseases/Illnesses
_____ Fever
_____ Headache _____ Stomachache _____Toothache
_____ Colds
_____ Nausea
_____ Cough
_____ Others, please specify: ____________________
2. Methods Used to Treat Illnesses/Diseases in the Family
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3. Agencies Utilized to Attend to the Health Needs of People
Private
Public

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4. Type of Toilet Used by the Family/Community
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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

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VII. Existing Values, Beliefs, and Practices of People in the Community
What are the beliefs and practices in the community in relation to the following:
A. Courtship _______________________________________________________
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B. Marriage _______________________________________________________
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C. Pregnancy______________________________________________________
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D. Burial
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VIII. Existing Association/Organization in the Community
1. Name of Association/Organization
2. Status
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IX. Problems in the Community
Problems
Effects
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Action(s) Taken
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X. Suggestions/Recommendations to Resolve the Identified Problem(s)

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