Local Media8154377969260507143 1

Philippine Muslims Teachers College
SOCIAL WORK DEPARTMENT

BSW 13 - Community Organization
HOUSEHOLD NO.:_______
Barangay ________________
Date:_______________
COMMUNITY PROFILE
Name:________________________________________________________________________________________.
Adress:_______________________________________________________________________________________.
Civil Status:_____________________.
 Are you:_____ Male _____ Female

 How many years have you lived in your community?
_____ 1 – 3 years _____ 11 – 15 years
_____ 4 – 6 years _____ 16 – 25 years
_____ 7 – 10 years _____ Over 25 years

 Do you expect to be living in your community five years from now?
_____ Yes _____ No _____ Don’t Know
 Are you renting or do you own your house?
_____ Renting _____ Own
 How many family members live in your house?
_____ 1 _____ 5
_____ 2 _____ 6
_____ 3 _____ 7
_____ 4 _____ 8 or more
 What is the present age of each family member living in your house?
a. Your present age: _____ years old

If applicable,
b. 2nd family member: _____ years old
c. 3rd family member: _____ years old
d. 4th family member: ____ years old
e. 5th family member: ____ years old
f. 6th family member: _____ years old
g. 7th family member: _____ years old
h. 8th and other family members: _______________ years old
 Is there any woman currently Pregnant in the Household? Yes or No? if yes, How Many?________.
 Do you or any other members of your household attend school?
_____ Yes _____ No
 If yes, how many of you attend the following schools?
Number of household members attending: _____
_____ Elementary schools
_____ Secondary schools
_____ Colleges or universities
_____ Home Study Programs
 In what industry is the major wage earner in your family employed?
_____ Agriculture _____ Finance, Insurance, Real Estate
_____ Mining _____ Government
_____ Construction _____ Education/Training
_____ Manufacturing _____ Services
_____ Retail/Wholesale _____ Retired

_____ Transportation, _____ Homemaker
Communications,
and Public Utilities _____ Student
Others, Please specify:_______________________________________________.
Page 1
Are you self employed? ___ Yes or No ___

If yes, what is your source of income: _____________________________________
How much do you earn on a daily Basis? __________________________________
 Which of the following categories best describes your gross total family income last year?
_____ P 170,000 and over

_____ P 130,000 – P 169,000
_____ P 100,000 – P 129,999
_____ P 70,000 – P 99,999
_____ P 30,000 – P 69,999
_____ Less than P 30,00
 What was the level of education you completed?
_____ Elementary _____ Vocational
_____ High School
_____ Postgraduate
_____ College
 Sources of Water:
___ Deep well ___ Water District ___Spring others, Pls. Specify:_______________
 Sources of Electricity:________________________________.
 What do you use in the kitchen for cooking:
___ Stove ___Charcoal ___Wood ___ Electric Stove/Rice Cooker
 Do you own your house? Yes or no? if No, is it for rent? And how much per month? _________________.
 House is Made of :
___ Light Materials
___ Heavy Materials
___Mixed of Light and Heavy Materials
___Dilapidated House
How Many Story, ___________________________?
 Are you a beneficiary of any poverty alleviation program under the Department of Social Welfare Development or
Ministry of Social Services and Development? Yes or No? ________.
( ) Pantawid Pamilyang Pilipino Program
( ) Sustainable Livelihood Program
( ) Bangsamoro Sagip Kabuhayan Program
( ) Educational Cash Assistance
( ) Cash for Work
( ) Unconditional Cash Transfer Program
 Can you cite three (3) Community Problems that is present in your barangay as of now:
1.
2.
3.
 Can you cite three (3) Problems you and your family is experiencing now.
1.
2.
3.
 If you have additional comments about your community, write them below.
__________________________________________________________
__________________________________________________________
__________________________________________________________
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Philippine Muslims Teachers College

SOCIAL WORK DEPARTMENT

 Are you:_ Male _ Female

_ 4 – 6 years _ 16 – 25 years

_ 7 – 10 years _ Over 25 years

a. Your present age: _____ years old

_ Mining _ Government

_ Construction _ Education/Training

_ Manufacturing _ Services

_ Retail/Wholesale _ Retired

Are you self employed? _ Yes or No _

_____ P 170,000 and over

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