Federation of Solo Parents Luzvimin Inc. Members Data

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This form was created to gather data from all new and existing members of Federation of Solo Parents Luzvimin, Inc. All information entered herein will be treated with utmost confidentiality. Kindly indicate N/A to any question that are not applicable.

Surname *

First Name *

Middle Name (if applicable)

Gender *

Male

Female

LGBTQ

Why are you joining FSPL? *

I am a solo parent.

I am an associate. ( Solo parent without minor child/ten and/ or senior citizen.

I am affiliated with FSPL.

I am an advocate.

Other:

Age *

Classification / Circumstances of Being a Solo Parent *

Unwed

Separated

Widow/er

Abandoned

Annulled

Husband / Wife in jail

Husband / Wife PWD

Foster Parent/Guardian

Contact Number *

E-mail Address

Position/Committee in FSPL *

Which committee do you want to join? *

Programs/Special Events Committee (To plan/execute all programs and special events; to undertake research on possible programs the Fed could undertake with government and private entities and conduct monitoring of such, ie. Livelihood, education, mental health, etc;)

Financial Management/Resource Generation (To handle the finances of the Fed; to undertake resource generation, such as tapping of sponsors; to prepare an annual financial report )

Advocacy/Promotions/Publicity (To handle the Fed’s public relations by maintaining harmonious relationship with the media, partner NGAs/NGOs, stakeholders; plan advocacy activities and communicate this to target audience; draft an overall advocacy plan)

Membership/Grievance and Disciplinary Committee (To screen all prospective member orgs/individuals; to ensure that all member org/individual members pay the annual membership fee; to establish the Grievance and Disciplinary Committee which will handle all internal disputes among member orgs and impose sanctions on erring officers/members; to refer member orgs/members in dire need to appropriate agencies/NGOs/LGUs for assistance

From which umbrella organization are you currently affiliated with? *

DSWD-Central Office Solo Parent’s Employees Organization (DSWD CO-SPEO)

DSWD IVB-MIMAROPA Solo Parent Employees Association

DSWD FO 8 SOLOS ng Rehiyon Otso

DSWD FO 11 Davao Region Association of Solo Parent Employees

DSWD FO 3 SPEA

DSWD FO NCR –SPEA

Office of the Solicitor General Solo Parent Employees Association (OSG-SPEA)

Central Luzon Regional Federation of Solo Parents (Region 3)

Solo Parents Alliance for Community Empowerment, Angeles City, Pampanga (SPACE)

San Fernando City Solo Parents Federation

Solong Magulang ng San Lorenzo Village, Makati Inc. (SOMA ng SANLO)

Provincial Federation of Solo Parents, Bulacan Inc.

Naga City Solo Parents Federation (NCSFP)

Municipal Federation of Solo Parents in Pavia, Iloilo

Baguio City Solo Parents Federation

San Mateo, Rizal Solo Parents Association

Solo Parents Federation of Mondragon, Northern Samar

Solo Parents Assn of Cabuyao (SPACI) Inc.

NCR Regional Solo Parents Federation

Bay, Laguna Solo Parents Assn.

Los Banos, Laguna Solo Parents Assn.

Sunshine Bontoc Mountain Province SPA

La Trinidad, Benguet, CAR, SPA

Other:

Position/Committee in Umbrella Organization *

Address *

City / Municipality *

Region *

National Capital Region (NCR)

Region 1 (Ilocos Region)

Region 2 (Cagayan Valley)

Region 3 (Central Luzon)

Region 4A (Calabarzon)

Region 4B (Mimaropa)

Region 5 ( Bicol Region)

Region 6 (Western Visayas)

Region 7 (Central Visayas)

Region 8 (Eastern Visayas)

Region 9 (Zamboanga Peninsula)

Region 10 (Northern Mindanao)

Region 11 (Davao Region)

Region 12 (SOCCSKSARGEN)

Region 13 (Caraga Region)

CAR (Cordillera Administrative Region)

ARMM (Autonomous Region in Muslim Mindanao)

Living in other Country

Are you a PWD / with Illness? *

Yes

If YES, please state your condition

Occupation *

Do you have SP I.D? *

Yes

For Renewal

If yes, indicate I.D Number

If none, when do you plan to apply for an I.D?

Skills (e.i Driving, computer technology, writing/editing, events organizing)

Number of Children *

Other:

Name of Child (1st) *

Age *

Is he/she a PWD or with illness? *

Yes

If YES, please state his/her condition

Is he/she currently studying? *

Yes

Other:

If yes, in public or in private school?

Public

Private

Other:

Clear selection

In what level?

Pre-school ( Nursery, Kinder, Preparatory)

Elementary (Grade 1- 6)

Junior High School (Grade 7 - 10)

Senior High School (Grade 11 - 12)

College

Other:

Clear selection

If no, please state the reason.

Name of Child (2nd)

Age

Is he/she a PWD or with illness?

Yes

Clear selection

If YES, please state his/her condition

Is he/she currently studying?

Yes

Other:

Clear selection

If yes, in public or in private school?

Public

Private

Other:

Clear selection

In what level?

Pre-school ( Nursery, Kinder, Preparatory)

Elementary (Grade 1- 6)

Junior High School (Grade 7 - 10)

Senior High School (Grade 11 - 12)

College

Other:

Clear selection

If no, please state the reason.

Name of Child (3rd)

Age

Is he/she a PWD or with illness?

Yes

Clear selection

If YES, please state his/her condition

Is he/she currently studying?

Yes

Other:

Clear selection

If yes, in public or in private school?

Public

Private

Other:

Clear selection

In what level?

Pre-school ( Nursery, Kinder, Preparatory)

Elementary (Grade 1- 6)

Junior High School (Grade 7 - 10)

Senior High School (Grade 11 - 12)

College

Other:

Clear selection

If no, please state the reason.

Name of Child (4th)

Age

Is he/she a PWD or with illness?

Yes

Clear selection

If YES, please state his/her condition

Is he/she currently studying?

Yes

Other:

Clear selection

If yes, in public or in private school?

Public

Private

Other:

Clear selection

In what level?

Pre-school ( Nursery, Kinder, Preparatory)

Elementary (Grade 1- 6)

Junior High School (Grade 7 - 10)

Senior High School (Grade 11 - 12)

College

Other:

Clear selection

If no, please state the reason.

Name of Child (5th)

Age

Is he/she a PWD or with illness?

Yes

Clear selection

If YES, please state his/her condition

Is he/she currently studying?

Yes

Other:

Clear selection

In what level?

Pre-school ( Nursery, Kinder, Preparatory)

Elementary (Grade 1- 6)

Junior High School (Grade 7 - 10)

Senior High School (Grade 11 - 12)

College

Other:

Clear selection

If no, please state the reason.

Name of Child (6th)

Age

Is he/she a PWD or with illness?

Yes

Clear selection

If YES, please state his/her condition

Yes

Clear selection

Is he/she currently studying?

Yes

Clear selection

In what level?

Pre-school ( Nursery, Kinder, Preparatory)

Elementary (Grade 1- 6)

Junior High School (Grade 7 - 10)

Senior High School (Grade 11 - 12)

College

Other:

Clear selection

If no, please state the reason.

Name of Child (7th)

Age

Is he/she a PWD or with illness?

Yes

Clear selection

If YES, please state his/her condition

Is he/she currently studying?

Yes

Other:

Clear selection

If yes, in public or in private school?

Public

Private

Other:

Clear selection

In what level?

Pre-school ( Nursery, Kinder, Preparatory)

Elementary (Grade 1- 6)

Junior High School (Grade 7 - 10)

Senior High School (Grade 11 - 12)

College

Other:

Clear selection

If no, please state the reason.

Are you willing to pay P 500.00 individual / P 2,000 organization membership fee annually? NOTE: FSPL is not currently enforcing the P500.00 individual membership fee, but the P2,000 per organization membership fee is mandatory based on our Constitution and By-Laws. *

Yes

Other:

Are you willing to donate for the Federation's events and their children? If yes, indicate the amount and please send it to GCash number, 0917-5424489. If no, indicate 0. *

Remarks/Comments *

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