Vision of Quirino State

Republic of the Philippines Mission of Quirino State

University QUIRINO STATE UNIVERSITY University
Diffun Campus Develop competent and morally
The leading center for academic
and technological excellence and upright professionals and generate
appropriate knowledge and
prime catalyst for a progressive COLLEGE OF HEALTH SCIENCES technologies to meet the needs of
and sustainable Quirino Province
and Southern Cagayan Valley. PUBLIC HEALTH NUTRITION PRACTICUM Quirino Province and Southern
Approved through In coordination with Brgy. Cajel, Diffun, Quirino Cagayan Valley.
Resolution No. SBM-05-11-05, Approved through
Series of 2011 Resolution No. SBM-05-11-05,
Series of 2011
EVALUATION FORM

Name (optional): _________________________________________________________

Directions: Kindly provide us a feedback by accomplishing this form. Your response will greatly assist us
to identify areas for our improvement. Check the indicator that describes your response for each item.
5- Best/Outstanding 3- Good 1-Poor
4- Better/Very Good 2- Fair
Indicators Ratings
5 4 3 2 1
1. Clarity of the objectives ( Kalinawan ng mga layunin)
2. Sufficiency of the activities conducted (Sapat na dami ng mga
naisagawang aktibidades)
3. Flow of the activities ( Daloy ng aktibidades)
4. Appropriateness of the venue( kaangkupan ng pinagdausang lugar)
5. Involvement of audience (pakikilahok ng mga tagapakinig)
6. Performance of the facilitators incharge ( kahusayan ng mga
tagapangasiwa)
7. Time management ( wastong paggamit ng itinakdang oras)
8. Relevance of the activities conducted ( kahalagahan ng aktibidades):
8 8.1. Opening Program
8 8.2. Lecture on Breastfeeding Promotion
8 8.3. Lecture on Common Breastfeeding Difficulties
8 8.4 Pabasa sa Nutrisyon (Kabanata 1&2)
8 8.5 Closing Program
9. Effectiveness of methods used in activities (Bisa ng mga paraang
ginamit sa mga aktibidades)
9 9.1 Lecture on Breastfeeding Promotion
9 9.2 Lecture on Common Breastfeeding Difficulties
9 9.3 Pabasa sa Nutrisyon (Kabanata 1&2)
10. Performance of the Speaker (kahusayan at kalidad ng mga
tagapagsalita)
10 10.1 Lecture on Breastfeeding Promotion
10 10.2 Lecture on Common Breastfeeding Difficulties
10 10.3 Pabasa sa Nutrisyon (Kabanata 1&2)

OVER-ALL EVEALUTION:
Best/Outstanding (4:20-5.00) Good ( 2.60 – 3.64) Poor ( 1.00 – 1.79)
Better/ Very Good ( 3.40- 4.19) Fair ( 1.80 – 2.59)
Other Comments and Suggestion:_________________________________________________________
 Republic of the Philippines
Vision of Quirino State Mission of Quirino State
University QUIRINO STATE UNIVERSITY University
Diffun Campus
The leading center for academic Develop competent and morally
and technological excellence and upright professionals and generate
prime catalyst for a progressive COLLEGE OF HEALTH SCIENCES appropriate knowledge and
and sustainable Quirino Province technologies to meet the needs of
and Southern Cagayan Valley.
PUBLIC HEALTH NUTRITION PRACTICUM Quirino Province and Southern
Approved through In coordination with Brgy. Cajel, Diffun, Quirino Cagayan Valley.
Resolution No. SBM-05-11-05, Approved through
Series of 2011 Resolution No. SBM-05-11-05,
Series of 2011
EVALUATION FORM
Name (optional): _________________________________________________________
Directions: Kindly provide us a feedback by accomplishing this form. Your response will greatly assist us
to identify areas for our improvement. Check the indicator that describes your response for each item.
5- Best/Outstanding 3- Good 1-Poor
4- Better/Very Good 2- Fair
Indicators Ratings
5 4 3 2 1
1. Clarity of the objectives ( Kalinawan ng mga layunin)
2. Sufficiency of the activities conducted (Sapat na dami ng mga
naisagawang aktibidades)
3. Flow of the activities ( Daloy ng aktibidades)
4. Appropriateness of the venue( kaangkupan ng pinagdausang lugar)
5. Involvement of audience (pakikilahok ng mga tagapakinig)
6. Performance of the facilitators incharge ( kahusayan ng mga
tagapangasiwa)
7. Time management ( wastong paggamit ng itinakdang oras)
8. Relevance of the activities conducted ( kahalagahan ng aktibidades):
8.1. Opening Program
8.2. Lecture on 3 Basic Food Groups
8.3. Lecture on Pinggang Pinoy for Pre School
8.4. Closing Program
9. Effectiveness of methods used in activities (Bisa ng mga paraang
ginamit sa mga aktibidades)
9.1 Lecture on 3 Basic Food Groups
9.2 Lecture on Pinggang Pinoy for Pre School
10. Performance of the Speaker (kahusayan at kalidad ng mga
tagapagsalita)
10.1 Lecture on 3 Basic Food Groups
10.2 Lecture on Pinggang Pinoy for Pre School

OVER-ALL EVEALUTION:
Best/Outstanding (4:20-5.00) Good ( 2.60 – 3.64) Poor ( 1.00 – 1.79)
Better/ Very Good ( 3.40- 4.19) Fair ( 1.80 – 2.59)
Other Comments and Suggestion:_________________________________________________________
 Vision of Quirino State Republic of the Philippines Mission of Quirino State
University QUIRINO STATE UNIVERSITY University

The leading center for academic Diffun Campus Develop competent and morally
and technological excellence and upright professionals and generate
prime catalyst for a progressive appropriate knowledge and
and sustainable Quirino Province COLLEGE OF HEALTH SCIENCES technologies to meet the needs of
and Southern Cagayan Valley. PUBLIC HEALTH NUTRITION PRACTICUM Quirino Province and Southern
Approved through Cagayan Valley.
Resolution No. SBM-05-11-05, In coordination with Brgy. Cajel, Diffun, Quirino Approved through
Series of 2011 Resolution No. SBM-05-11-05,
Series of 2011
EVALUATION FORM
Name (optional): _________________________________________________________
Directions: Kindly provide us a feedback by accomplishing this form. Your response will greatly assist us
to identify areas for our improvement. Check the indicator that describes your response for each item.
5- Best/Outstanding 3- Good 1-Poor
4- Better/Very Good 2- Fair
Indicators Ratings
5 4 3 2 1
1. Clarity of the objectives ( Kalinawan ng mga layunin)
2. Sufficiency of the activities conducted (Sapat na dami ng mga
naisagawang aktibidades)
3. Flow of the activities ( Daloy ng aktibidades)
4. Appropriateness of the venue( kaangkupan ng pinagdausang lugar)
5. Involvement of audience (pakikilahok ng mga tagapakinig)
6. Performance of the facilitators incharge ( kahusayan ng mga
tagapangasiwa)
7. Time management ( wastong paggamit ng itinakdang oras)
8. Relevance of the activities conducted ( kahalagahan ng aktibidades):
8.1. Opening Program
8.2. Lecture on Expressing Breastmilk
8.3. Lecture on Complementary Feeding
8.5 Closing Program
9. Effectiveness of methods used in activities (Bisa ng mga paraang
ginamit sa mga aktibidades)
9.1 Lecture on Expressing Breastmilk
9.2 Lecture on Complementary Feeding
10. Performance of the Speaker (kahusayan at kalidad ng mga
tagapagsalita)
10.1 Lecture on Expressing Breastmilk
10.2 Lecture on Complementary Feeding

OVER-ALL EVEALUTION:
Best/Outstanding (4:20-5.00) Good ( 2.60 – 3.64) Poor ( 1.00 – 1.79)
Better/ Very Good ( 3.40- 4.19) Fair ( 1.80 – 2.59)
Other Comments and Suggestion:_________________________________________________________
 Vision of Quirino State
Republic of the Philippines Mission of Quirino State
University QUIRINO STATE UNIVERSITY University
Diffun Campus Develop competent and morally
The leading center for academic
and technological excellence and upright professionals and generate
appropriate knowledge and
prime catalyst for a progressive COLLEGE OF HEALTH SCIENCES technologies to meet the needs of
and sustainable Quirino Province
and Southern Cagayan Valley. PUBLIC HEALTH NUTRITION PRACTICUM Quirino Province and Southern
Approved through In coordination with Brgy. Cajel, Diffun, Quirino Cagayan Valley.
Resolution No. SBM-05-11-05, Approved through
Series of 2011 Resolution No. SBM-05-11-05,
Series of 2011
EVALUATION FORM
Name (optional): _________________________________________________________
Directions: Kindly provide us a feedback by accomplishing this form. Your response will greatly assist us
to identify areas for our improvement. Check the indicator that describes your response for each item.
5- Best/Outstanding 3- Good 1-Poor
4- Better/Very Good 2- Fair
Indicators Ratings
5 4 3 2 1
1. Clarity of the objectives ( Kalinawan ng mga layunin)
2. Sufficiency of the activities conducted (Sapat na dami ng mga
naisagawang aktibidades)
3. Flow of the activities ( Daloy ng aktibidades)
4. Appropriateness of the venue( kaangkupan ng pinagdausang lugar)
5. Involvement of audience (pakikilahok ng mga tagapakinig)
6. Performance of the facilitators incharge ( kahusayan ng mga
tagapangasiwa)
7. Time management ( wastong paggamit ng itinakdang oras)
8. Relevance of the activities conducted ( kahalagahan ng aktibidades):
8 8.1. Opening Program
11 8.2. Lecture on Personal Hygiene
11 8.3. Lecture on Handwashing
8 8.4. Closing Program
9. Effectiveness of methods used in activities (Bisa ng mga paraang
ginamit sa mga aktibidades)
12 9.1 Lecture on Personal Hygiene
12 9.2 Lecture on Handwashing
10. Performance of the Speaker (kahusayan at kalidad ng mga
tagapagsalita)
13 10.1 Lecture on Personal Hygiene
13 10.2 Lecture on Handwashing

OVER-ALL EVEALUTION:
Best/Outstanding (4:20-5.00) Good ( 2.60 – 3.64) Poor ( 1.00 – 1.79)
Better/ Very Good ( 3.40- 4.19) Fair ( 1.80 – 2.59)
Other Comments and Suggestion:_________________________________________________________
 Republic of the Philippines
Vision of Quirino State Mission of Quirino State
University QUIRINO STATE UNIVERSITY University
Diffun Campus
The leading center for academic Develop competent and morally
and technological excellence and upright professionals and generate
prime catalyst for a progressive COLLEGE OF HEALTH SCIENCES appropriate knowledge and
and sustainable Quirino Province technologies to meet the needs of
and Southern Cagayan Valley.
PUBLIC HEALTH NUTRITION PRACTICUM Quirino Province and Southern
Approved through In coordination with Brgy. Cajel, Diffun, Quirino Cagayan Valley.
Resolution No. SBM-05-11-05, Approved through
Series of 2011 Resolution No. SBM-05-11-05,
Series of 2011
EVALUATION FORM

Name (optional): _________________________________________________________

Directions: Kindly provide us a feedback by accomplishing this form. Your response will greatly assist us
to identify areas for our improvement. Check the indicator that describes your response for each item.
5- Best/Outstanding 3- Good 1-Poor
4- Better/Very Good 2- Fair
Indicators Ratings
5 4 3 2 1
1. Clarity of the objectives ( Kalinawan ng mga layunin)
2. Sufficiency of the activities conducted (Sapat na dami ng mga
naisagawang aktibidades)
3. Flow of the activities ( Daloy ng aktibidades)
4. Appropriateness of the venue( kaangkupan ng pinagdausang lugar)
5. Involvement of audience (pakikilahok ng mga tagapakinig)
6. Performance of the facilitators incharge ( kahusayan ng mga
tagapangasiwa)
7. Time management ( wastong paggamit ng itinakdang oras)
8. Relevance of the activities conducted ( kahalagahan ng aktibidades):
8.1. Opening Program
8.2. Lecture on Nutrient Deficiency
8.3. Lecture on Healthy Lifestyle Promotion
8.4. Closing Program
9. Effectiveness of methods used in activities (Bisa ng mga paraang
ginamit sa mga aktibidades)
9.1. Lecture on Nutrient Deficiency
9.2. Lecture on Healthy Lifestyle Promotion
10. Performance of the Speaker (kahusayan at kalidad ng mga
tagapagsalita)
10.1. Lecture on Nutrient Deficiency
10.2. Lecture on Healthy Lifestyle Promotion

OVER-ALL EVEALUTION:
Best/Outstanding (4:20-5.00) Good ( 2.60 – 3.64) Poor ( 1.00 – 1.79)
Better/ Very Good ( 3.40- 4.19) Fair ( 1.80 – 2.59)
Other Comments and Suggestion:_________________________________________________________
 Vision of Quirino State Republic of the Philippines Mission of Quirino State
University QUIRINO STATE UNIVERSITY University

The leading center for academic Diffun Campus Develop competent and morally
and technological excellence and upright professionals and generate
prime catalyst for a progressive appropriate knowledge and
and sustainable Quirino Province COLLEGE OF HEALTH SCIENCES technologies to meet the needs of
and Southern Cagayan Valley. PUBLIC HEALTH NUTRITION PRACTICUM Quirino Province and Southern
Approved through Cagayan Valley.
Resolution No. SBM-05-11-05, In coordination with Brgy. Cajel, Diffun, Quirino Approved through
Series of 2011 Resolution No. SBM-05-11-05,
Series of 2011
EVALUATION FORM

Name (optional): _________________________________________________________

Directions: Kindly provide us a feedback by accomplishing this form. Your response will greatly assist us
to identify areas for our improvement. Check the indicator that describes your response for each item.
5- Best/Outstanding 3- Good 1-Poor
4- Better/Very Good 2- Fair
Indicators Ratings
5 4 3 2 1
1. Clarity of the objectives ( Kalinawan ng mga layunin)
2. Sufficiency of the activities conducted (Sapat na dami ng mga
naisagawang aktibidades)
3. Flow of the activities ( Daloy ng aktibidades)
4. Appropriateness of the venue( kaangkupan ng pinagdausang lugar)
5. Involvement of audience (pakikilahok ng mga tagapakinig)
6. Performance of the facilitators incharge ( kahusayan ng mga
tagapangasiwa)
7. Time management ( wastong paggamit ng itinakdang oras)
8. Relevance of the activities conducted ( kahalagahan ng aktibidades):
8.1. Opening Program
8.2. Lecture on 10 Kumainments
8.3. Lecture on Pinggang Pinoy
8.5 Closing Program
9. Effectiveness of methods used in activities (Bisa ng mga paraang
ginamit sa mga aktibidades)
9.1 Lecture on 10 Kumainments
9.2 Lecture on Pinggang Pinoy
10. Performance of the Speaker (kahusayan at kalidad ng mga
tagapagsalita)
10.1 Lecture on 10 Kumainments
10.2 Lecture on Pinggang Pinoy

OVER-ALL EVEALUTION:
Best/Outstanding (4:20-5.00) Good ( 2.60 – 3.64) Poor ( 1.00 – 1.79)
Better/ Very Good ( 3.40- 4.19) Fair ( 1.80 – 2.59)
Other Comments and Suggestion:_________________________________________________________
 Vision of Quirino State
Republic of the Philippines Mission of Quirino State
University QUIRINO STATE UNIVERSITY University
Diffun Campus Develop competent and morally
The leading center for academic
and technological excellence and upright professionals and generate
appropriate knowledge and
prime catalyst for a progressive COLLEGE OF HEALTH SCIENCES technologies to meet the needs of
and sustainable Quirino Province
and Southern Cagayan Valley. PUBLIC HEALTH NUTRITION PRACTICUM Quirino Province and Southern
Approved through In coordination with Brgy. Cajel, Diffun, Quirino Cagayan Valley.
Resolution No. SBM-05-11-05, Approved through
Series of 2011 Resolution No. SBM-05-11-05,
Series of 2011
EVALUATION FORM
Name (optional): _________________________________________________________
Directions: Kindly provide us a feedback by accomplishing this form. Your response will greatly assist us
to identify areas for our improvement. Check the indicator that describes your response for each item.
5- Best/Outstanding 3- Good 1-Poor
4- Better/Very Good 2- Fair
Indicators Ratings
5 4 3 2 1
1. Clarity of the objectives ( Kalinawan ng mga layunin)
2. Sufficiency of the activities conducted (Sapat na dami ng mga
naisagawang aktibidades)
3. Flow of the activities ( Daloy ng aktibidades)
4. Appropriateness of the venue( kaangkupan ng pinagdausang lugar)
5. Involvement of audience (pakikilahok ng mga tagapakinig)
6. Performance of the facilitators incharge ( kahusayan ng mga
tagapangasiwa)
7. Time management ( wastong paggamit ng itinakdang oras)
8. Relevance of the activities conducted ( kahalagahan ng aktibidades):
8 8.1. Opening Program
14 8.2. Lecture on Foods to Fill the Energy Gaps
14 8.3. Lecture on Foods to Fill the Iron and Vitamin A deficiency
8 8.4. Closing Program
9. Effectiveness of methods used in activities (Bisa ng mga paraang
ginamit sa mga aktibidades)
15 9.1 Lecture on Breastfeeding Promotion
15 9.2 Lecture on Complementary Feeding
10. Performance of the Speaker (kahusayan at kalidad ng mga
tagapagsalita)
16 10.1 Lecture on Breastfeeding Promotion
16 10.2 Lecture on Complementary Feeding

OVER-ALL EVEALUTION:
Best/Outstanding (4:20-5.00) Good ( 2.60 – 3.64) Poor ( 1.00 – 1.79)
Better/ Very Good ( 3.40- 4.19) Fair ( 1.80 – 2.59)
Other Comments and Suggestion:_________________________________________________________
 Republic of the Philippines
Vision of Quirino State Mission of Quirino State
University QUIRINO STATE UNIVERSITY University
Diffun Campus
The leading center for academic Develop competent and morally
and technological excellence and upright professionals and generate
prime catalyst for a progressive COLLEGE OF HEALTH SCIENCES appropriate knowledge and
and sustainable Quirino Province technologies to meet the needs of
and Southern Cagayan Valley.
PUBLIC HEALTH NUTRITION PRACTICUM Quirino Province and Southern
Approved through In coordination with Brgy. Cajel, Diffun, Quirino Cagayan Valley.
Resolution No. SBM-05-11-05, Approved through
Series of 2011 Resolution No. SBM-05-11-05,
Series of 2011
EVALUATION FORM
Name (optional): _________________________________________________________
Directions: Kindly provide us a feedback by accomplishing this form. Your response will greatly assist us
to identify areas for our improvement. Check the indicator that describes your response for each item.
5- Best/Outstanding 3- Good 1-Poor
4- Better/Very Good 2- Fair
Indicators Ratings
5 4 3 2 1
1. Clarity of the objectives ( Kalinawan ng mga layunin)
2. Sufficiency of the activities conducted (Sapat na dami ng mga
naisagawang aktibidades)
3. Flow of the activities ( Daloy ng aktibidades)
4. Appropriateness of the venue( kaangkupan ng pinagdausang lugar)
5. Involvement of audience (pakikilahok ng mga tagapakinig)
6. Performance of the facilitators incharge ( kahusayan ng mga
tagapangasiwa)
7. Time management ( wastong paggamit ng itinakdang oras)
8. Relevance of the activities conducted ( kahalagahan ng aktibidades):
8.1. Opening Program
8.2. Lecture on Dietary management of Diabetes and Hypertension
among Elderly
8.3 Closing Program
9. Effectiveness of methods used in activities (Bisa ng mga paraang
ginamit sa mga aktibidades)
9.1 Lecture on Dietary management of Diabetes and Hypertension
among Elderly
10. Performance of the Speaker (kahusayan at kalidad ng mga
tagapagsalita)
10.1 Lecture on Dietary management of Diabetes and Hypertension
among Elderly

OVER-ALL EVEALUTION:
Best/Outstanding (4:20-5.00) Good ( 2.60 – 3.64) Poor ( 1.00 – 1.79)
Better/ Very Good ( 3.40- 4.19) Fair ( 1.80 – 2.59)
Other Comments and Suggestion:_________________________________________________________
 Vision of Quirino State Republic of the Philippines Mission of Quirino State
University QUIRINO STATE UNIVERSITY University

The leading center for academic Diffun Campus Develop competent and morally
and technological excellence and upright professionals and generate
prime catalyst for a progressive appropriate knowledge and
and sustainable Quirino Province COLLEGE OF HEALTH SCIENCES technologies to meet the needs of
and Southern Cagayan Valley. PUBLIC HEALTH NUTRITION PRACTICUM Quirino Province and Southern
Approved through Cagayan Valley.
Resolution No. SBM-05-11-05, In coordination with Brgy. Cajel, Diffun, Quirino Approved through
Series of 2011 Resolution No. SBM-05-11-05,
Series of 2011
EVALUATION FORM
Name (optional): _________________________________________________________
Directions: Kindly provide us a feedback by accomplishing this form. Your response will greatly assist us
to identify areas for our improvement. Check the indicator that describes your response for each item.
5- Best/Outstanding 3- Good 1-Poor
4- Better/Very Good 2- Fair
Indicators Ratings
5 4 3 2 1
1. Clarity of the objectives ( Kalinawan ng mga layunin)
2. Sufficiency of the activities conducted (Sapat na dami ng mga
naisagawang aktibidades)
3. Flow of the activities ( Daloy ng aktibidades)
4. Appropriateness of the venue( kaangkupan ng pinagdausang lugar)
5. Involvement of audience (pakikilahok ng mga tagapakinig)
6. Performance of the facilitators incharge ( kahusayan ng mga
tagapangasiwa)
7. Time management ( wastong paggamit ng itinakdang oras)
8. Relevance of the activities conducted ( kahalagahan ng aktibidades):
8.1. Opening Program
8.2. Lecture on Healthy Lifestyle with Assessment among Elderly
8.3 Closing Program
9. Effectiveness of methods used in activities (Bisa ng mga paraang
ginamit sa mga aktibidades)
9.1 Lecture on Healthy Lifestyle with Assessment among Elderly
10. Performance of the Speaker (kahusayan at kalidad ng mga
tagapagsalita)
10.1 Lecture on Healthy Lifestyle with Assessment among Elderly

OVER-ALL EVEALUTION:
Best/Outstanding (4:20-5.00) Good ( 2.60 – 3.64) Poor ( 1.00 – 1.79)
Better/ Very Good ( 3.40- 4.19) Fair ( 1.80 – 2.59)
Other Comments and Suggestion:_________________________________________________________
 Vision of Quirino State
Republic of the Philippines Mission of Quirino State
University QUIRINO STATE UNIVERSITY University
Diffun Campus Develop competent and morally
The leading center for academic
and technological excellence and upright professionals and generate
appropriate knowledge and
prime catalyst for a progressive COLLEGE OF HEALTH SCIENCES technologies to meet the needs of
and sustainable Quirino Province
and Southern Cagayan Valley. PUBLIC HEALTH NUTRITION PRACTICUM Quirino Province and Southern
Approved through In coordination with Brgy. Cajel, Diffun, Quirino Cagayan Valley.
Resolution No. SBM-05-11-05, Approved through
Series of 2011 Resolution No. SBM-05-11-05,
Series of 2011
EVALUATION FORM
Name (optional): _________________________________________________________
Directions: Kindly provide us a feedback by accomplishing this form. Your response will greatly assist us
to identify areas for our improvement. Check the indicator that describes your response for each item.
5- Best/Outstanding 3- Good 1-Poor
4- Better/Very Good 2- Fair
Indicators Ratings
5 4 3 2 1
1. Clarity of the objectives ( Kalinawan ng mga layunin)
2. Sufficiency of the activities conducted (Sapat na dami ng mga
naisagawang aktibidades)
3. Flow of the activities ( Daloy ng aktibidades)
4. Appropriateness of the venue( kaangkupan ng pinagdausang lugar)
5. Involvement of audience (pakikilahok ng mga tagapakinig)
6. Performance of the facilitators incharge ( kahusayan ng mga
tagapangasiwa)
7. Time management ( wastong paggamit ng itinakdang oras)
8. Relevance of the activities conducted ( kahalagahan ng aktibidades):
8 8.1. Opening Program
17 8.2. Lecture on Livelihood among Adult
8 8.3. Closing Program
9. Effectiveness of methods used in activities (Bisa ng mga paraang
ginamit sa mga aktibidades)
18 9.1 Lecture on Livelihood among Adult
10. Performance of the Speaker (kahusayan at kalidad ng mga
tagapagsalita)
19 10.1 Lecture on Livelihood among Adult

OVER-ALL EVEALUTION:
Best/Outstanding (4:20-5.00) Good ( 2.60 – 3.64) Poor ( 1.00 – 1.79)
Better/ Very Good ( 3.40- 4.19) Fair ( 1.80 – 2.59)
Other Comments and Suggestion:_________________________________________________________
 Republic of the Philippines
Vision of Quirino State Mission of Quirino State
University QUIRINO STATE UNIVERSITY University
Diffun Campus
The leading center for academic Develop competent and morally
and technological excellence and upright professionals and generate
prime catalyst for a progressive COLLEGE OF HEALTH SCIENCES appropriate knowledge and
and sustainable Quirino Province technologies to meet the needs of
and Southern Cagayan Valley.
PUBLIC HEALTH NUTRITION PRACTICUM Quirino Province and Southern
Approved through In coordination with Brgy. Cajel, Diffun, Quirino Cagayan Valley.
Resolution No. SBM-05-11-05, Approved through
Series of 2011 Resolution No. SBM-05-11-05,
Series of 2011
EVALUATION FORM
Name (optional): _________________________________________________________
Directions: Kindly provide us a feedback by accomplishing this form. Your response will greatly assist us
to identify areas for our improvement. Check the indicator that describes your response for each item.
5- Best/Outstanding 3- Good 1-Poor
4- Better/Very Good 2- Fair
Indicators Ratings
5 4 3 2 1
1. Clarity of the objectives ( Kalinawan ng mga layunin)
2. Sufficiency of the activities conducted (Sapat na dami ng mga
naisagawang aktibidades)
3. Flow of the activities ( Daloy ng aktibidades)
4. Appropriateness of the venue( kaangkupan ng pinagdausang lugar)
5. Involvement of audience (pakikilahok ng mga tagapakinig)
6. Performance of the facilitators incharge ( kahusayan ng mga
tagapangasiwa)
7. Time management ( wastong paggamit ng itinakdang oras)
8. Relevance of the activities conducted ( kahalagahan ng aktibidades):
8.1. Opening Program
8.2. Lecture on Weight management and Healthy Lifestyle among
Adult
8.5 Closing Program
9. Effectiveness of methods used in activities (Bisa ng mga paraang
ginamit sa mga aktibidades)
9.1 Lecture on Weight management and Healthy Lifestyle among
Adult
10. Performance of the Speaker (kahusayan at kalidad ng mga
tagapagsalita)
10.1 Lecture on Weight management and Healthy Lifestyle among
Adult

OVER-ALL EVEALUTION:
Best/Outstanding (4:20-5.00) Good ( 2.60 – 3.64) Poor ( 1.00 – 1.79)
Better/ Very Good ( 3.40- 4.19) Fair ( 1.80 – 2.59)
Other Comments and Suggestion:_________________________________________________________
 Vision of Quirino State Republic of the Philippines Mission of Quirino State
University QUIRINO STATE UNIVERSITY University

The leading center for academic Diffun Campus Develop competent and morally
and technological excellence and upright professionals and generate
prime catalyst for a progressive appropriate knowledge and
and sustainable Quirino Province COLLEGE OF HEALTH SCIENCES technologies to meet the needs of
and Southern Cagayan Valley. PUBLIC HEALTH NUTRITION PRACTICUM Quirino Province and Southern
Approved through Cagayan Valley.
Resolution No. SBM-05-11-05, In coordination with Brgy. Cajel, Diffun, Quirino Approved through
Series of 2011 Resolution No. SBM-05-11-05,
Series of 2011
EVALUATION FORM
Name (optional): _________________________________________________________
Directions: Kindly provide us a feedback by accomplishing this form. Your response will greatly assist us
to identify areas for our improvement. Check the indicator that describes your response for each item.
5- Best/Outstanding 3- Good 1-Poor
4- Better/Very Good 2- Fair
Indicators Ratings
5 4 3 2 1
1. Clarity of the objectives ( Kalinawan ng mga layunin)
2. Sufficiency of the activities conducted (Sapat na dami ng mga
naisagawang aktibidades)
3. Flow of the activities ( Daloy ng aktibidades)
4. Appropriateness of the venue( kaangkupan ng pinagdausang lugar)
5. Involvement of audience (pakikilahok ng mga tagapakinig)
6. Performance of the facilitators incharge ( kahusayan ng mga
tagapangasiwa)
7. Time management ( wastong paggamit ng itinakdang oras)
8. Relevance of the activities conducted ( kahalagahan ng aktibidades):
8.1. Opening Program
8.2. Lecture on Healthy Lifestyle among Teenagers
8.3. Closing Program
9. Effectiveness of methods used in activities (Bisa ng mga paraang
ginamit sa mga aktibidades)
9.1 Lecture on Healthy Lifestyle among Teenagers
10. Performance of the Speaker (kahusayan at kalidad ng mga
tagapagsalita)
10.1 Lecture on Healthy Lifestyle among Teenagers

OVER-ALL EVEALUTION:
Best/Outstanding (4:20-5.00) Good ( 2.60 – 3.64) Poor ( 1.00 – 1.79)
Better/ Very Good ( 3.40- 4.19) Fair ( 1.80 – 2.59)
Other Comments and Suggestion:_________________________________________________________