CITY SOCIAL WELFARE AND DEVELOPMENT DEPARTMENT

SETS OF DATA BEING COLLECTED

                The CSWDD is in charge of overseeing the delivery of social welfare and development services and upholds the City of Mandaluyong mission, vision, mandates, and priorities. As the lead agency in the social protection arena, the department mandates to provide appropriate interventions and opportunities to the distressed and marginalized individuals, families, groups, and communities. It also acts as the first point of contact for assistance and offers urgent relief during and after calamities or disasters.

                As City Department, the department operates five (5) divisions: Child and Youth Welfare Division, Family, Women and Community Welfare Division, Center Care Services Division, Emergency Assistance Division, and Administrative Division which are anchored with (23) twenty- three programs.

                The front desk personnel uses the General Intake Sheet to collect information / data before forwarding it to the relevant division for appropriate action.

GENERAL INTAKE SHEET

Clientele Category
Case No.
Date
New
Barangay
Old

I. IDENTIFYING DATA:
Name of Client
Age
Date of Birth
Place of Birth
City Address
Prov’l Address
Civil Status
Sex
Educational Attainment
Occupation
Nature of Need

II. FAMILY COMPOSITION
Name
Age
Sex
Civil Status
Relation to Client
Edducational Attainment
Civil Status
Sex
Educational Attainment

III. PROBLEM PRESENTED

IV. BACKGROUND INFORMATION:

V. ASSESSMENT / RECOMMENDATION:

_______________              _________________________________
Client’s Signature                Social Worker / Welfare Worker Signature

1. CHILD AND YOUTH WELFARE DIVISION

(Home Based ECCD cum Supervised Neighborhood Play Program, Children in Needs of Special Protection, Adoption Program, Foster Care Program, Issuance of case summary for temporary custody, Issuance of Certificate for Local Travel, Pag-Asa Youth Association of the Philippines Inc. (PYAP), Day Care Services Program)

A. Home Based ECCD Cum Supervised Neighborhood Play Program

Name
Age
Date of Birth
Place of Birth
City Address
Sex
Educational Attainment
Contact Number
Name of Parent/s
Siblings’ Name
Occupation/Income

Other Requirements
- Barangay Certificate of Indigency
- Birth Certificate
- Parents’ consent

B. Children in Need of Special Protection

Name of Client
Age
Date of Birth
Place of Birth
City Address
Prov’l Address
Sex
Educational Attainment
Parent’s Name / Guardian’s Name

Checklist Requirements
-Medical Certificate
-Police Blotter / Sworn Statement of the victim Barangay Blotter
-Government Issued Identification Card (Parent/s of the minor)
-Any child’s documents/ identification card (school id, birth certificate, baptismal certificate or school records.

C. Adoption Program

Application and undertaking form for Adoptive Applicant/s for Male and Female Applicant

Home Study
Report Date Prepared

Part 1: Information and personal data of applicant/s
Full Name
Age
Date of Birth
Place of Birth
Religion
Nationality/Citizenship
Residence Address
Home Phone Number
Mobile Number
E-mail Address
Civil Status
If married, date and place of marriage
Date of previous marriage, if any, and manner of termination
Educational Attainment
Present Occupation
Monthly Income
Monthly Expenses
Name of Employer/Agency
Business Address
Business Phone Number
Other Income Sources (specify)
Savings
Insurance
Real Properties
Membership in Association/clubs
Hobbies/Interest
Recreational Activities

Household Composition: (Nuclear family and other individuals living with applicant/s in present address)
Name
Relation of Applicants
Date of Birth
Age
Sex
Educational Attainment
Disability/Sickness, Specify
How did you learn about Adoption
Motivation to adopt
Our/My experience in caring for children
Our/My experience of being cared for by/my parents are

Part 2: Character References
Name
Address
Contact No. & Email Address

Part 3: Child Preference Sex & Age of the child (1st to 3rd Preference)
Health condition
Development condition
Physical condition
Child background
Parental background

Part 4: Undertaking / Oath
Name and signature of Applicant
Date Signed

CHILD STUDY REPORT
Date Prepared

I. Identifying Information Name (First, Middle and Last Name. For Child without known parents, indicate the given first and last name and alias, if applicable)
Sex
Date of Birth/Given Date of Birth
Age
Place of Birth/Place Found
Birth Status (Marital/Non-Marital/Child)
Category (Surrendered/Abandoned/Dependent/Neglected/Without Known Parents, Orphan)
Legal Status (with issued CDCLAA / IVC / Judicially declared abandoned)
Health condition (healthy or with special needs, specify)
Date of Admission to the Agency
Date of Placement to Guardian (for FA/IP)
Type of Adoption (Regular, Domestic Relative, Stepparent, Adult, SIBRA, ICA, IP, Foster-Adopt)
Current Whereabouts

II. Sources of Information and Circumstances of Referral

III. Background Information
A. The Child Description of child upon Admission
Medical History of the Child
Developmental History of the Child
Current Functioning of the Child
Description of the Child’s Present Environment

B. The Family back ground

IV. Termination of Parental Rights (facts of Abandonment - for child without known parent)

V. Assessment

VI. Recommendation

Prepared by:

(Signature)
(Name of Social Worker)
(License Number and Validity Date)

Approved by:

(Signature)
Name of Head of Office
D. Foster Care Program

Foster Family Care Application
I. Identifying Data
Name
Age
Sex
Date of Birth
Place of Birth
Civil Status
Religion
Nationality / Citizenship
Residence Address
Home Phone Number
Mobile Number
E-mail Address
Educational Attainment
Present Occupation
Monthly Income
Membership in Association / clubs
Hobbies / interest
Recreational Activities

II. Household Composition: (List of all persons living with the family)
Child Case Study report (Foster Care)
Date prepared

I. Identifying Data
Name
Sex
Date of Birth/Given Date of Birth
Age
Place of Birth/Place Found
Birth Status (Marital/Non-Marital/Child)
Legal Status (with isued CDCLAA / IVC / Judicially declared abandoned)
Health condition (healthy or with special needs, specify)
Date of Admission to the Agency / date of placement to custodians (for Kinship care cases)
Current Whereabouts

II. Sources of Information and Circumstances of Referral

III. Background Information
The Child
Description of child upon Admission
Medical History of the Child
Developmental History of the Child
Current Functioning of the Child
Description of the Child’s Present Environment
The Family back ground

IV. Assessment

V. Recommendation

Prepared by:
(Signature over Printed name)
(Designation)
(PRC License Number)
(Validity)

Reviewed by:
(Signature over Printed name)
(Agency Supervisor)
(PRC License Number)
(Validity)

Approved by
(Signature over Printed name)
(Head of Agency)
(PRC License Number)
(Validity)

E. Issuance of Case Summary for Temporary Custody

I. IDENTIFYING DATA:
Name of Client
Age
Date of Birth
Place of Birth
City Address
Prov’l Address
Civil Status
Sex
Educational Attainment
Occupation
Nature of Need

II. FAMILY COMPOSITION
Name
Age
Sex
Civil Status
Relation to Client
Educational Attainment

III. PROBLEM PRESENTED:
IV. BACKGROUND INFORMATION:

Related documents needed
-Barangay Clearance of Temporary Custodian
-Birth Certificate or Baptismal Certificate of Minor
-Government Issued Identification Card of Temporary Custodian
-Death Certificate (if necessary)
-School Id of Minor or Certificate of Enrolment and Non-Issuance of ID

F. Issuance of Certificate for Local Travel

I. IDENTIFYING DATA:
Name of Client
Age
Date of Birth
Place of Birth
City Address
Prov’l Address
Civil Status
Sex
Educational Attainment
Occupation
Nature of Need

II. FAMILY COMPOSITION
Name
Age
Sex
Civil Status
Relation to Client
Educational Attainment

III. PROBLEM PRESENTED:

IV. BACKGROUND INFORMATION:

Related documents needed
-Barangay Clearance in Mandaluyong of Assisting Person and Parents of Minor (1 original and 1 photocopy)
-Birth Certificate of the Minor (1 original and 1 photocopy)
-Government Issued Identification Card of Assisting Person and Parents of Minor
-Travel Details from the Airlines

G. Pag-Asa Youth Association of The Philippines Inc. (PYAP)

Registration Number
Date
Name
Address
Contact Details
Date of Birth
Age
Sex
Place of Birth
Self Description
Educational background
Family Composition
Name
Age
Date of Birth
Relationship to
Occupation
Membership to other organization
Goals/Aspiration in becoming PYAP
In Case of Emergency
Name
Contact Number
Signature of Applicant

Related documents needed
-Birth Certificate
-Barangay Certificate / Certificate of Indegency
-2x2 ID picture

H. Day Care Services Section

Child’s Profile/Information
Date Completed
Child’s Full Name
Child’s Nickname
Date of birth
Sex
Age
Complexion
Hair color
Hair length
Type color
Height
Weight
Build
Home Address
Parent/Guardian name
(1) Parent Place of Employment
Contact number
(1) Parent Address
Contact number/Home number
(2) Parent Place of Employment
Contact number
(2) Parent Address
Contact number/Home number
Other Distinguishing marks
Blood type
Allergies
Pre-existing condition
Medication
Doctor’s name & contact number
Finger prints of the child

Related documents needed
-Birth Certificate
-Initial Health Record (Baby Book) ECCD Growth Chart
-Parent’s Consent
-Barangay Certificate

2. FAMILY, WOMEN, AND COMMUNITY WELFARE DIVISION

(Issuance of Solo Parent Identification Card, Empowerment and Reaffirmation of Paternal Abilities, Pantawid Pamilya Pilipino Program (4P’s) Livelihood Assistance Through Microenterprise Development Track, Livelihood Assistance through Employment Facilitation Track, Pre-Marriage Counseling & Comprehensive Program for Children, Individuals, Families in Street Situtation)

A. ISSUANCE OF SOLO PARENT IDENTIFICATION CARD
ID No.
Booklet No
Date of Application
For New Applicant
For Renewal

I. Identifying Information
Complete Name
Birthdate
Age
Sex
Civil Status
Birthplace
Educational Attainment
Religion
Occupation/Work:
Monthly Income:
Other Source of Income:
Address:
In case of emergency
Contact number
Client Category
-Pantawid Beneficiary
-Person with Disability
-Senior Citizen
-LGBTQIA+

III. Family Composition
Name
Relation to Client
Age
Sex
Educational Attainment
Birth date

IV. Category as Solo Parent
V. Needs and Problems as Solo Parent
VI. Programs and Services availed from DSWD and other agencies
VII. Assessment of Social Worker

Home Visited by:
Date:
Signature of the client

VIII. Remarks

B. EMPOWERMENT AND REAFFIRMATION OF PATERNAL ABILITIES

Registration Number
Date
Name
Address
Contact Details
Date of Birth
Age
Sex
Place of Birth
Self Description
Educational background
Family Composition
Name
Age
Date of Birth
Relationship to
Occupation
Membership to other organization
Goals/Aspiration

In Case of Emergency
Name Contact Number
Signature of Applicant

Related documents needed
-Birth Certificate
-Barangay Certificate / Certificate of Indegency
-1x1 ID picture

C. PANTAWID PAMILYA PILIPINO PROGRAM (4P’S)
I. IDENTIFYING DATA:
Name of Client
Age
Date of Birth
Place of Birth
Contact Details
City Address
Prov’l Address
Civil Status
Sex
Educational Attainment
Occupation
Nature of Need

II. FAMILY COMPOSITION
Name
Age
Sex
Civil Status
Relation to Client
Educational Attainment

III. PROBLEM PRESENTED
IV. BACKGROUND INFORMATION
V. ASSESSMENT / RECOMMENDATION

Related documents needed
-Birth Certificate / Baptismal
-Marriage Contract
-Government Issued Identification Card
-Health Record
-School Certification of Enrolment, ID or Form 137
-Barangay Certificate of Residency

D. LIVELIHOOD ASSISTANCE THROUGH MICROENTERPRISE DEVELOPMENT TRACK (A. LIVELIHOOD ASIISTANCE GRANT, B. PARTNERSHIP SUSTAINABLE LIVING, C. SEED CAPITAL FUND ) LIVELIHOOD SETTLEMENT GRANT, LIVELIHOOD ASSISTANCE THROUGH EMPLOYMENT FACILITATION TRACK ISSUANCE OF CASE STUDY FOR LIVELIHOOD ASSISTANCE

I. IDENTIFYING DATA:
Name of Client
Age
Date of Birth
Place of Birth
Contact Details
City Address
Prov’l Address
Civil Status
Sex
Educational Attainment
Occupation
Nature of Need

II. FAMILY COMPOSITION
Name
Age
Sex
Civil Status
Relation to Client
Educational Attainment

III. PROBLEM PRESENTED
IV. BACKGROUND INFORMATION
V. ASSESSMENT / RECOMMENDATION

Related documents needed
-Letter address to the City Mayor or CSWD Officer in Charge
-Government Issued Identification Card
-Barangay Identification Card

E. PRE-MARRIAGE COUNSELING
Name of Client
Age
Date of Birth
Place of Birth
Contact Details
City Address
Prov’l Address
Civil Status
Sex
Educational Attainment
Occupation
Name of Parents

Related documents needed -Referral slip from City Registrar Department

F. COMPREHENSIVE PROGRAM FOR CHILDREN, INDIVIDUALS, FAMILIES IN STREET SITUATION

IDENTIFYING DATA:
Name of Client
Age
Date of Birth
Place of Birth
Contact Details
City Address
Prov’l Address
Civil Status
Sex
Educational Attainment
Occupation
Nature of Need

VI. FAMILY COMPOSITION
Name
Age
Sex
Civil Status
Relation to Client
Educational Attainment

VII. PROBLEM PRESENTED
VIII. BACKGROUND INFORMATION
IX. ASSESSMENT / RECOMMENDATION

Related documents needed
-Endorsement letter from referring party
-Medical certificate
-Antigen Test
-Barangay Blotter/Police Blotter
-Birth Certificate of minor
-Valid Id of family member

3. CENTER CARE SERVICES DIVISION
(BAHAY PAG-ASA YOUTH DEVELOPMENT CENTER, BAHAY TULUYAN CENTER, LINGAP KABATAAN CENTER, MANDALUYONG CITY PROTECTION FOR CHILDREN, WOMEN, AND LGBTQIA+ CENTER)