National Service Training Program – Civic Welfare Training Service
Community Profiling Form
I. Basic Information
Name of Respondent : _____________________________
Age : _____________________________
Citizenship : _____________________________
Civil Status : _____________________________
Ethnicity : _____________________________
Religion : _____________________________
Complete Address : _____________________________
Contact No./s : _____________________________
Highest Educational Attainment : ______________________
Occupation/Source of Income : ________________________
Est. Monthly Income : _____________________________
Family type: Living Arrangement:
1 Nuclear 1 Owned
2 Extended 2 Rented (unsubsidized)
No. of persons living in the house: ______ 3 Rented (subsidized)
4 Living with parents and/or relatives
5 Others _____________
II. Household Members
Name Age Sex Birthdate Highest Occupation Est. Relationship
Educ. Income to HH
Attainment
III. Status of Lifelines
Sector Guide Questions Answers
Power Is the House fully energized?
What is the source of
energy?
What are existing appliances in
the house?
Water Is there potable drinking
water?
What is the source of
potable water? (Level 1, 2 or 3)
If Level 2 or 3, how far is it
from the house?
Sanitation Is there a latrine inside the
house? If it’s outside how far is it
from the house?
What is the type of latrine?
(Bowl or Squat plate)
What is the type of septic tank
used? (Closed pit or
reinforced concrete
chambers)
How does the family manage
solid wastes?
Health What are the common
illnesses experienced by the
family?
House What material is the house
structure made of? (Full Concrete, Semi-
and Concrete or
Partitions Indigenous materials?
How many rooms are there? Are
there any spaces
available for long term
guests?
IV. Community Description/Information
Describe the Community: (Community Name, Community Background/History, Geographic
Information)
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Sector Guide Questions Answers
Sources of Where do they get information on
Information national and local events? What are
the sources of information available
in the community? What modes of
communication are available in the
community? What type of
information do they get?
Education Are there schools in the
Facilities community? What level are these
schools catering for? (List the
names of the schools present in
the community)
Are all school-age children in
school?
Health Where do they get health
Facilities services? How far is the service
provider from the community?
Socio What is the main livelihood of the
Economic people in the community? Other
sources of income? Are there crops,
products and others sold or
produced by the community?
Socio What are the cultural groups of the
Cultural residents of the
community? Common Dialect
used? What are the Peculiar
Cultural Characteristic of the
community?
Environment What is the state of the
environment in the
community? Are wastes
disposed of accordingly?
Describe the conditions.
Peace and Is the house located on a
Order relatively peaceful
environment?
What are common disputes if
there are any?
Where is the nearest Police
Station or Armed Forces
detachment?
Who are the identified
mediators in the Community
Political How is the political
Information atmosphere in the
community? Are the
members of the community
well informed? Give a brief
description of the political
climate in the community.
Existing What are the existing
Organizations organizations present in the
community? Who are their
leaders?
Record of What program/projects have
Past been (or are being)
Interventions implemented in the
community?
Who are the implementers?
What was its perceived level of
success?
V. Pressing Problems and Perceived needs of the Community
1. What common problems/pressing issues currently found in the community?
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2. Based on the identified problems/issues. What are the perceived needs of the
community? In addition, what are the possible interventions?
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VI. Brief Assessment and Recommendation
Name of Data Gatherer : ________________________
Date : ________________________