BARANGAY INTAKE FORM

4Ps assessment request

This locally designed form is not an official DOLE or DSWD form. Staff will review your request.

Change program · Fields marked * are required.

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1. Tell us about yourself First name(s) * Middle name (optional) Last name * Date of birth * Complete address *Include your house or street, barangay, city or municipality, and province.

2. Your household

Help staff prepare your assessment or referral to DSWD. This is not enrollment.

How many people live in your household? *Include yourself in the total. How many household members are aged 0–18? * Is there a pregnant household member? * Is your household currently in 4Ps? * Civil status * Approximate monthly household income in pesos (optional) Do you have documents ready for staff to check? * Accessibility or application assistance needed (optional) School attendance or school-related concerns (optional) Main household source of income * Has a DSWD worker contacted your household? *

3. Documents and updates Email for your account *

We will email your application ID and username to this address.

Email verification code (OTP) *

Select Get OTP to receive a code by email. Enter it here before submitting your application. The code expires in 10 minutes.

Your username and temporary password will appear on your receipt and in your confirmation email. Sign in within 24 hours and change the temporary password before opening your profile.

Upload clear JPG or PNG photos for staff review. Up to 5 MB per photo, 8 photos and 20 MB per submission. PDFs, HEIC, GIF and other file types are not accepted. Uploading does not confirm residency or eligibility.

4Ps document photos

Include all four corners and make sure every word is readable. Photograph both sides if needed. For multiple pages or household members, select several photos in the appropriate category. Leave requirements that do not apply blank.

PhilSys ID or proof of registration; confirm current acceptance with DSWDBirth certificates of household membersSchool records, when applicableHealth or pregnancy records, when applicableMarriage, death, or disability records, when applicable

You can add more photos later through My Profile, up to 40 per application. Each photo may be up to 8 megapixels and 6,000 pixels on either side; the server may ask for a smaller image if memory is limited.

Only you and authorized staff can access the stored copies. Photos are recreated as JPG files before saving; transparency becomes white. Check text clarity and orientation in the saved copy. If the form shows an error, select your photos again. Ask the help desk if you only have a PDF.

Preferred method Email or mobile number (if selected)

Your registration confirmation is sent to your account email. SMS notifications are not available.

4. Review and send

Read the privacy notice

Check your answers. After saving, keep your application reference number for follow-up.

I have read the privacy notice and confirm that the information I have provided is accurate to the best of my knowledge. *

Already applied to this program? Sign in to My Profile to check your existing application before applying again. Need help?