Integrated Youth Activity (IYA)

Event organization/Mass awareness (E.g. Edutainment activity) Recording Form

Region Name___________________________________
City/Town/Hub______________________CSO Office_________________________________
Site Coordinator/Focal person_______________________Reporing period (dd/mm/yy)__________________

Number of
Persons reached
Types of the Event: through the
1)Edutainment, Event
2)Mini- Name of
media, 3) Forum Event Organized by Responsible
Date Drama 1:IYA-CSO person/ Signature of the
(DD/MM/YY) 4)Other Theme of the Event Place of the Event M F 2:IYA-Amref organizer organizer
SN
Remark
 Integrated Youth Activity (IYA)
Event organization/Mass awareness (E.g. Edutainment activity) Recording Form
Region Name:- Amhara
City/ Debirbirhan
Site Coordinator/Focal person_____ Muluwork Beyene DD/MM/YY Jan 21 /2022

Number of participants
Number of reached through mass awareness events
No. Type of Event events Male Female Total

Form Completed by;- Muluwork Beyene Form Approved by:__________________________

Date: Jan 21/2022 Date:__________________
 Integrated Youth Activity (IYA)
Skills Training Attendance Sheet
Region Name/Code______________________//_____________
CSO Office_________________________________
Organizer/Reporting person for the event____________________________________Date (dd/mm/yy)_____________________Signature______________________
Training Title/Topic_________________________________________
Name of Training Provider:_______________________________________
Date of Training From______________________ to __________________

S.N Name of Trainee Sex Age Educational status Disability Region Zone Woreda/ Organization/ Position/Title (if Pre-Test Post-Test Telephone E-mail (if any)
(M/F) (comple Educational level status Town Affiliation (if working)
ted 1:Read and write (Y/N) any)
years) 2: Elementary (1-8)
3: Secondary (9-12)
4: College and
above
LEMI
1 M 28
GADISA HIDISA 9th N A.A KURA 9 JOBSEEKR 70/100 90/100 0924899182
2 GIRMA AYELE M 27 10th N A.A " 9 " 50/100 100/100 0930606799
3 TERESA NUGUSA M 26 Degree N A.A " 9 " 40/100 70/100 0919568612
4 SECHALE TASHOME F 26 " N A.A " 9 " 40/100 80/100 0911434478
5 MEAZA HAILU F 23 10th N A.A " 10 " 90/100 100/100 0934497278
6 GENET TRUYE F 28 8th N A.A " 10 Employment 80/100 80/100 0935004524
7 WAKJIRA ALEMU M 27 5th N A.A " 10 " 70/100 100/100 0920310865
8 BIRHANU DIRIBE M 24 DEGREE N A.A " 9 JOBSEEKER 90/100 80/100 0934146819
9 BEKELE ABERE M 27 " N A.A " 9 " 70/100 90/100 0962323585
10 KIBITU DABA F 27 " Y A.A " 9 " 70/100 80/100 0939637142
11 AMANU HASSEN M 29 " N " " 9 " 80/100 100/100 0913347541
12 DERSO ARARSA F 27 " N " " 9 " 70/100 90/100 0910554603
13 EWUNETU TESEMA M 24 12th N " " 9 " 80/100 100/100 0947587673
14 KEBEDE MENGSTU M 26 Degree N " " 13 Employment 90/100 100/100 0929134656
15 ALEMNESH TEGEGNE F 23 7th N " " 1 JOBSEEKER 70/100 100/100 0961669965
16 TIGIST ABEBE F 28 - N " " 10 " 60/100 100/100 0993650507
17 ZEWDE SISAY F 22 10th N " " 13 " 70/100 80/100 0949987632
18 ABERASH SISAY F 21 Degree N " " 13 " 50/100 100/100 0940757702
19 BIRE SIRAJ F 27 " N " " 13 Employment 90/100 100/100 0969180366
20 TADLU ALAMNE M 26 " N " " 13 " 70/100 100/100 0923256389
21 MEKUANINT ANDUALEM M 27 " " " " 13 " 90/100 100/100 0922276059
22 DIRBA ERGSSA M 26 " " " " 9 " 80/100 90/100 0955083646
23 ASFAW REGASA M 26 " " " " 13 JOBSEEKER 90/100 100/100 0962721524
24 EYERUSALM MENGIST F 27 " " " " 10 EMPLOYMENT 80/100 100/100 0901260030
25 YIRBEB AWOKE F 27 " " " " 10 JOBSEEKER 80/100 100/100 0936807406
26 DEREGE SERTEO M 27 2th " " " 13 " 100/100 0912029514
27 TESHOME TADESSE M 27 Degree " " " 10 " 90/100 100/100 0925756944
28 ALMETSHY ABERA F 22 10th " " " 13 " 50/100 90/100 0980221087

SUBCITY LEMI KURA WOREDA 13

Completed by :- Betelhem Approved by :-

Approved by :-
Completed by :- Betelhem
 Integrated Youth Activity (IYA)
Training Summary Reporting Form
Region City/Town/Hub
CSO Office:
Reporting Period (dd/mm/yy)

Training Dates Tota

SN Training Topic
Duration of
Training in Training Name of Training Male
Begin End Hours Objective in brief Provider 15-19 20-24 25-29 >29 Total 15-19

0
0

0
1 All participants should be dissaggregated by sex and their age group from the training register book. 2. Participants with disability are sub-set of the total trainees.
Form Completed by:______________________________ Form Approved by:___________________________________
Date:__________________ Date:__________________
Total number of participants (Sex and Age group)1

Female Total Participants with disability2 Remark

20-24 25-29 >29 Total 15-19 20-24 25-29 >29 Total M F T

0 0 0
0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0
 Integrated Youth Activity (IYA)
Peer Education/Volunteers Training Profile
CSO Office_________________________________
Region_________________________ City/Town/Hub ____________________________________
Name of Regional Workplace Coordinator_______________________________
Reporing period From_____________ To ___________ Reporting Date (dd/mm/yy): _______________________
Date of the training (dd/mm/yy):From _______________________ To (dd/mm/yy): _______________________
Name of Training Provider:_______________________________________

S.N Name of Trainee Sex Age Educational level Region Zone Woreda/ Work status Name of Position/Title Telephone Pre-Test Post-test Remark
}.l 1:Read and write Town Organization if
2: Elementary (1-8) 01=Employee working
3: Secondary (9- 02=Surrounding
12) Community
4: College and 03=Other
above marginalized groups

Form Completed by: Form Approved by:__________________________

Date:__________________ Date:__________________
 Integrated Yoth Activity (IYA)
Workshop/Meeting Summary Recording
Region Name______________________City/Town/Sub-city_____________
CSO Office_________________________________
Reporing period (dd/mm/yy)__________________
Workshop organized for a)IYA staff members; b)CSO staff; c) Government staff; d) Youth coalition members; e) Others; f) Combined groups
Summary of workshops, seminars, meetings, etc
Duration of Workshop/Meeting From________To________________
Purpose/ Topic of the workshop/Meeting_______________________________________
Organizing Agency____________________________________
Place of the workshop______________________________
S.N Workshop/Meeting Attendants Sex (M/F) Name of Position Contact information
Organization/Affiliation

e-mail Telephone
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Signature
 Employement Tracking Form
Region______________________City/Town/Hub_______
CSO Office_________________________________
Reporting Period (Month and Year) ___________________________
Report submitted in (dd/mm/yy) ____________________________

Unique
S/No. Beneficiary Name of emplyee Sex Age Education Name of Employer
ID (UBI)
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Form Completed Form Approved

by:______________________________
Date:__________________ by:___________________________________
Date:__________________
 Employment Employment start Employement type
Position Woreda Kebele date (Permanent/Tempor
ary)

___________________