ACTION RESEARCH PROPOSAL EVALUATION FORM

(As contained in DepEd Order No. 16, s. 2017)

TITLE: TGSIK PA MORE

NAME OF PROPONENT/S: ______________________________________________________

_____________________________________________________________________

MAIN CRITERIA SUB-CRITERIA % SCORE REMARKS

Context
Rationale of the 15
Action Research
Proposed Intervention,
(30 points) 15
Innovation, Strategy
Action Research Minimum of 1 research
30
Questions question, maximum of 3
(30 points) research questions
Participants and/or other
Sources of Data and 10
Action Research
Information
Methods
Data Gathering
(30 points) 10
Method/s
Data Analysis Plan 10
Action Research Includes Interventions,
Work Plan and Innovations & strategies
5
Timelines
(5 points)
Cost Estimates Includes specific items
5
(5 points) and expenses
TOTAL SCORE 100%
Evaluation Result: (Check 1 only)
Approved Evaluated by:
Disapproved
Conditionally Approved Signature: ________________________________
Need some revision on: Printed Name: ____________________________
__________________ Date Evaluated: ___________________________
__________________
__________________
 BASIC RESEARCH PROPOSAL EVALUATION FORM
(As contained in DepEd Order No. 16, s. 2017)

TITLE: _____________________________________________________________________
_____________________________________________________________________

NAME OF PROPONENT/S: ______________________________________________________

_____________________________________________________________________
_____________________________________________________________________

MAIN CRITERIA SUB-CRITERIA % SCORE REMARKS

The nature, extent o&
salience of the research
topic are
comprehensively
Rationale of the
discussed, showing in
Basic Research
depth & critical analysis 10
(10 points)
of the situation. Policy
implications, benefits &
limitations of the study
are stated
Research -Research questions
Questions logically proceed from
(20 points) the context of the study.
-Questions are
formulated to clearly 20
show the extent &
different angles of
inquiry.
- maximum of 3 research
questions
 -Viewpoints & issues
underlying the research
are discussed &
synthesized & critically
Use of related
evaluated to identify the
Literature &
inconsistencies. 10
Proper Citation
-Constructs are defined
(10 points)
& presented in a
conceptual framework.
-Citation of literature
sources is consistent
Participant and/or other
sources of data and 10
Research information
Methods Data Gathering
(40 points) Method(s) and Research 20
Instruments
Data Analysis Plan 10
Basic Research -Provided detailed work
Work Plan and plan covering start to
Timelines completion.
(10 points) -Timelines are realistic
-Overall plan reflects the 10
capacity to concretize
ideas into clear and
sequential steps to
undertaken
Cost Estimates Includes specific items
10
(10 points) and expenses
TOTAL SCORE 100%

Evaluation Result: (Check 1 only)

Evaluated by:
Approved
Disapproved
Conditionally Approved Signature: ________________________________
Need some revision on: Printed Name: ____________________________
__________________ Date Evaluated: ___________________________
__________________
__________________
 Annex 1

RESEARCH PROPOSAL APPLICATION FORM & ENDORSEMENT

A. RESEARCH INFORMATION
RESEARCH TITLE: “TIGSIK PA MORE” IMPROVES READING SKILLS OF GRADE ONE PUPILS

SHORT DESCRIPTION OF RESEARCH:

This research will be conducted to grade One pupils of Datag Central Elementary School

RESEARCH CATEGORY (Check only one) RESEARCH AGENDA CATEGORY (Check only one
National main research theme)
Region Teaching & Learning
School Division
Child Protection
District
School Human Resource Development
Governance
(Check only one) (check up to one cross-cutting theme, if applicable)
Action Research DRRM
Basic Research Gender and Development
Inclusive Education
Others (please specify): __________________
_____________________________________
FUND SOURCE (e.g. BERF, SEF, others) * AMOUNT

TOTAL AMOUNT
*indicate also if proponent will use personal funds

B. PROPONENT INFORMATION
LEAD PROPONENT/INDIVIDUAL PROPONENT
LAST NAME: FIRST NAME: MIDDLE NAME:

BIRTHDAY (MM/DD/YYYY) SEX: POSITION/DESIGNATION:

REGION/DIVISION/SCHOOL
CONTACT NUMBER 1: CONTACT NUMBER 2: EMAIL ADDRESS:

EDUCATION ATTAINMENT TITLE OF THESIS/RELATED RESEARCH PROJECT

(Degree Title)
Enumerate from bachelor’s
Degree up to doctorate degree

SIGNATURE OF PROPONENT:

PROPONENT 2
LAST NAME: FIRST NAME: MIDDLE NAME:

BIRTHDAY (MM/DD/YYYY) SEX: POSITION/DESIGNATION:

REGION/DIVISION/SCHOOL

CONTACT NUMBER 1: CONTACT NUMBER 2: EMAIL ADDRESS:

EDUCATION ATTAINMENT TITLE OF THESIS/RELATED RESEARCH PROJECT

(Degree Title)
Enumerate from bachelor’s
Degree up to doctorate degree

SIGNATURE OF PROPONENT:

PROPONENT 3
LAST NAME: FIRST NAME: MIDDLE NAME:

BIRTHDAY (MM/DD/YYYY) SEX: POSITION/DESIGNATION:

REGION/DIVISION/SCHOOL

CONTACT NUMBER 1: CONTACT NUMBER 2: EMAIL ADDRESS:

EDUCATION ATTAINMENT TITLE OF THESIS/RELATED RESEARCH PROJECT

(Degree Title)
Enumerate from bachelor’s
Degree up to doctorate degree

SIGNATURE OF PROPONENT:
 IMMEDIATE SUPERVISOR’S CONFORME

I hereby endorse the attached research proposal. I certify that the proponent/s has/have the
capacity to implement a research study without compromising his/her office functions.

_____________________________________
Name and Signature of Immediate Supervisor
Position/Designation: ___________________
Date: ______________________

Name and Signature of Immediate Supervisor

Position/Designation: ___________________
Date: ______________________

Name and Signature of Immediate Supervisor

Position/Designation: ___________________
Date: ______________________
 Annex 3

DECLARATION OF ANTI-PLAGIARISM

1. I, _____________________________________, understand that Plagiarism is the act

of taking and using another’s ideas and works and passing them off as one’s own. This
includes explicitly copying the whole work of another person and/or using some parts
of their work without proper acknowledgement and referencing.

2. I hereby attest to the originality of this research proposal and has cited properly all the
references used. I further commit that all deliverables and the final research study
emanating from this proposal shall be of original content. I shall use appropriate
citations in referencing other works from various sources.

3. I understand that violation from this declaration and commitment shall be subject to
consequences and shall be dealt with accordingly by the Department of Education and
___________________ (insert grant mechanism).

PROPONENT: __________________________
SIGNATURE: __________________________
DATE: __________________________

PROPONENT: __________________________
SIGNATURE: __________________________
DATE: __________________________

PROPONENT: __________________________
SIGNATURE: __________________________
DATE: __________________________
 Annex 3

DECLARATION OF ABSENCE OF CONFLICT OF INTEREST

1. I, _____________________________________, understand that conflict of interest

refers to the situations in which financial or other personal considerations may
compromise my judgement in evaluating, conducting or reporting research.1

2. I hereby declare that I do not have any personal conflict of interest that may arise from
my application and submission of my research proposal. I understand that my research
proposal may be returned to me if found out that there is conflict of interest during the
initial screening as per DepEd Order No. 16, s. 2017.

3. Further, in case of any form of conflict of interest, (possible or actual) which may
inadvertently emerge during the conduct of my research, I will duly report it to the
research committee for immediate action.

4. I understand that I may be held accountable by the Department of Education and

_________________________ (insert grant mechanism) for any conflict of interest
which I have intentionally concealed.

PROPONENT: __________________________
SIGNATURE: __________________________
DATE: __________________________

PROPONENT: __________________________
SIGNATURE: __________________________
DATE: __________________________

PROPONENT: __________________________
SIGNATURE: __________________________
DATE: __________________________
 Annex 5.A

LETTER OF APPROVAL

____________________
Date

Mr./Ms. _______________________________
______________________________________
______________________________________

Dear Mr./Ms. ___________________________:

Greetings!

This refers to the research proposal you submitted to the ________________________

for possible funding under _________________________.

The Research Committee has carefully evaluated the final research proposal entitled
______________________________________________________________________
based on the criteria prescribed in the Research Management Guidelines and we are
pleased to inform you that the said research proposal was approved for
implementation.

In this regard, may we invite you to the ______________________________________

on ________________________________ for an orientation regarding the
implementation of your research proposal. Further, this will also be a venue for the
signing of the Memorandum of Agreement (MOA) which will contain the details of
your engagement.

For clarifications and any concerns, kindly contact

______________________________________________________________________.

We look forward to the successful implementation of your research. Thank you very
much.

Very truly yours,

_____________________________
Chairman, Research Committee
 Annex 5.A

LETTER OF APPROVAL

____________________
Date

Mr./Ms. _______________________________
______________________________________
______________________________________

Dear Mr./Ms. ___________________________:

Greetings!

This refers to the research proposal you submitted to the ________________________

for possible funding under _________________________.

The Research Committee has carefully evaluated the final research proposal entitled
______________________________________________________________________
based on the criteria prescribed in the Research Management Guidelines and we are
pleased to inform you that the said research proposal was approved for implementation.

In this regard, may we invite you to the ______________________________________

on ________________________________ for an orientation regarding the
implementation of your research proposal. Further, this will also be a venue for the
signing of the Memorandum of Agreement (MOA) which will contain the details of your
engagement.

For clarifications and any concerns, kindly contact

______________________________________________________________________.

We look forward to the successful implementation of your research. Thank you very
much.

Very truly yours,

_____________________________
Chairman, Research Committee
 _____________________
Date

APPROVAL SHEET

This research proposal entitled _________________________________________,

had been reviewed and passed the quality assurance process taken by the School Division

Research Committee (SRDC) team. In this regard, please complete your Action/Basic

Research following the attached template.

MA. LUISA T. DELA ROSA

Assistant Schools Division Superintendent
Chairman

JOSEFA V. ZAFE MIGUEL C. OGALINOLA

Chief, Curriculum Implementation Division Chief, Sch. Governance and Operation Division
Co-Chairman Co-Chairman

RAQUEL L. PAHUYO ________________________

Senior Education Program Specialist Area Supervisor
Member Member
 LETTER OF APPROVAL

____________________
Date
Mr./Ms. ___________________________
__________________________________
__________________________________

Dear Mr./Ms._______________________

Greetings!

This refers to the Research Proposal you submitted to the School Division Research
Committee. The Research Committee has carefully evaluated the final research proposal
entitled__________________________________________________________________
________________________________________________________________________
based on the criteria prescribed in the Research Management Guidelines and we are pleased
to inform you that the said research proposal was approved for implementation.
In this regard, may we invite you to the Office of the Asst. Schools Division
Superintendent, SDRC Chairman on _______________________ for an orientation
regarding the implementation of your research proposal. For clarifications and any
concerns, kindly contact any of the SDRC Secretariat members at the SDO-SGOD:
NAME CELL NO.

Ms. Mary Jean S. Romero 09988653521

Ms. Raquel L. Pahuyo 09289572295

We look forward to the successful implementation of your research. Thank you

very much!

Very truly yours,

MA. LUISA T. DELA ROSA

Assistant Schools Division Superintendent
Chairman
 LETTER OF DISAPPROVAL

____________________
Date

Mr./Ms. _______________________
______________________________
______________________________

Dear Mr./Ms. ___________________:

Greetings!

This refers to the Research Proposal you submitted to the School Division Research
Committee. The Research Committee has carefully evaluated the final research proposal
entitled_____________________________________________________________________
_____________________________________________________________________based
on the criteria prescribed in the Research Management Guidelines. We regret to inform you
that the said research proposal did not pass the evaluation due to the following reasons:
___________________________________________________________________________
__________________________________________________________________________

We thank you for your interest in submitting your proposal. Kindly take note that you
can still resubmit your research proposal once all the comments and recommendations are
incorporated.

For clarifications and any concerns, kindly contact any of the SDRC Secretariat
members at the SDO-SGOD:
NAME CELL NO.

Ms. Mary Jean S. Romero 09988653521

Ms. Raquel L. Pahuyo 09289572295

We look forward to future collaborations with you. Thank you very much!

Very truly yours,

MA. LUISA T. DELA ROSA

Assistant Schools Division Superintendent
Chairman
ANNEX 2: MINIMUM REQUIREMENTS OF THE RESEARCH PROPOSAL

A. BASIC RESEARCH PROPOSAL TEMPLATE

I. Introduction and Rationale

II. Literature Review
III. Research Questions
IV. Scope and Limitation
V. Research Methodology
a. Sampling
b. Data Collection
c. Ethical Issues
d. Plan for Data Analysis
VI. Timetable/Gantt Chart
VII. Cost Estimates
VIII. Plans for Dissemination and Advocacy
IX. References

B. ACTION RESEARCH PROPOSAL TEMPLATE

I. Context and Rationale

II. Action Research Questions
III. Proposed Innovation, Intervention, and Strategy
IV. Action Research Methods
a. Participants and/or other Sources of Data & Information
b. Data Gathering Methods
c. Data analysis Plan
V. Action Research Work Plan and Timelines
VI. Cost Estimates
VII. Plans for Dissemination and Utilization
VIII. References
ANNEX 6: MINIMUM REQUIREMENTS OF COMPLETED RESEARCH REPORT

A. COMPLETED BASIC RESEARCH TEMPLATE

I. Title Page
II. Abstract
III. Acknowledgment
IV. Introduction of the Research
V. Literature Review
VI. Research Question
VII. Scope and Limitation
VIII. Research Methodology
a. Sampling
b. Data collection
IX. Discussion of Results and Recommendations
X. Dissemination and Advocacy Plans
XI. References
XII. Financial Report

B. COMPLETED ACTION RESEARCH TEMPLATE

I. Title Page
II. Abstract
III. Acknowledgment
IV. Context and Rationale
V. Innovation, Intervention, and Strategy
VI. Action Research Questions
VII. Action Research Methods
a. Participants and/or other Sources of Data Information
b. Data Gathering Methods
VIII. Discussion of Results and Reflection
IX. Action Plan
X. References
XI. Financial Report