27 OCTOBER 2021

DIVISION MEMORANDUM
No. 479 s. 2021
2021 GAWAD KAMPILAN

To: Assistant Schools Division Superintendents 1352

Division Chiefs and Unit Heads 10-29-21
Education Program Supervisors
Public Schools District Supervisors 11:35
Public Elementary and Secondary School Heads
All Others Concerned

1. Anchored on the Civil Service Commission Program on Awards and Incentives

for Service Excellence (PRAISE) and DepEd Order No. 78, s. 2007, Strengthening the
Program on Awards and Incentives for Service Excellence of the Department of
Education, SDO Rizal will hold its Search for the 2021 GAWAD KAMPILAN from
November to December 2021.

2. This program aims to recognize and reward the exemplary contribution of the
instructional leaders, teachers and non-teaching personnel who have put premium
on delivering quality basic education services amidst the new normal in education
contributing to efficiency, economy, improvement in the processes and operations
which lead to organizational productivity.
3. The awards categories are:
3.1. Individual Category
a) Outstanding Elementary School Teacher (K-Grade 6);
b) Outstanding High School Teacher (Grade 7-12);
c) Outstanding Elementary School Master Teacher (K-Grade 6);
d) Outstanding High School Master Teacher (Grade 7-12);
e) Outstanding SPED Teacher (K-Grade 12);
f) Outstanding Multi-grade Teacher (K-Grade 6);
g) Outstanding ALS Teacher (K-Grade 12);
h) Outstanding School Head – Elementary;
i) Outstanding School Head – Secondary;
j) Outstanding Education Program Supervisor;
k) Outstanding Public Schools District Supervisor;
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l) Outstanding Non-Teaching Personnel Level 1 – SG 1-9;

m) Outstanding Non-Teaching Personnel Level 2 – SG 10-22
(except EPS & PSDS);
n) Outstanding Researcher – Elementary;
o) Outstanding Researcher – High School; and
p) Outstanding Researcher – Non-Teaching Personnel.

3.2. School Category

a) Most Functional BRB4 Implementer (Elementary);

b) Most Functional BRB4 Implementer (JHS/SHS);
c) Best MHPSS Program Implementer (Elementary);
d) Best MHPSS Program Implementer (Secondary);
e) Best Partnership/Community Engagement Program Implementer
(Elementary);
f) Best Partnership/Community Engagement Program Implementer
(Secondary);
g) Best Data Management Program Implementer (Elementary);
h) Best Data Management Program Implementer (Secondary);
i) Best Safety School Program Implementer (Elementary);
j) Best Safety School Program Implementer (Secondary);
k) Best SBM Program Implementer (Elementary);
l) Best SBM Program Implementer (Secondary);
m) Best in Information Advocacy (Elementary);
n) Best in Information Advocacy (Secondary);
o) Most Innovative and Responsive School PPA Implementer
(Elementary);
p) Most Innovative and Responsive School PPA Implementer (Secondary);
q) Best Performing Public Elementary School;
r) Best Performing Public High School; and
s) Best Performing Sub-Office.

4. Schools are highly encouraged to participate in all categories in the Sub-Office

Level Search. The 13 Sub-Offices shall send one official nominee in each award
category.
5. The Top 1 in the Individual Award Category and School Award Category for
Best Performing Public Elementary/Secondary School shall represent SDO Rizal in
the 2021 Gawad Patnugot.
DIVISION MEMORANDUM
No. ________
479 s. 2021

6. Please be guided by the following schedule of activities and specified dates

relative to the said Search.
Activity Date Remarks

Submission of the Nomination folder to Nov. 08-  late documents shall not be
the Division Office 10, 2021 accepted.
 onsite/offsite screening &
Stage 1
shortlisting shall be done;
Screening & Shortlisting Period
November  only the Top 5 qualifiers
 evaluation of the Nomination
11-12 & who reach the 70% cut-off
Write-Up including required
15, score shall proceed to Stage
documents; and
2021 2; and
 shortlisting of nominees based
 qualified nominees shall be
on the set criteria.
notified through email.
 only the Top 3 qualifiers
Stage 2 November
who reach the 80% cut-off
 onsite/offsite validation of 16-19,
score based on the criteria
qualified nominees from Stage 1 2021
will proceed to Stage 3.
 there shall be no more than
Stage 3 November 3 finalist per category; and
 final panel interview of qualified 22-23,  to be notified through a
nominees from Stage 2 2021 memorandum for the final
panel interview.
 list of finalist to be
Preparation, Finalization and PRAISE Nov. 25,
announced through a
Meetings 2021
Memorandum.
 the Top 1 in Individual
Deadline for submission of the Award Category and School
electronic nomination folder to the Dec. 02, Award Category for Best
Regional Office via @ 2021 Performing Public
https://bit.ly/2021GAWADPATNUGOT Elementary/Secondary
School.
Awarding Ceremony Dec. 10,  scheme of awarding to be
2021 determined.
Note: The committees shall strictly follow the scheduled dates.

7. Expenses relative to the conduct of the said activity shall be charged against
local funds while expenses during the awarding ceremony such as trophies,
certificates, tokens, and stage decorations shall be charged against Division funds
subject to the usual accounting and auditing rules and regulations.
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8. A Division Committee on Evaluation and Selection have been created. Prior

to evaluation, the committee is tasked to prepare the stage 2 criteria for the category
assigned to them as per attached list. Deadline for submission of Stage 2 criteria per
category is on November 04, 2021, to be sent to rizal.praise@deped.gov.ph. The
Secretariat shall collect the criteria for consolidation.

9. For further information regarding the Search, you may contact the Secretariat
at rizal.praise@deped.gov.ph.

10. Attached are the Search Guidelines, Checklist of Required Documents and
Nomination Forms.

11. Immediate and wide dissemination of this Memorandum is earnestly desired.

CHERRYLOU D. REPIA, CESO V

Schools Division Superintendent
fcp
DIVISION MEMORANDUM
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479 s. 2021

Enclosure No. 1

GUIDELINES ON THE 2021 GAWAD KAMPILAN

(Adapted from 2021 Gawad Patnugot)

I. SCOPE OF THE PROGRAM

The Division of Rizal Gawad Kampilan is an SDO program on rewards and

recognition anchored on the Civil Service Commission’s Program on Awards and
Incentives for Service Excellence (PRAISE) and adapted from DepEd
CALABARZON’s Gawad Patnugot. The program was designed to honor
outstanding contributions of teaching, non-teaching personnel and schools and
to inspire among them creativity, innovativeness, integrity and excellence in the
delivery of public services. This year’s search shall focus on the exemplary
contributions or innovations of individuals who have gone beyond their call of
duty, created breakthroughs, and become trailblazers in their path amidst a
pandemic. In the same manner to schools in the delivery of their functions in
providing relevant, accessible, liberating and continuous education amidst a
pandemic through their effective and innovative implementation of BE-LCP.

Inclusivity is advocated in SDO Rizal, hence this award is open to all nominees
regardless of age, sex, religion, ethnicity, or any other physical disability. The
nominees include the teaching and non-teaching personnel holding
regular/permanent positions, as well as the public schools within the Division.

II. ELIGIBILITY REQUIREMENTS OF NOMINEES

Nominated teaching, teaching-related, non-teaching personnel, schools and

schools’ division offices shall be evaluated based on their outstanding
contributions or innovations in the delivery of their functions. They must
meet the following qualifications:

A. Individual Category

1. Filipino Citizen, active in the service and have rendered for not less than three
(3) years of continuous government service as of deadline of nomination’s
submission. Nominee’s accomplishments which he/she is being recognized
should also be made within SY 2020-2021 for teachers, school heads and
school personnel and FY 2020 for supervisors and non-teaching personnel in
the SDOs;

2. Must not be on leave at the time of the Search;

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3. Must have obtained at least a Very Satisfactory (VS) performance ratings for
the last two (2) years. For Outstanding School Head, accomplishment shall be
based on the school where they are assigned within SY 2020-2021 prior to the
nomination. In the event that the nominees are transferred to another school
during the Search, they shall be validated in the school where they
implemented their PPAs;

4. Has not been subjected to any form of disciplinary actions;

5. No pending administrative, criminal, and civil case filed;

6. No Notice of Disallowance from COA; and

7. Nominees for Outstanding Teacher and Master Teacher categories must have
a minimum of five (5) teaching loads.

B. School Categories

1. Certification signed by the SDS through the School Monitoring and Evaluation
(SME) Section that the school nominee is at least SBM Level 2 implementer by
the time of the Search. (For Best Performing Elementary and Secondary
Schools only);

2. Certification signed by the Public Schools District Supervisor that the school
nominee has obtained at least Very Satisfactory (VS) performance ratings for
the last two years, SY 2019-2020 and SY 2020-2021;

3. Certification of No Unliquidated Cash Advances and Disallowances for

previous accountabilities as of December 31 of the year prior to nomination to
be secured from the Division Accountant; and

4. In case of existing unliquidated cash advance and disallowance, a certificate

of the status of such financial obligation may be issued by the COA Resident
Auditor, or Financial Officer/Accountant.

III. DISQUALIFICATION

1. Lone Contender in a specific category; and

2. Previous awardees in the same category for the last 3 years.

IV. CRITERIA FOR STAGE 1 EVALUATION

A. Individual Category

Nominees under this category shall be subjected to the Stage 1 Criteria.

The criteria are:
DIVISION MEMORANDUM
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479 s. 2021

1. Performance Rating (IPCRF/OPCRF) – 30 points

MOV: Duly signed IPCRF/OPCRF on the specified year.

To be certified true copy by the Rater, or by the PSDS
as representative of the SDO.

2. Significant Accomplishment/s within the year (SY 2020-2021/

FY 2020) – 60 points
Description of the Contribution/s or Innovation/s done that have
significantly impacted the performance of the learner/ school / school
community/district/schools division or region with relevance to the
current situation. Indicate problems addressed, people/office
benefited, and transactions facilitated. Indicate that the
accomplishments are part of the nominee’s regular
functions/mandated or the product of his/her initiative. Justify why
the accomplishments are considered exemplary or extraordinary.

Scope of Outstanding Contribution or Innovation – 15 points

Discuss the coverage of the contribution or innovation. Scope and
magnitude of how unique and original the contribution or innovation
that has brought significant impact to education. (Certification from the
immediate superior that the contribution or innovation is original and
within the function shall be checked during the Stage 2 validation.)

Beneficiaries – 15 points
Discuss how many have benefited from the contribution or
innovation.

Impact of Contribution/Innovation – 20 points

Percentage of increase of performance of beneficiaries

Reliability of Contribution/Innovation – 10 points

Descriptions, explanations on the reliability of contribution or
innovation. This criterion includes the following indicators:

a) replicability of the innovation or contribution;

b) support contributed by internal and external stakeholders to
the innovation or contribution;
c) knowledge and competence in the implementation of the
innovation or contribution within the KRA;
d) clear and concise purpose of innovation; and
e) responsive to the needs of the stakeholders/beneficiaries.
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479 s. 2021 Page 8 of 22

MOV: Proof of Accomplishments duly filed and labeled by criteria in

an electronic folder. Link to the eFolder as MOVs to be included
in the Nomination write-up.

3. Awards and Membership – 10 points

List or mention major awards/citations received relevant to the

category and active membership in a reputable professional
organization.

MOVs: Electronic documents of Certificates, Memoranda/ Bulletin/

Advisory/Endorsement Letter/ criteria (if available). Only duly
endorsed activity by the DepEd shall be accepted. These documents
shall be filed an electronic folder organized by award. Link to the
eFolder as MOVs to be included in the Nomination Write-up.

B. SCHOOL CATEGORIES

Nominees under these categories shall be subjected to the Stage 1

Criteria. The criteria are:

1. Performance Rating (OPCRF) – 30 points

Duly signed IPCRF/OPCRF – Certified True Copy by the PSDS.

2. Significant Accomplishment/s within the year (FY 2020) –

60 points

Description of the Contribution/s or Innovation/s done that have

significantly impacted the performance of the learner/ school / school
community/district/schools division or region with relevance to the
current situation. Indicate problems addressed, people/office
benefited, and transactions facilitated. Indicate that the
accomplishments are part of the nominee’s regular
functions/mandated or the product of the initiative. Justify why the
accomplishments are considered exemplary or extraordinary.

Scope of Outstanding Contribution or Innovation – 15 points

Discuss the coverage of the contribution or innovation. Scope and

magnitude of how unique and original the contribution or innovation
that has brought significant impact to education. (Certification from the
immediate superior that the contribution or innovation is original and
within the function shall be checked during the Stage 2 validation.)

Beneficiaries – 15 points

Discuss how many have benefited from the contribution or innovation.

DIVISION MEMORANDUM
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479 s. 2021

Impact of Contribution or Innovation – 20 points

Percentage of increase of performance of beneficiaries.

Reliability of Contribution/Innovation – 10 points

Descriptions, explanations on the reliability of contribution or

innovation. This criterion includes the following indicators:

a) replicability of the innovation or contribution;

b) support contributed by internal and external stakeholders to the
innovation or contribution;
c) knowledge and competence in the implementation of the
innovation or contribution within the KRA;
d) clear and concise purpose of innovation; and
e) responsive to the needs of the stakeholders/beneficiaries.

MOV: Proof of Accomplishments duly filed and labeled by criteria in

an electronic folder. Link to the eFolder as MOVs to be included
in the Nomination Write-up.

3. Awards – 10 points

Major awards/citations received in connection to the awards

category.

MOVs: Electronic documents of Certificates, Memoranda/ Bulletin/

Advisory/Endorsement Letter/ criteria (if available). Only duly
endorsed activity by the DepEd shall be accepted. These documents
shall be filed an electronic folder organized by award. Link to the
eFolder as MOVs to be included in the Nomination Write-up.

V. REQUIRED NOMINATION DOCUMENTS

Each nomination requires the submission of one (1) original nomination folder
containing the fully accomplished Gawad Kampilan Nomination Form and other
documentary requirements, and two (2) additional copies of the original
nomination folder. No hard copies of MOVs shall be accepted.

A. Completely filled-out Gawad Kampilan Nomination Form (Maximum of 10

pages including Executive Summary and Nomination Write Up. Last page
certification not included in the number of pages).
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 Gawad Kampilan Nomination Form 1 – Nomination for the

Individual categories.

 Gawad Kampilan Nomination Form 2 – Nomination for the School

categories.

B. Nominee’s updated Form 212 or Personal Data Sheet with passport size
photo with nametag taken during the last six months prior to the nomination
(for Individual Category only).

C. Certification from the Chairperson of the Sub-Office Search Committee that

the nomination has undergone deliberation.

D. Letter from the PSDS endorsing the nomination to the Division PRAISE
Committee.

E. Self-certification of No Pending Administrative, Civil and Criminal (for

Individual Category only).

F. Certification signed by the Public Schools District Supervisor/ and or

immediate Supervisors for SDO-based personnel, that the nominee has
obtained at least Very Satisfactory (VS) performance ratings (IPCRF) for the
last two (2) years for the individual category and Very Satisfactory (VS)
performance rating (OPCR) for the last two (2) years for the school categories.
Copy of the rating forms should be attached to the nomination folder. For
Outstanding Sub-Office, Certification of VS Performance shall be signed by
the CID Chief, based on the OPCRF of the PSDS/s assigned.

G. Copy of the recent CSC appointment (for Individual Category only).

H. Certified True Copy of Updated PRC License signed by the School Head (for
Individual Category only).

I. Certification of No Unliquidated Cash Advances and Disallowances for

previous accountabilities as of December 31 of the year prior to nomination
to be secured by the nominee from the SDO Accounting Office through the
assigned ADAs (For School Heads, Supervisors and Non-teaching Personnel
in the SDO and for school categories)

J. In case of existing unliquidated cash advance and disallowance, a certificate

of the status of such financial obligation may be issued by the COA Resident
Auditor or Division Accountant.
DIVISION MEMORANDUM
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479 s. 2021

K. Self-certification that all documents submitted are true and correct.

Each completely filled up nomination form should be accompanied by a

write-up using the Nomination Write-up form. In no case shall the write up
exceed the maximum allowable ten (10) pages of A4 size bond paper, using
Century Gothic font #11. (The last page certification is not included in the
number of pages)

The nomination form and documentary requirements (A-K) should be placed

in legal size folder (white color). Hard bound and creative covers are
discouraged. Copies of certificates of training, seminars and recognition
should not be included in the nomination folder. ONLY REQUIRED
DOCUMENTS shall be submitted.

VI. WRITE UP OF ACCOMPLISHMENTS

A. The write-up must highlight outstanding accomplishments or exemplary

contributions, or innovations manifested within specified School Year or Fiscal
Year. Presentation of accomplishments or contributions or innovations
manifested should be in order of significance, complete with descriptions,
justifications and should adhere to the following pointers:

 Use specific terms. Define/clarify terms such as “assisted”, “contributed”

or “innovated”;
 State outstanding accomplishments or contributions or innovations of
exemplary performance displayed and impact in brief, factual and in bullet
form; and
 Present impact of the significant accomplishments by responding to the
indicators presented in criterion 2.

B. The following information must be adequately provided:

 For outstanding contributions or innovations, state that the

accomplishments presented are part of the regular duties of the nominee
or if these are his/her own initiative. Cite justifications on why the
contributions or innovations are considered exceptional or extraordinary.

C. Limitation on Nomination

 The nomination write-up should be for a maximum of 10 pages (A4

size bond paper, Century Gothic #11 font) to include the
summary of accomplishments, impact and other information; and

 While there are 16 individual award categories and 19 school

categories under the Search, an employee or official should be
 DIVISION MEMORANDUM
No. ________
479 s. 2021 Page 12 of 22

nominated to only one award category. However, schools may be

nominated more than once.

VII. PROCEDURE FOR NOMINATION

Nomination to the Search may be done by the Public Schools District

Supervisors within SDO Rizal. The following are the steps on how to
nominate outstanding instructional leaders, teaching and non-teaching
employees and schools.

A. For Individual Category Nomination

 Schools are expected to nominate their exemplars, however each

Sub-office shall only have one nominee in every award.

 The Sub-Office Search Committee shall be responsible for

reviewing the nomination write-up and required documents, and
for preparing the nomination folder.

 The District Supervisor shall approve the nomination and shall

issue an endorsement letter to the Division PRAISE committee.

B. For School Nomination

 Sub-offices are expected to nominate their exemplars. Each Sub-

Office shall only have one nominee in every award category.

 The Search Committee shall be responsible for reviewing the

nomination write-up and required documents, and for preparing
the nomination folder.

 The PSDS shall approve the nomination and shall issue an

endorsement letter to the Division PRAISE Committee.

VIII. PROCEDURE FOR SCREENING AND EVALUATION

A. Division Level Screening

SDO Rizal through the Division PRAISE committee shall create a three
member Division Selection Committee on Awards for each award category.

Likewise, the Division Selection Committee shall screen all nominations as

regards completeness and accuracy of documentary requirements. For Stage
1, it shall shortlist qualified nominees (Top 5 Qualifiers per Category) using
the template below:
DIVISION MEMORANDUM
No. ________
479 s. 2021

SUMMARIZED RESULTS of STAGE 1 EVALUATION

INDIVIDUAL/SCHOOL CATEGORY:

SIGNIFICANT ACCOMPLISHMENTS AWARDS TOTAL

PERFORMANCE
NAME OF NOMINEE received POINTS
RANK
(30 points) SCOPE BENEFICIARIES IMPACT RELIABILITY
(10 POINTS)
(15 points) (150 POINTS) (20 POINTS) (10 POINTS)

Stage 1 Qualifiers shall receive an email on the further details of the next
stage of the Search from the Division Selection Committee. Please refer to the
Search Timeline.

IX. GROUNDS FOR DISQUALIFICATION OF NOMINATIONS

A. Non-compliance with the submission of complete documentary requirements

shall render the nominee ineligible for the Search (deadline, size and number
of folders, accuracy and completeness of information required in the
nomination form, maximum number of pages for the accomplishment write-
up, clearances and other required documents). Nomination with incomplete
document shall no longer be processed.

B. Any misrepresentation made in any of the documents submitted shall be a

ground for disqualification and for disciplinary action against the certifying
nominee/authority pursuant to the applicable CSC laws and rules.

X. SUBMISSION OF NOMINATION

Nominations to the 2021 Gawad Kampilan must be submitted on a hard copy to

the Division Office, Attention: PRAISE SECRETARIAT not later than November
10, 2021.

XI. DEFINITION OF TERMS (Based on Regional Memorandum No. 06-21-502)

Beneficiaries. These are learners, teachers, learning leaders, parents, schools,

community stakeholders that receive help or benefits from innovations or
contributions of nominee/s.
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479 s. 2021 Page 14 of 22

Contribution. This refers to the giving or supplying of something that plays a

significant part in making something happen. (reference:https://www.merriam-
webster.com/dictionary/contribution)

Innovation. This refers to something new or to a change made to an existing product,

idea, or field. (reference: https://www.merriam-webster.com/dictionary/innovation)

National Awardee. This refers to a DepEd personnel in DepEd CALABARZON who

is an awardee of a reputable award giving body recognized by the Department of
Education. The said awardee has undergone nomination and screening process in
the SDO or in the Region through the PRAISE Committee.

Teaching Personnel. These include Teacher I for pre-elementary, elementary and

secondary education, alternative learning system, Madrasah, technical-vocational
education and Special Education Teacher I for special education classes. (source:
Deped Order No. 77, s. 2010)
DIVISION MEMORANDUM
No. ________
479 s. 2021

Enclosure No. 2
COMMITTEE ON THE SELECTION AND EVALUATION OF NOMINEES

CATEGORY CHAIRPERSON MEMBERS

Individual Category
1 Outstanding Elementary School Teacher Ma. Cristina Camarse
(K-Grade 6) Benito L. Picones
2 Outstanding High School Teacher Genaro Cequena
(Grade 7-12)
3 Outstanding Elementary School Master Magno Abueme
Teacher (K-Grade 6) Dr. Aileen E.
4 Outstanding High School Master Teacher Vocal Dr. Cecilia D.
(Grade 7-12) Ramirez
Outstanding SPEd Teacher ( K - Grade 12) Grace Ancheta
5 Arceli Tejada
Imelda Asuncion
6 Outstanding Multigrade Teacher Edna Ramos
Dalisay B. Torres
(K - Grade 6) Armando Ponce
Outstanding ALS Teacher (K - Grade 12) Marcial B. Elecho
7 Meliton Berin Jr.
Aniver Vergara
8 Outstanding School Head - Elementary Nicanor Macarulay
Nedia E. Lagustan Judith Clarito
9 Outstanding School Head - Secondary
Ederlinda Isles
Rosemarie C. Blando
Outstanding Education Program Babylyn M.
10
Supervisor Pambid Ferdinand C. Pascual
April Dream Rabago
Outstanding Public Schools District
11 Gloria C. Roque
Supervisor Mellodine A. Antonio

Outstanding Non-Teaching Personnel Janette S. Rivera

12 Rizaldy Cristo
Level 1 – SG 1-9 Teodelyn V. Lucas
Outstanding Non-Teaching Personnel Amelia R. Dean
13 Dahlia S. Certeza
Level 2 – SG 10-22 (Except EPS &PSDS) Jane S. Fuentes
14 Outstanding Researcher - Elementary Melissa C. Garrovillas
Dr. Pitsberg de
15 Outstanding Researcher - Secondary Rosas Dr. Merle B. Lopez
Analiza G. Soriano
Outstanding Researcher - Non-Teaching Karl Erickson
16 Bjorn Jose F.
Personnel Ebora
Francisco III
School Category
1 Most Functional School BRB4 Minerva David
Implementer (Elementary)
Leonisa Awarayan
2 Most Functional School BRB4 Mil F. Ponciano
Dr. Emilia Cayabyab
Implementer (JHS/SHS)
3 Best MHPSS Program Implementer Dr. Georgina John Ildefonso T.
(Elementary) Tubon Reyes Pascual
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479 s. 2021 Page 16 of 22

4 Best MHPSS Program Implementer Rex Marvin S.

(Secondary) Superiano
5 Best Partnership/Community Engagement Engr. Ritchie A.
Program Implementer (Elementary) Lagunda
Jovelyn C.
6 Best Partnership/Community Engagement Jaqueca
Program Implementer (Secondary) Ma Kripper Valmonte

7 Best Data Management Program Roxell Vincent G.

Implementer (Elementary) Remorento
Cristina G. Tia
8 Best Data Management Program Jessica V.
Implementer (Secondary) Panganiban
9 Best Safety School Program Implementer Tirso Arambulo
(Elementary) Paul James San
August M. Diego
Jamora
10 Best Safety School Program Implementer Glenn Albert Fuyoc
(Secondary) Mary Grace L. Danak
11 Best SBM Program Implementer
(Elementary) Rhea A. Tolentino
Emmalyn P.
12 Best SBM Program Implementer Guevarra
Magdalena C. Valdez
(Secondary)
13 Best in Information Advocacy (Elementary) Atty. Rona A. Erbon
Sheila B. Penano
14 Best in Information Advocacy (Secondary) Nico N. Aquino

15 Most Innovative and Responsive PPA Marita L. Gonzales

Implementer (Elem)
Gorgenia Jepa
16 Most Innovative and Responsive PPA Atty. Filipino
Implementer (Sec) Mendoza
Priscilla V. Jose
17 Best Performing Public Elementary School Jeffrey Erni
Fredelito Cabalang
Ramon Patay
18 Best Performing Public Secondary School Melinda Marquez
Grace Adriano
Irish V. Balunton
Marlon S.
19 Best Performing Sub-Office
Marquez Xandra Lee Cervitillo

2021 Gawad Kampilan Secretariat/Documenters

Individual Category School & Special Award Category

Frances Beanne E. Corbilla Ma. Aurora T. Masangkay
Joan Balboa Roxell Vincent Remorento (R&R)
 DIVISION MEMORANDUM
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479 s. 2021

Enclosure No. 3

Gawad Kampilan Nomination Form 1 (Individual Category)

Category:

THE NOMINEE
Name: Signature:
Sex: Place of Birth:
Home Address:
Mobile Number: Civil Status:
School /Office Address:
Sub-Office:
Phone Number: DepEd Email Address:
OFFICE/DIVISION HEAD
Name: Position:
Telephone/Mobile No: Email Address:

NOMINATOR
Name: Position:
Office: Telephone/Mobile No.:
Office Address: Email Address:

ADDITIONAL INFORMATION ABOUT THE NOMINEE

Were you a previous Gawad Kampilan Nominee? Yes No If yes, what
year?________

What award category?________________________________________________________________

Were you a previous Gawad Kampilan Semi-finalist? Yes No If yes, what year?
______

What award category? __________________________________________________________________

Were you a previous Gawad Kampilan Winner? Yes No If yes, what year?
________
What award category __________________________________________________________________
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NOMINATION WRITE-UP
(Maximum of 10 pages, A4 size bond paper, Century Gothic #11 font, including executive summary)

Category:
Name: Current Position:
Length of Service in the Position: Length of Service in Government:
I. Executive Summary - Outstanding Accomplishments (Description of the Contribution/s or
Innovation/s done that have significantly impacted the performance of the learner/ school / school
community/district/schools division or region with relevance to the current situation. Indicate problems addressed,
people/office benefited, and transactions facilitated.)

II. Scope of Outstanding Contribution of Innovation - 15 Points (Discuss the coverage of the
contribution or innovation. Scope and magnitude of how unique and original the contribution or innovation that
has brought significant impact to education.)

III. Beneficiaries - 15 Points (Discuss how many have benefited from the contribution of innovation.)

IV. Impact of Contribution- 20 Points (Percentage of increase of performance of beneficiaries.)

V. Reliability - 10 Points (Descriptions, explanations on the reliability of contribution or innovation. This

criterion includes the following indicators: replicability of the innovation or contribution; support contributed by
internal and external stakeholders to the innovation or contribution; knowledge and competence in the
implementation of the innovation or contribution within the KRA; clear and concise purpose of innovation; and
responsive to the needs of the stakeholders/beneficiaries)

VI. Awards and Membership - 10 Points (Indicate major awards/citations received relevant to the
category and active membership in a reputable professional organization.)
DIVISION MEMORANDUM
No. ________
479 s. 2021

DATA PRIVACY NOTICE: Data and information in this form are intended exclusively for the purpose of this
activity. This will be kept by the process owner for the purpose of verifying and authenticating identity of
the nominee. Serving other purposes not intended by the process owner is a violation of Data Privacy
Act of 2012. Data subjects voluntarily provided these data and information explicitly consenting the
process owner to serve its purpose.

CERTIFICATION

We attest to all facts contained herein and authorize the use of these information
for publication. We understand that the SDO Rizal PRAISE Committee will validate the
accuracy of the information contained in this form and grant our consent to the conduct
of a background investigation. Any misrepresentation made by the signatories shall be a
ground for disciplinary action pursuant to applicable CSC laws and rules.

PRINTED NAME AND SIGNATURE

______________________________________ ______________________________________
Nominee School Head/Immediate Supervisor

______________________________________
PSDS/Chief/ASDS
 DIVISION MEMORANDUM
No. ________
479 s. 2021 Page 20 of 22

Gawad Kampilan Nomination Form 2

Gawad Kampilan Nomination Form 2 (School Category)

Category:

THE NOMINEE
School:
School Address:
Sub-office: Mobile No.:
DepEd Email Address:

SCHOOL/OFFICE HEAD
Name: Position:
Email Address:
Telephone/Mobile No:

NOMINATOR
Name: Position:
Office: Telephone/Mobile No.:
Email Address:
Office Address:

ADDITIONAL INFORMATION ABOUT THE NOMINEE

Was your school a previous Gawad Kampilan Nominee? Yes No If yes, what
year?________. What award category?____________________________________________________

Was your school a previous Gawad Kampilan Semi-finalist Yes No If yes, what
year? ________. What award category? ____________________________________________________

Was your school a previous Gawad Kampilan Winner? Yes No If yes, what year?
__________. What award category? _______________________________________________________
DIVISION MEMORANDUM
No. ________
479 s. 2021

NOMINATION WRITE-UP
(Maximum of 10 pages, A4 size bond paper, Century Gothic #11 font, including
executive summary)

Category:
School: Sub-Office:
I. Executive Summary - Outstanding Accomplishments (Description of the Contribution/s or
Innovation/s done that have significantly impacted the performance of the learner/ school / school
community/district/schools division or region with relevance to the current situation. Indicate problems addressed,
people/office benefited, and transactions facilitated.)

II. Scope of Outstanding Contribution of Innovation - 15 Points (Discuss the coverage of the
contribution or innovation. Scope and magnitude of how unique and original the contribution or innovation that
has brought significant impact to education.)

III. Beneficiaries - 15 Points (Discuss how many have benefited from the contribution of innovation.)

IV. Impact of Contribution - 20 Points (Percentage of increase of performance of beneficiaries.)

V. Reliability - 10 Points (Descriptions, explanations on the reliability of contribution or innovation. This

criterion includes the following indicators: replicability of the innovation or contribution; support contributed by
internal and external stakeholders to the innovation or contribution; knowledge and competence in the
implementation of the innovation or contribution within the KRA; clear and concise purpose of innovation; and
responsive to the needs of the stakeholders/beneficiaries.)

VI. Awards and Membership - 10 Points (Indicate major awards/citations received relevant to the
category and active membership in a reputable professional organization.)
 DIVISION MEMORANDUM
No. ________
479 s. 2021 Page 22 of 22

DATA PRIVACY NOTICE: Data and information in this form are intended exclusively for the purpose of this
activity. This will be kept by the process owner for the purpose of verifying and authenticating identity of
the nominee. Serving other purposes not intended by the process owner is a violation of Data Privacy
Act of 2012. Data subjects voluntarily provided these data and information explicitly consenting the
process owner to serve its purpose.

CERTIFICATION

We attest to all facts contained herein and authorize the use of these
information for publication. We understand that the SDO Rizal PRAISE Committee
will validate the accuracy of the information contained in this form and grant our
consent to the conduct of a background investigation. Any misrepresentation
made by the signatories shall be a ground for disciplinary action pursuant to
applicable CSC laws and rules.

PRINTED NAME AND SIGNATURE

_________________________________ __________________________________
Nominee School Head

______________________________________
Public Schools District Supervisor