Republic of the Philippines

Department of Education

FORM R.1 Professional Development Program/Course Recognition Application Form

INSTRUCTIONS: Input the necessary details. Indicate N/A if not applicable. DO NOT ABBREVIATE.

LEARNING SERVICE PROVIDER PROFILE

Learning Service Provider (Name of School)
Complete Office Address (Address of School)
Contact Person (Name of School Head) Mobile No.
Telephone No. (of either the school/school head) Email Address (of either the school/school head)
NEAP Authorization Number N/A
National Educators Academy of the Philippines

Version April 2021 Page 1

PROGRAM PROFILE
You will need to complete the following components to describe the program you would like to be recognized.
1
Title
2
Rationale
100-150 minimum words

Terminal Objective:
By the end of the program, participants will be able to:
3
Program Description

Enabling Objectives: (are the specific objectives that support the Terminal Objective/s)

4
Professional Development (State the DepEd Professional Development Priorities this program covered or DM 50 s. 2020 and/or other
Priorities emerging needs of the teachers/school.)
6
(Please specify your participants based on their career stage, subject PRC Program (For Non-DepEd
5
Target Participant area, grade level, etc.) Accreditation LSPs)
No.
Identify the delivery platform From Start Date to End Date
7 8
Modality here. (e.g. Indicative Date of Implementation
in-person/virtual/blended)

LIST OF TOPICS

9 10 11 12 13
Course Title Professional Standards Covered Schedule Modality
1 Type here. (PPST with specific domain/s and strand/s, From Start Date to Choose an item.
indicator/s) End Date
2 Type here. (PPST with specific domain/s and strand/s, From Start Date to Choose an item.
indicator/s) End Date
3 Type here. (PPST with specific domain/s and strand/s, From Start Date to Choose an item.
indicator/s) End Date
Add more rows to add courses.

Professional Development Programs/Courses Recognition Application Form Page 2

ACTIVITY DESIGN
Provide a detailed description of each of the topics.
14
Activity Title Type the Activity Title here.
15
Course Description Provide a brief description of the activity.
22
18 20 Resource
16 17 Session 19 Assessment 21
Duration Topic Methodology Outputs Person/ Learning
Objectives Strategies
Facilitator
1 State the Describe its Explain, in detail, the professional Explain how Describe what Identify the
duration topic (focus, development activities including the learning the expected Resource Person/
of each content, and the learning resources that outcomes will teachers’ Learning
topic key learning teachers will engage in, clearly be assessed; if outputs are to Facilitator
(e.g. 90 points or what describing how the presenter will possible, achieve responsible for
minutes) teachers will be facilitate each session and how attach an learning this session.
learning about). the participants will engage with assessment outcomes.
the content and meet the tool.
domain/s, strand/s and
indicator/,s in the selected
Professional Standards.
2 Type here. Type here. Type here. Type here. Type here. Type here. Type here.
3 Type here. Type here. Type here. Type here. Type here. Type here. Type here.
4 Type here. Type here. Type here. Type here. Type here. Type here. Type here.
5 Type here. Type here. Type here. Type here. Type here. Type here. Type here.

Add more rows to add sessions.

Declaration:

I hereby declare the information provided in this application is true and correct and there have been no misleading statements,
omission of any relevant facts nor any misinterpretation made.

I agree that the DepEd-National Educators Academy of the Philippines to be the co-owner of all the data gathered and the
copyright of any publication of the use of these data.

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Sign off by the Program/Course Manager or its equivalent
Program Manager Type here
Signature
Date Click here to enter a date.
This Form R.1 is not valid if not signed.

Required Attached Documents:

Detailed Course Design
Sample Learning Resources (Modules, Worksheets, etc.)
Sample Session Guides
Sample Assessment Tools
CVs of Primary, Secondary, or Alternate Resource Persons
Budget Estimate Form

Professional Development Programs/Courses Recognition Application Form Page 4