DDOSC-REC Form 2.

4
Informed Consent/Assent Evaluation Form
Republic of the Philippines April 12, 2018
Davao de Oro State College
RESEARCH ETHICS COMMITTEE

INFORMED CONSENT/ASSENT EVALUATION FORM

Note: Kindly fill all the items with a red asterisk (*)
REC Code 034-01-2023
*Study Protocol Title Differentiated Teaching Strategies in Identifying Multiple Intelligences in
Kindergarten Students
*Researcher/s Baylosis, Jhester D., Bot-oy, Revo Jan C., Villamero, Julito Jr. B.
*Submission Date December 28, 2022

INSTRUCTIONS
*To the Researcher/s:
To the Primary Reviewer/s:
Please indicate in the space provided below whether or not the
specified element is addressed by the Informed Consent/Assent Form
(ICF). To facilitate the evaluation of the assessment point, indicate the
page and paragraph where this information can be found. Further,
those items with RED asterisks shall be indicated in your ICF and that
be checked as YES.
Please evaluate how the elements outlined below have been
appropriately addressed by the Informed Consent/Assent Form (ICF),
as applicable, and by confirming the submitted information and putting
your comments in the space provided under “REVIEWER
COMMENTS.” In your comments, ensure that vulnerability,
recruitment process, and process of obtaining informed consent
are always assessed in the context of the study protocol and the
participant. Finalize your review by indicating your conclusions under
“RECOMMENDED ACTION” and signing in space provided for the
primary reviewer.

To be filled out by the

Investigator/Researcher
ESSENTIAL ELEMENTS Indicate if the Page and REVIEWER COMMENTS
(as applicable to the study) ICF has the paragraph
specified where
element element is
found
YES N/A
1. Statement that the study involves ✓ Page 1/ complied
research* Paragraph 1
2. Statement describing the ✓ Page complied
purpose of the study* 1/Paragraph
2
3. Study-related treatments and ✓ n/a
probability for random
assignment
4. Study procedures including all ✓ Page complied
invasive procedures* 1/Paragraph
3
5. Responsibilities of the ✓ Page complied
participant*S 2/Paragraph
2
6. Expected duration of ✓ Page complied
participation in the study* 2/Paragraph
1
7. Approximate number of ✓ Page complied
participants in the study* 1/Paragraph
3
8. Study aspects that are ✓ n/a
experimental

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 DDOSC-REC Form 2.4
Informed Consent/Assent Evaluation Form
Republic of the Philippines April 12, 2018
Davao de Oro State College
RESEARCH ETHICS COMMITTEE

9. Foreseeable risks to participant Page Complied

nursing infant; including pain, ✓ 2/Paragraph
discomfort, or inconvenience 2
associated with participation
including risks to spouse or
partner; and integrating risks as
detailed in the investigator’s
brochure*
10. Reasonably expected benefits; ✓ Page complied
or absence of direct benefit to 2/Paragraph
participants, as applicable* 3
11. Expected benefits to the √ Page complied
community or to society, or 2/Paragraph
contributions to scientific 3
knowledge*
12. Description of post-study access ✓ N/A Please indicate
to the study product or
intervention that have been
proven safe and effective*
13. Alternative procedures or ✓ N/A n/a
treatment available to participant
14. Compensation or insurance or ✓ N/A n/a
treatment entitlements of the
participant in case of study-
related injury
15. Anticipated payment, if any, to ✓ N/A n/a
the participant in the course of
the study; whether money or
other forms of material goods,
and if so, the kind and amount
16. Compensation (or no plans of ✓ N/A n/a
compensation) for the participant
or the participant’s family or
dependents in case of disability
or death resulting from study-
related injuries
17. Anticipated expenses, if any, to ✓ N/A n/a
the participant in the course of
the study
18. Statement that participation is ✓ Page complied
voluntary, and that participant 2/Paragraph
may withdraw anytime without 5
penalty or loss of benefit to which
the participant is entitled*
19. Statement that the records ✓ Page complied
identifying the participant will be 2/Paragraph
kept confidential and will not be 4
made publicly available, to the
extent permitted by law; and that
the identity of the participant will
remain confidential in the event
the study results are published;
including limitations to the
investigator’s ability to guarantee
confidentiality*
20. Statement that the participant or ✓ Page complied
participant’s legally acceptable 1/Paragraph
representative will be informed in 2
a timely manner if information
becomes available that may be
relevant to willingness of the
participant to continue to
participation

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 DDOSC-REC Form 2.4
Informed Consent/Assent Evaluation Form
Republic of the Philippines April 12, 2018
Davao de Oro State College
RESEARCH ETHICS COMMITTEE

21. Statement describing access of ✓ Page complied

participant to the result of the 2/Paragraph
study* 2
22. Statement describing extent of ✓ N/A Please indicate
participant’s right to access
his/her records (or lack thereof
vis à vis pending request for
approval of non or partial
disclosure)*
23. Foreseeable circumstances and ✓ N/A Please indicate
reasons under which
participation in the study may be
terminated*
24. Sponsor, institutional affiliation of ✓ N/A n/a
the investigators, and nature and
sources of funds
25. Person(s) to contact in the study ✓ Page complied
team for further information 2/Paragraph
regarding the study and whom to 6
contact in the event of study-
related injury*
26. Statement that the DDOSC-REC ✓ Page
(specify) has approved the study, 3/Paragraph complied
and may be reached through the 1
following contact for information
regarding rights of study
participants, including grievances
and complaints:*
Name of DDOSC-REC Chair
Address: Purok 10 Poblacion,
Compostela, Davao de
Oro, Philippines 8803
Email: rec@ddosc.edu.ph
Mobile: 0998-571-7507

27. Comprehensibility of language

used
28. Other comments not addressed Minor grammar review
by items 1-27
RECOMMENDED ACTION:
• APPROVE
• MINOR MODIFICATIONS
• MAJOR MODIFICATIONS
• DISAPPROVE

JUSTIFICATION FOR RECOMMENDED ACTION

Prepared by: Jhester D. Baylosis, Revo Jan C. Bot-oy, Julito B. Villamero jr. (Signature over
Printed Name)

Note by:

_____IVONE CARL PEÑAFLOR_______

Research Adviser (Signature over Printed Name)

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 DDOSC-REC Form 2.4
Informed Consent/Assent Evaluation Form
Republic of the Philippines April 12, 2018
Davao de Oro State College
RESEARCH ETHICS COMMITTEE

Reviewed by:

________________________________________
Reviewer (Signature over printed name)

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