Republic of the Philippines

Department of Education
CARAGA REGION
DIVISION OF AGUSAN DEL SUR
(NAME OF DISTRICT FOR DISTRICT L&D AND SCHOOL FOR SCHOOL LEVEL L&D)

LEARNING AND DEVELOPMENT ACTIVITY PROPOSAL

Level: Division District School

A. Information about the Applicant/Proponent

Name of Applicant/Proponent:
Position/Functional Division:

B. Profile of the Program or Course

Title of the Program or Course:

Rationale:

Program or Course Description:

Professional Development Priorities (Please refer to DepEd Memo No. 50, s. 2020 and Div. Memo
No. 194, s. 2020 for the List of PD Priorities, Needs Assessment Results, School/District Plan for
Professional Development, Office Learning Plan (for Non-Teaching Personnel)

Professional Standards Covered (PPST, PPSSH, or PPSS domain/s, strand/s, indicator/s)

Target Participant Profile (Career Stage, Grade Level, Learning Area, PQF Level, Sex)

Number of Hours (face to face instruction and/or online learning, and classroom application (if
applicable)
List of Resource Persons/ Learning Facilitators supported by Curriculum Vitaes

D.O. Plaza Government Center, Patin-ay, Prosperidad, Agusan del Sur

depedagusandelsur@deped.gov.ph
(085) 839-5456
Modality (Formal Learning, possibly with Job-Embedded Learning (JEL), Learning Action Cell (LAC),
relationship and discussion-based learning, among other modalities)

Delivery Platform (Online, face-to-face, blended delivery)

Indicative date of Implementation

Professional Regulation Commission (PRC) Program Accreditation No. ( if applicable)

C. Program or Course Design

Objective/s or Outcome/s
General Objective:
Specific Objectives:

Detailed Program or Course Matrix (Attach Instructional Design, please see attached format)

Modules or Learning Resources to be Used

Assessment Plan

D. Program or Course Implementation Plan

Schedule of Activities (pls. insert Specific Course Objectives/Program of Activities)

Budget Requirements

Item Description Unit Cost Quantity Unit Total Cost

ESTIMATED TOTAL BUDGETARY REQUIREMENT

Per Total Cost of Activity, the estimated cost of activity per participant is
Php ________________. No registration fee shall be collected from the participant.
Fund Source

D.O. Plaza Government Center, Patin-ay, Prosperidad, Agusan del Sur

depedagusandelsur@deped.gov.ph
(085) 839-5456
Monitoring and Evaluation

Gender and Development Mainstreaming

Minimum Health Standards (MHS)

Prepared by:

_____________________________
Proponent
(Name, Position & Signature of Proponent)
Contact No.: _________________
Date: ________________________

For School Level L&D Activity Signatories:

Prepared by: Proponent (may also be the School Head, if he/she is the actual proponent of the
proposed PD activity)
Funds Available: Bookkeeper
Approved: School Head
Noted by: PSDS/PSDI

For District Level L&D Activity Signatories:

Prepared by: Proponent

Funds Available: School Heads of the Participating Schools
Approved: PSDS/PSDI

For Division Level L&D Activity Signatories (Not applied for NEAP Recognition):

Prepared by: Proponent

Reviewed by: SGOD Chief/CID Chief/AO V (depending on the Functional Division where the
Activity is being lodged, countersigned by the HRD Section)
Funds Available:
ROCHELIEU M. SERRANO KRISHNA PREM M. PATOSA
AOV/Budget Officer Accountant III
Recommending Approval:
HECTOR DN. MACALALAG, PhD, CESO VI
Assistant Schools Division Superintendent/PDC Chair
Approved:
MINERVA T. ALBIS, PhD
Schools Division Superintendent

For Division Level L&D Activity Signatories (for NEAP Recognition and CPD Accreditation):

D.O. Plaza Government Center, Patin-ay, Prosperidad, Agusan del Sur

depedagusandelsur@deped.gov.ph
(085) 839-5456
Prepared by: Proponent
Reviewed by: SGOD Chief/CID Chief/AO V (depending on the Functional Division where the
Activity is being lodged, countersigned by the HRD Section)
HECTOR DN. MACALALAG, PhD, CESO VI
Assistant Schools Division Superintendent/PDC Chair
Funds Available:
ROCHELIEU M. SERRANO KRISHNA PREM M. PATOSA
AOV/Budget Officer Accountant III
Recommending Approval:
MINERVA T. ALBIS, PhD
Schools Division Superintendent
Approved:
MA. GEMMA MERCADO LEDESMA
Regional Director

D.O. Plaza Government Center, Patin-ay, Prosperidad, Agusan del Sur

depedagusandelsur@deped.gov.ph
(085) 839-5456