Ref No.

GS – GTDPPCN - 011
Status: Rev 01
Date Issued: September 2022

GRADUATE THESIS/DISSERTATION/
CONCEPT NOTE
TITLE OF PROPOSED
STUDY

NAME OF STUDENT

COURSE: AREA OF
SPECIALIZATION
RATIONALE
(State the situation that is
problematic situation and
provide legal basis)
(Discuss the importance
and validity of your
research/project) What are
the research gaps in the
scientific literature on your
topic?
PURPOSE
(What are the objectives of
your study?)
INTRUCTIONAL
MANDATE
(How will this research
contribute to instruction?)
(What new knowledge will
this research generate for
the academic community?)
COMMUNITY EXTENSION
MANDATE
(How will this research
contribute to extension?)
(What can communities
learn from this research?)
(What extension activities
can be provided by this
research?)
PRODUCTION MANDATE
(How will this research
contribute to production?)
(What concrete
products/services can be
produced from this
research?)
(What production activities
can be provided/assisted
by this research?)
BENEFICIARIES
(Who can benefit from the
study?)
(Include both direct &
indirect beneficiaries)
APPROACH/ DESIGN
(How will the study be
conducted?)
(What is your work program
for your study?)
(How long will your study
take?)
RESULTS
(What are the expected
outputs of the study?) What
journals/publishers will
publish your results? Will
the study provide policy
recommendations? Will
results be presented in
1
 research conferences?
LEGACY
(What will be the study’s
value contribution?) Can a
MOA/MOU/resolution be
crafted? Who are the
signatories in a
MOA/MOU/resolution
representing stakeholders?
Which local radio stations
you will disseminate
results? What social media
platforms to utilize for
advocacy?
CAPACITY
(What are the proofs that
the study can be
conducted?) Who are the
expert consultants to help
you? Any funder to cover
research cost? What
material and software
technologies are needed?
IMPLEMENTATION
(How will the output be
disseminated to
stakeholders? Describe the
activities and timetable.

NAME OF PROPONENT Program of Study Signature Date Submitted

Agency Position

OFFICE OF THE DEAN - ACTION TAKEN

Recommended Adviser Dean’s Signature Date Signed

Recommended
Panel Members

Dean’s Remarks

Procedure:

1. Accomplish this form in two copies and submit to the Dean’s Office for review.
2. Once acted by the Dean, leave one copy for the office.
3. Present your copy to your assigned adviser for reference, guidance, and consultation.

Note: The direction of the study will be finalized during the oral defense.