ANNEX 1: Research Proposal Application Form and Endorsement of Immediate

Supervisor (Please fill-out completely)

A. RESEARCH INFORMATION

RESEARCH TITLE
(Done/Already conducted study is not allowed for funding under BERF)
Aha! BRAIN BREAK EXERCISE: IT’S BEHAVIORAL IMPACT ON THE NATIONAL
LEARNING CAMP (NLC) LEARNER-PARTICIPANTS

SHORT DESCRIPTION OF THE RESEARCH/STUDY

A qualitative research study in nature on the teaching-learning process involving
teaching strategy. The Aha! Brain break exercise is an interactive and engaging
activity which aims to enhance the learners’ skills and abilities, re-focusing and
working out positive learning behaviors by developing their physical, mental, social
and emotional well-being to produce individuals that can be considered as globally
competent lifelong learners.
SCHOOL/DISTRICT/DIVISION WHERE THE STUDY TO BE CONDUCTED
Santa Barbara National Comprehensive High School/District of Santa Barbara/
Schools Division of Iloilo

RESEARCH CATEGORY SOURCE (S) OF RESEARCH TOPIC

(check the source (s))
(check only one)
___National Agenda (DO 39, s. 2016)
o ___National ___Regional Agenda (RM 329, s. 2023)

o ___Region

o ___Schools Division RESEARCH AGENDA CATEGORY/THEME

o ___District (check only one main research theme)

o ___School/Office ___Teaching and Learning

___Child Protection

Address: Duran Street, Iloilo City, 5000

Telephone Nos: (033)509-7653; (033)336-2816
Email Address: region6@deped.gov.ph
Website: region6.deped.gov.ph
 ___Human Resource Development
(check only one) ___Governance
(check up to one cross-cutting theme, if
applicable)
o ___Action Research
___DRRM
o ___Basic Research
___Inclusive Education
___Gender and Development
___Others (please specify): ____________

RESEARCH TOPIC National Topic:

(Specify the topic under the TEACHING AND LEARNING:
identified theme, as indicated in
Learners – Teaching strategies
the chosen research agenda (s).)
e.g. CLASS SPACE under teaching
Regional Topic:
and learning theme in the national
agenda
e.g. CURRICULUM DELIVERY-
NUMERACY AND LITERACY
under teaching and learning in
the regional agenda (must include
the sub topic if applicable)

FUND SOURCE (e.g. BERF, SEF, AMOUNT

others)*
(Note: Action Research-Maximum of 30,000.00
Pesos regardless of level)

BERF ₱ 3, 290.00

TOTAL AMOUNT ₱ 3, 290.00

*indicate also if proponent will use personal funds

Address: Duran Street, Iloilo City, 5000

Telephone Nos: (033)509-7653; (033)336-2816
Email Address: region6@deped.gov.ph
Website: region6.deped.gov.ph
*amount requested should be proportionate to the study being conducted, subject to
liquidation process as per government accounting rules and regulations.

B. PROPONENT/S INFORMATION
(Maximum of 3 Proponents per Study and 1 Study Only per Year should be
submitted)
Note: Previous researcher/s with unfinished study/research will not be accepted/
recommended for further evaluation by the RRC and TWC

LEAD PROPONENT / INDIVIDUAL PROPONENT

LAST NAME: FIRST NAME: MIDDLE NAME:

PATADON APRIL GLORY ARGUELLES

BIRTHDATE SEX: POSITION / DESIGNATION:

(MM/DD/YYYY)
FEMALE TEACHER III
04/03/1988

REGION / DIVISION / SCHOOL (whichever is applicable)

ILOILO/ SANTA BARBARA NATIONAL COMPREHENSIVE HIGH SCHOOL

CONTACT NUMBER 1: CONTACT NUMBER 2: EMAIL ADDRESS:

09098896130 aprilglory.patadon@depe
d.gov.ph

EDUCATIONAL TITLE OF THESIS / RELATED RESEARCH PROJECT

ATTAINMENT
(DEGREE TITLE)
(Enumerate from
bachelor’s degree up to
doctorate degree)

Bachelor of Science in Effects of Negligence to the Academic Performance of

Nursing; Nursing Students
Diploma in Teaching

Address: Duran Street, Iloilo City, 5000

Telephone Nos: (033)509-7653; (033)336-2816
Email Address: region6@deped.gov.ph
Website: region6.deped.gov.ph
Master in Instructional
Instructional Practices and Academic Performance of
Leadership in
Students in Science
Education

SIGNATURE OF PROPONENT:

IMMEDIATE SUPERVISOR’S CONFORME

I hereby endorse the attached research proposal. I certify that the proponent/s
has/have the capacity to implement a research study without compromising
his/her office functions.

RALPH F. PEREZ
______________________________________
Name and Signature of Immediate Supervisor
Position / Designation: OIC – Office of the School Principal
___________________
August 1, 2023
Date: _________________

PROPONENT 2

LAST NAME: FIRST NAME: MIDDLE NAME:

PATADON ISMAEL SUARNABA

BIRTHDATE SEX: POSITION / DESIGNATION:

(MM/DD/YYYY)
MALE TEACHER III
09/19/1989

SCHOOL / OFFICE ADDRESS: DIVISION / REGION:

SANTA BARBARA NATIONAL COMPREHENSIVE ILOILO/VI
HIGH SCHOOL/ROOSEVEL ST., SANTA

Address: Duran Street, Iloilo City, 5000

Telephone Nos: (033)509-7653; (033)336-2816
Email Address: region6@deped.gov.ph
Website: region6.deped.gov.ph
BARBARA, ILOILO

CONTACT NUMBER 1: CONTACT NUMBER 2: EMAIL ADDRESS

09123954534 ismael.patadon@deped.gov.p
h

EDUCATIONAL TITLE OF THESIS / RELATED RESEARCH PROJECT

ATTAINMENT (DEGREE
TITLE)
(enumerate from
bachelor’s degree up to
doctorate degree)

Bachelor of Secondary
Education

Master in Instructional Time Management and Science Academic Achievement

Leadership in Education of Students

SIGNATURE OF PROPONENT:

IMMEDIATE SUPERVISOR’S CONFORME

I hereby endorse the attached research proposal. I certify that the proponent/s
has/have the capacity to implement a research study without compromising
his/her office functions.

RALPH F. PEREZ
______________________________________
Name and Signature of Immediate Supervisor
Position / Designation : OIC
___________________
– Office of the School Principal
August 1, 2023
Date: _________________

PROPONENT 3

LAST NAME: FIRST NAME: MIDDLE NAME:

Address: Duran Street, Iloilo City, 5000

Telephone Nos: (033)509-7653; (033)336-2816
Email Address: region6@deped.gov.ph
Website: region6.deped.gov.ph
LEONARDO DHAN ANGELO MANDAR

BIRTHDATE SEX: POSITION / DESIGNATION:

(MM/DD/YYYY)
MALE TEACHER II
02/10/1990

SCHOOL / OFFICE ADDRESS: DIVISION / REGION:

SANTA BARBARA NATIONAL COMPREHENSIVE ILOILO/VI
HIGH SCHOOL/ROOSEVEL ST., SANTA
BARBARA, ILOILO

CONTACT NUMBER 1: CONTACT NUMBER 2: EMAIL ADDRESS:

dhanangelo.leonardo@
deped.gov.ph

EDUCATIONAL TITLE OF THESIS / RELATED RESEARCH

ATTAINMENT PROJECT
(DEGREE TITLE)
(enumerate from
bachelor’s degree up to
doctorate degree)

Bachelor of Secondary
Education

SIGNATURE OF PROPONENT:

IMMEDIATE SUPERVISOR’S CONFORME

I hereby endorse the attached research proposal. I certify that the proponent/s
has/have the capacity to implement a research study without compromising
his/her office functions.

RALPH F. PEREZ
______________________________________

Address: Duran Street, Iloilo City, 5000

Telephone Nos: (033)509-7653; (033)336-2816
Email Address: region6@deped.gov.ph
Website: region6.deped.gov.ph
Name and Signature of Immediate Supervisor
Position / Designation : ___________________
OIC – Office of the School Principal
August 1, 2023
Date: _________________

ANNEX 2: Declaration of Anti-Plagiarism

DECLARATION OF ANTI-PLAGIARISM

1. We, April Glory A. Patadon, Ismael S. Patadon Jr., and Dhan Angelo M.
Leonardo, understand that plagiarism is the act of taking and using another’s
ideas and works and passing them off as one’s own. This includes explicitly
copying the whole work of another person and/or using some parts of their
work without proper acknowledgment and referencing.

2. We hereby attest to the originality of this research proposal and have cited
properly all the references used. We further commit that all deliverables and
the final research study emanating from this proposal shall be of original
content. We shall use appropriate citations in referencing other works from
various sources.

3. We understand that violation of this declaration and commitment shall be

subject to consequences and shall be dealt with accordingly by the
Department of Education and 2023 Basic Education Research Fund.

APRIL GLORY A. PATADON

Proponent 1 Printed Name: ____________________________________
Signature:__________________________________
August 1, 2023
Date Signed: ____________________
ISMAEL S. PATADON JR.
Proponent 2 Printed Name: ____________________________________
Signature:__________________________________
August 1, 2023
Date Signed: ____________________
Proponent 3 Printed Name: ____________________________________
DHAN ANGELO M. LEONARDO

Address: Duran Street, Iloilo City, 5000

Telephone Nos: (033)509-7653; (033)336-2816
Email Address: region6@deped.gov.ph
Website: region6.deped.gov.ph
 Signature:__________________________________
August 1, 2023
Date Signed: ____________________
ANNEX 3: Declaration of Absence of Conflict of Interest

DECLARATION OF ABSENCE OF CONFLICT OF INTEREST

1. We, April Glory A. Patadon, Ismael S. Patadon Jr., and Dhan Angelo M.
Leonardo, understand that conflict of interest refers to situations in which financial
or other personal considerations may compromise our judgment in evaluating,
conducting, or reporting research.

2. We, hereby declare that we do not have any personal conflict of interest that
may arise from our application and submission of our research proposal. We
understand that our research proposal may be returned to us if found out that there
is conflict of interest during the initial screening as per RMG provision.

3. Further, in case of any form of conflict of interest (possible or actual) which

may inadvertently emerge during the conduct of our research, we will duly report it
to the research committee for immediate action.

4. We understand that we may be held accountable by the Department of

Education and 2023 Basic Education Research Fund for any conflict of interest
which we have intentionally concealed.

APRIL GLORY A. PATADON

Proponent 1 Printed Name: ____________________________________
Signature:__________________________________

August 1, 2023
Date Signed: ____________________
ISMAEL S. PATADON JR.
Proponent 2 Printed Name: ____________________________________
Signature:__________________________________

August 1, 2023
Date Signed: ____________________
DHAN ANGELO M. LEONARDO
Proponent 3 Printed Name: ____________________________________

Address: Duran Street, Iloilo City, 5000

Telephone Nos: (033)509-7653; (033)336-2816
Email Address: region6@deped.gov.ph
Website: region6.deped.gov.ph
 Signature:__________________________________
Date Signed: ____________________
August 1, 2023
DATA PRIVACY CONSENT FORM

We, April Glory A. Patadon, Ismael S. Patadon Jr., and Dhan Angelo M.
Leonardo allow the DepEd RO VI to collect and process our personal information
such as birth date, sex, school address, education, contact number, and place of
work to be used as reference upon the submission of research proposals to be
funded by Basic Education Research Fund (BERF) grant.

We further gave consent to DepEd RO VI to disclose our personal

information to Central Office in case of the approval of our research as well as
publication of the manuscript in print and online.

APRIL GLORY A. PATADON

Proponent 1 Printed Name: ____________________________________
Signature:__________________________________
August 1, 2023
Date Signed: ____________________

ISMAEL S. PATADON JR.

Proponent 2 Printed Name: ____________________________________
Signature:__________________________________
August 1, 2023
Date Signed: _______________________

DHAN ANGELO M. LEONARDO

Proponent 3 Printed Name: ____________________________________
Signature:__________________________________
August 1, 2023
Date Signed: ________________________

Address: Duran Street, Iloilo City, 5000

Telephone Nos: (033)509-7653; (033)336-2816
Email Address: region6@deped.gov.ph
Website: region6.deped.gov.ph