Republic of the Philippines

Department of Education
REGION IV-A
SCHOOLS DIVISION OFFICE OF CAVITE PROVINCE

L&D PROGRAM/ACTIVITY PROPOSAL

PROPONENT’S PROFILE

School/ District/ Office Bienvenido R Fojas Memorial Elementary

School

School/ Office Address Sitio Postema, Sahud-Ulan, Tanza, Cavite

Name of Proponent Jean Catherine J. Nismal

Position/ Designation of Proponent Teacher 1

Proponent’s Contact Number 09060385393

Proponent’s Email Address Jeancatherine.nismal@deped.gov.ph

ACTIVITY PROFILE

I. Title of Activity

II. Rationale (Outline the reasons for the proposed conduct of this
activity. )

III. Statement of (Provide a brief description of the activity. State the

Terminal and Enabling rationale and declare the terminal and enabling objectives
Objectives of the activity.)

IV. Target Teaching

Participants
Male Female Total
For teachers and school
leaders, include career Teaching-related
stages, subjects taught,
Male Female Total
grade level, specialization
Non-teaching

Male Female Total

V. Professional Refer to DepEd Order No. 50, s. 2020 and choose from
Development there the applicable PD Priority which will be addressed
Priorities through your activity

Document Reference Code:

DOC-HRD-FR-024

Revision No.:

Rev.01
 Republic of the Philippines
Department of Education
REGION IV-A
SCHOOLS DIVISION OFFICE OF CAVITE PROVINCE
VI. Professional Refer to DO No. 42, s. 2017- PPST, D0 No. 24, s. 2020-
Standards PPSSH and DO No. 25, s. 2020- PPSS to fill up this part
and declare the Domain, Strand and Indicator relevant to
If the participants are
your activity
teachers or school
leaders, otherwise N/A

VII. Date of Conduct (Inclusive dates and number of hours to be allotted per day)
and Duration

VIII. Modality (Face-to-face, blended, virtual, JEL, etc.)

IX. Location/ Venue/

Delivery Platform

X. Resource Requirements
(If face-to-face with venue to be procured, please specify resources needed below. Otherwise, put “N/A”.)

Specifics Quantity Remarks

e.g. Plenary Hall 1 Big hall for social distancing measures

Breakout Session Rooms 3 For group discussions

Tables 5 Rectangular tables

Seats 12 Seats arranged in a classroom type

Projector with Screen 1 Projector with Screen

Microphone 2 Wireless with batteries and reserve

Food Preferences 2 Hypoallergenic meals

WIFI connection - Reliable and stable

Others, specify 1 Posting boards for activities with metacards

1 HDMI cable wire connector
1 VGA cable wire connector

(Additional rows may be added if necessary)

XI. Funding Source Identify source of fund (HRTD, MOOE, Local Fund, SARO,
etc.); For Division Activity Proposals- indicate Activity Code
and attach the copy of Activity Request (AR) or Authority to
Conduct (ATC) generated from the PMIS.

XII. Proposed Budget

Document Reference Code:

DOC-HRD-FR-024

Revision No.:

Rev.01
 Republic of the Philippines
Department of Education
REGION IV-A
SCHOOLS DIVISION OFFICE OF CAVITE PROVINCE

Item Description Quantity Unit Cost Amount

e.g. Accommodation 12 pax x 1 day P 1,800.00 /pax P 21,600.00

Batteries (AAA) 1 pack (4 pcs) P 200.00 P 200.00

Printer ink set (644) 1 set P 2,000.00 P 2000.00

Pilot sign pen 12 pcs Php 835/12 pcs P 835.00

pack

Certificate frames 1 pc P 200.00 P 200.00

(Glass, Letter size)

Certificate paper (Letter 2 packs of 10 pcs Php 45.00/pack P 90.00

size) each

Colored papers (A4 2 packs of 10 pcs Php 45.00/pack P 90.00

Size) each

Masking tape (1 inch) 1 pc Php 25.00/pc P 25.00

Small notebook 12 pcs Php 30.00/pc P 360.00

Total P 25,400.00

XIII. Program Matrix/ Design

Date/ Time Activity Speaker/ Facilitator

e.g. 8:00-8:15 Preliminaries PMT

a.m.
National Anthem
Invocation
DepEd Quality Policy
Presentation of Activity
Rationale and/ or
Objectives

Document Reference Code:

DOC-HRD-FR-024

Revision No.:

Rev.01
 Republic of the Philippines
Department of Education
REGION IV-A
SCHOOLS DIVISION OFFICE OF CAVITE PROVINCE
Protocol
Temperature check
Opening Message
Inspirational Message

8:15-9:00 a.m.

(Additional rows may be added if necessary)

XIV. Program Management Team and Terms of Reference

Committee Terms of Reference Members

Program/
● Prepare all documentary
Planning
requirements such as, but
not limited to, activity
proposal

● Organize and lead the whole

program flow

● Coordinate duties and

responsibilities of PMT
members

● Prepare Activity
Completion Report
Attendance and
● Prepare and secure the
Certificates
accomplishment of
registration and attendance
sheets (whether printed or
online)

● Prepare and ensure

dissemination of
certificates for

Document Reference Code:

DOC-HRD-FR-024

Revision No.:

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 Republic of the Philippines
Department of Education
REGION IV-A
SCHOOLS DIVISION OFFICE OF CAVITE PROVINCE
participants and PMT
members
Technical
● Collect/ prepare/ assist in
preparation and lead in
playing of audio-visual
presentations and materials
to be used

● Provide technical assistance

on setting up and managing
the platform to be used for
online/ virtual activities

Documentation
● Prepare/ collect all audio-
visual presentations and
materials to be used during
the event

● Prepare a narrative or news

report regarding the event

● Assist in accomplishing
the Activity Completion
Report
Monitoring and
● Prepare QATAME link/ form
Evaluation/
QATAME
● Consolidate participants’
evaluation of conducted
activity and identify areas for
improvement

● Provide proponent and all

units concerned with a copy
of the evaluation results with
corresponding
recommendations

Safety and
● Secure physical and cyber-

Document Reference Code:

DOC-HRD-FR-024

Revision No.:

Rev.01
 Republic of the Philippines
Department of Education
REGION IV-A
SCHOOLS DIVISION OFFICE OF CAVITE PROVINCE
Security safety and security of the
participants including the
provision and collection of
Signed Parental Consent
Form if learners are involved
as participants

● Ensure observance of
appropriate health and
safety standards for physical
or face-to-face activities

Prepared by:

<<FULL NAME OF PROPONENT>>

<<Position/ Designation of Proponent>>
<<Contact Number>>
Date: ______________

Noted by:1

<<FULL NAME OF PROPONENT’S IMMEDIATE HEAD>>

<<Position/ Designation of Proponent’s Immediate Head/s>>
Date: ______________

Quality Assured by:2

RONALYN P. SALAZAR MARLENE P. PANGANIBAN

SEPS, HRD SEPS, Soc Mob and Networking
Date: ______________ Date: ______________

MAY ANNE JOY D. ROMANES

SEPS, Planning and Research
Date: _____________

Document Reference Code:

DOC-HRD-FR-024

Revision No.:

Rev.01
 Republic of the Philippines
Department of Education
REGION IV-A
SCHOOLS DIVISION OFFICE OF CAVITE PROVINCE
JOSEPHINE MONZAGA
EPS-EsP, CID
Date: ______________

NEIL IVAN P. LONTOC/ LITO CAMO JR./ERICA ERSANDO

PDO I, Youth Formation
Date: ______________

Recommending Approval:3

DIANA P. TOPACIO ELPIDIA B. BERGADO

Chief, SGOD Chief, CID
Date: ______________ Date: ______________

Acknowledged with allotted budget and resources:4

JOYCE L. MOJICA CHERRY D. BAYOT

Division Budget Officer Division Accountant
Date: ______________ Date: ______________

EDWARD JOEVAN R. ROMEN

Division Supply Officer
Date: ______________

Approved by:

ROMMEL C. BAUTISTA, CESO V

Schools Division Superintendent
Date: _____________

Document Reference Code:

DOC-HRD-FR-024

Revision No.:

Rev.01
 Republic of the Philippines
Department of Education
REGION IV-A
SCHOOLS DIVISION OFFICE OF CAVITE PROVINCE

NOTES:
1
Applicable for school-level activities only, shall include School Head and PSDS as
immediate heads
2
Signatories for non-L&D activities vary according to nature of activity.
a. If Division, District and/ or school level awarding ceremonies for teaching and non-
teaching personnel, RONALYN P. SALAZAR, HRD SEPS, shall be signatory as
representative of the Division’s PRAISE Committee.
b. If Division, District and/ or school level non-L&D GAD activities for teaching and
non-teaching personnel, RONALYN P. SALAZAR, HRD SEPS, shall be signatory as
the Division’s GAD Focal Person.
c. For educational trips and fund-raising activities, donation drives (Division, District,
school) and other similar activities, MARLENE P. PANGANIBAN, SEPS SocMob shall
be the signatory. If initiated by and for learners in collaboration with PTA, NEIL
IVAN P. LONTOC/ LITO CAMO JR./ ERICA ERSANDO, PDO-Youth Formation and
Development must also be included as signatory.
d. Other culminating activities such as but not limited to school/ District career fairs,
shall have SEPS SocMob and JOSEPHINE MONZAGA, EPS-EsP, as signatories for
quality assurance.
e. Division culminating activities such as DSPC and DFOT shall be quality assured by
SEPS SocMob
f. For research-related activities, include MAY ANNE JOY D. ROMANES, SEPS,
Planning and Research as signatory for quality assurance.
g. For proposals related to the 7PPAs of the CID, refer to the EPS assigned to the
particular PPA for quality assurance.
3
Recommending approval signatories must always include DIANA P. TOPACIO, SGOD
Chief. If Curriculum-related or involving teaching personnel, include ELPIDIA B.
BERGADO, CID Chief.

4
If District and/ or school activity, secure approval of District/ School Supply/ Procurement
Officer (if any), Bookkeeper (if any), Disbursing Officer (if any), and/ or Administrative
Officer as counterparts of Division signatories; omit, if not available

Required Attachments:

1. GAD plan for GAD Training and Activities

2. Budget declaration (included in this template; N/A if no budget needed)
3. Program Matrix (included in this template)
4. List of Program Management Team (included in this template)
5. Session Guide for Training Programs (DOC-HRD-FR-018)
6. CV of Learning Facilitators – for accounting purposes

Document Reference Code:

DOC-HRD-FR-024

Revision No.:

Rev.01
 Republic of the Philippines
Department of Education
REGION IV-A
SCHOOLS DIVISION OFFICE OF CAVITE PROVINCE
7. For Division Proposals with funding, attach the Activity Request or Authority
to Conduct downloadable from the PMIS

Document Reference Code:

DOC-HRD-FR-024

Revision No.:

Rev.01