Republic of the Philippines

Department of Education
Region IV-A CALABARZON
City Schools Division of Dasmariñas

HTN:__________________
To be filled out by HRD
ACTIVITY PROPOSAL FORM

TITLE OF PROJECT/ACTIVITY:

LEVEL:
Division-Wide Division Level
District School Level (GAD with Budget)
TYPE OF ACTIVITY:

Program Project
General Assembly Orientation
Exhibit Sports/ Tournament
Spiritual Activity Media-Related Activity
Publicity/Awareness Campaign Contest/ Competition
Awarding Ceremony Others: ________________________

QUARTER: (1st, 2nd, 3rd, or TRAINING TYPE: (Type A CLUSTER: (Put NA if not
4th) [Included in AIP/WFP], Type B applicable)
[Scope Creep])

CONDUCTING OFFICE/ SCHOOL: CONDUCTING UNIT/

ORGANIZATION:
(Put NA if not applicable)

PROPONENT:

EMAIL ADDRESS: CONTACT NUMBER:

AMOUNT REQUESTED: FUND SOURCE: (GASS, SARO, etc.)

CATEGORY OF PARTICIPANTS: TYPE OF PARTICIPANTS: (Division

(Teaching, Teaching-Related, Non-Teaching, Job Personnel, Teachers 1-3, Master Teachers 1-2,
Order and/or Local School Board) etc.)

TOTAL NUMBER OF NUMBER OF FEMALE NUMBER OF MALE

Address: CSDO Bldg., DasCA Compound, Burol-II, City of Dasmariñas, 4115

Telephone No: (046) 432 9355
Email Address: dasmarinas.city@deped.gov.ph Doc. Ref. Code QMS-HRD-F03 Rev 04
Website: https://depeddasma.edu.ph Effectivity 01.13.23 Page 1 of 8
 Page 2 of 8

PARTICIPANTS: PARTICIPANTS: PARTICIPANTS:

Start Date of Implementation: End Date of Implementation:

Start Time of Implementation: End Time of Implementation:

Venue: (Put Virtual if Online) Online Platform: (Put NA if not

applicable)

PARTNERS: (If any. Put NA if none)

RATIONALE:

OBJECTIVES:

EXPECTED OUTPUT/S:

RESOURCE REQUIREMENT:

Address: CSDO Bldg., DasCA Compound, Burol-II, City of Dasmariñas, 4115

Telephone No: (046) 432 9355
Email Address: dasmarinas.city@deped.gov.ph Doc. Ref. Code QMS-HRD-F03 Rev 04
Website: https://depeddasma.edu.ph Effectivity 01.13.23 Page 2 of 8
 Page 3 of 8

Declaration:

The information provided in this training proposal are true and correct and there
have been no misleading statements, omission of any relevant facts nor any
misinterpretation made.

The Program Management Team have fully reviewed and agreed with Division
Memorandum No. 109, s. 2022 on Human Resource Development (HRD) training
guidelines and other additional training guidelines on the nationwide
implementation of alert level system for covid-19 response.

Furthermore, the Program Management Team have fully understood and shall
comply with the Division Order No. 1, s. 2019 titled Regulating the Use of Plastic
Products in Schools and Offices in the City Schools Division of Dasmariñas and
Division Memorandum No. 45, s. 2021 titled Banning of Single-Use Plastic
Products in All Division and School Training and Activities.

Sign off by the Proponent and immediate head or its equivalent.

Prepared by:

(Signature over Printed Name)

Designation:
Date:

Recommending Approval as to Purpose:

(Signature over Printed Name)

School Head/Chief
Designation:
Date:

Reviewed by: Recommending Approval as to

Content & Availability of Fund:

(Signature over Printed Name) (Signature over Printed Name)

Human Resource Development Budget and Accounting
Designation: Designation:
Date: Date:

Approved:

(Signature over Printed Name)

Schools Division Superintendent
Designation:

Address: CSDO Bldg., DasCA Compound, Burol-II, City of Dasmariñas, 4115

Telephone No: (046) 432 9355
Email Address: dasmarinas.city@deped.gov.ph Doc. Ref. Code QMS-HRD-F03 Rev 04
Website: https://depeddasma.edu.ph Effectivity 01.13.23 Page 3 of 8
 Page 4 of 8

Date:

Attachment No. 1
BUDGETARY REQUIREMENT

Quantit Unit Source of

Unit Particulars Total Cost
y Cost Fund

TOTAL AMOUNT
**Insert more rows if necessary

Address: CSDO Bldg., DasCA Compound, Burol-II, City of Dasmariñas, 4115

Telephone No: (046) 432 9355
Email Address: dasmarinas.city@deped.gov.ph Doc. Ref. Code QMS-HRD-F03 Rev 04
Website: https://depeddasma.edu.ph Effectivity 01.13.23 Page 4 of 8
 Page 5 of 8

Attachment No. 2
PROGRAMME/ SCHEDULE OF ACTIVITY

DATE/ TIME ACTIVITIES PERSONS INVOLVED

Address: CSDO Bldg., DasCA Compound, Burol-II, City of Dasmariñas, 4115

Telephone No: (046) 432 9355
Email Address: dasmarinas.city@deped.gov.ph Doc. Ref. Code QMS-HRD-F03 Rev 04
Website: https://depeddasma.edu.ph Effectivity 01.13.23 Page 5 of 8
 Page 6 of 8

Attachment No. 3
RESOURCE SPEAKER’S PROFILE
(Remove if not applicable)

FULL NAME: (First Name, Middle Initial, Last Name)

TOPIC ASSIGNED:

AGE: SEX: GENDER: (Cisgender, Gay,

Lesbian, Transgender, etc.)

CONTACT NUMBER: CIVIL STATUS: RELIGION:

COMPLETE ADDRESS:

EDUCATIONAL BACKGROUND
SCHOOL (COLLEGE):

YEAR GRADUATED: DEGREE RECEIVED:

SCHOOL (POSTGRADUATE):

YEAR GRADUATED: DEGREE RECEIVED:

EMPLOYMENT RECORD
CURRENT COMPANY/ INSITUTION

POSITION: YEARS IN SERVICE:

SPECIALIZATION:

TRAINING/ SEMINAR(s) ATTENDED RELATED TO THE TOPIC TO BE

DISCUSSED
TITLE OF THE TRAINING/ YEAR
SEMINAR(S)

Address: CSDO Bldg., DasCA Compound, Burol-II, City of Dasmariñas, 4115

Telephone No: (046) 432 9355
Email Address: dasmarinas.city@deped.gov.ph Doc. Ref. Code QMS-HRD-F03 Rev 04
Website: https://depeddasma.edu.ph Effectivity 01.13.23 Page 6 of 8
 Page 7 of 8

Attachment No. 4
PROGRAM MANAGEMENT TEAM
(Samples are in red)
EXECUTIVE COMMITTEE

Raymundo M. Cantonjos
Schools Division Superintendent

Bernadette T. Luna
Assistant Schools Division Superintendent

Leticia T. Lopez, Ph.D.

Chief Education Supervisor, SGOD

Gemma G. Cortez, Ed.D.

Chief Education Supervisor, CID

PLANNING COMMITTEE

Renante O. Salimbao
Senior Education Program Specialist, HRD

TECHNICAL COMMITTEE

Registration/ Accommodation
___________________________________
___________________________________

Attendance, Evaluation and Certification

___________________________________
___________________________________

Secretariat
___________________________________
___________________________________

Documentation
___________________________________
___________________________________

Welfare and Benefits

___________________________________
___________________________________

**Add other TWG if necessary

Address: CSDO Bldg., DasCA Compound, Burol-II, City of Dasmariñas, 4115

Telephone No: (046) 432 9355
Email Address: dasmarinas.city@deped.gov.ph Doc. Ref. Code QMS-HRD-F03 Rev 04
Website: https://depeddasma.edu.ph Effectivity 01.13.23 Page 7 of 8
Attachment No. 5 (For Program/ Project proposal ONLY)
ACTION PLAN
(Remove if not applicable)

TITLE: _______________________________________________________________________________________________________
DATE: ____________________________________ VENUE/ ONLINE PLATFORM: _______________________________

No. of Resources Target Person in Source of

Activity Objectives Venue
Participants Needed Date Charge Fund