Republic of the Philippines

DEPARTMENT OF EDUCATION
Region IX, Zamboanga Peninsula
Division of Zamboanga del Sur
TORIBIO MINOR NATIONAL HIGH SCHOOL
Gabay, Margosatubig Zamboanga del Sur

PARTICIPANT’S CONSENT FORM

I, _______________________________, agree to participate in the study entitled ““Exploring

Student’s Mathematical Stigma: Basis of Intervention” being conducted by Lloyd Gabriel P.

Poligrates, April Joy C. Bantilan, Julie Ann L. Golbin, and Jhonrey T. Golbin, the student researchers

from Grade 11 STEM of Toribio Minor National High School.

By signing this form, I am allowing the said student researchers to conduct a FACE-TO-FACE

INTERVIEW with me, knowing that my identity will remain confidential, and my response be only used

for the said undertaking. I am fully aware that the participation is voluntary, and my form of remuneration

is not necessary. I have also been informed that I can retract my participation anytime in the course of the

study should I find any violation in this agreement.

__________________________________________ _________________________

Signature Over Printed Name of the Participant Date Signed