Republic of the Philippines

Department of Education
Region II – Cagayan Valley
Schools Division of Cagayan

Proponent 1: ________________________________________ Position:________________

Proponent 2: ________________________________________ Position:________________
Proponent 3: ________________________________________ Position:________________
School:______________________________________________ District:_________________
Research Title: ______________________________________________________________
______________________________________________________________

I. CHECKLIST IN APPRAISING ACTION RESEARCH PROPOSAL

NON-
INDICATORS COMPLIANT
COMPLIANT
REMARKS

2nd Indorsement – PSDS to SDS

1st Indorsement – SH to PSDS

FM-SGO-RES-011 (Letter Endorsement)

Letter to SH
Certification from the District Screening
Committee
Certification from the School Screening
Committee
Certificate of Presentation/Actual Photo of
Presentation
Minutes of Presentation
Annex 1 – Research Proposal Application
Form and Endorsement of Immediate
Supervisor
Annex 3 – Declaration of Anti-Plagiarism

Action Research Proposal Manuscript

Memorandum of Agreement

Parental Consent
Baseline Data duly certified by the SH (at
least 3)
Least Mastered Competency

Table of Specifications (Pretest)

Pretest

Address: Regional Government Center, Carig Sur, Tuguegarao City, 3500

Telephone Nos.: PLDT (078) 377-1065; Globe Landline (078) 255-5317, (078) 255-5318

DepEd Tayo – Division of Cagayan sdo.cagayan@deped.gov.ph deped-sdocagayan.com.p

 Test Validation (SQAT)

Table of Specifications (Posttest)

Posttest

Test Validation (SQAT)

Interventions

Quality Assurance Certificate (SQAT)

Lesson Plans

REMARKS:______________________________________________________________________

__________________________________________________________________________________

Checked by:
________________________ __________________________ __________________________
DRTWG DRTWG DRTWG

II. CHECKLIST IN APPRAISING COMPLETED ACTION RESEARCH

NON-
INDICATORS COMPLIANT REMARKS
COMPLIANT
5th Indorsement (PSDS to SDS)

4th Indorsement (SH – PSDS)

FM-SGO-RES-011 (Letter
Endorsement
Letter to SH
Certification from the District
Screening Committee
Certification from the School
Screening Committee
Certificate of Presentation/Actual
Photo of Presentation
Minutes of Presentation
Completed Action Research
Manuscript
A. NOVELTY OF THE
INTERVENTION
Parents’ Conference
(Pictorials with Captions)
Attendance Sheet

Minutes of Meeting
Administration of Pretest
(Pictorials with captions)
Distribution of Intervention

Address: Regional Government Center, Carig Sur, Tuguegarao City, 3500

Telephone Nos.: PLDT (078) 377-1065; Globe Landline (078) 255-5317, (078) 255-5318

DepEd Tayo – Division of Cagayan sdo.cagayan@deped.gov.ph deped-sdocagayan.com.p

(Pictorials with captions)
Distribution List (Pandemic Time)
Utilization of the Intervention
(Pictorials with captions)
Monitoring the Utilization of the
Intervention (Pictorials)
Administration of the Posttest
(Pictorials with captions)
Pretest Raw Score

Posttest Raw Score

Statistically Run Data signed by SDO
Statistician

B. DISSEMINATION OF RESEARCH
FINDINGS
(Sample MOV’s per Organization)
Letter seeking permission to disseminate

Slide Decks/Flyers

Minutes of Meeting

Attendance Sheet

Pictorials with caption

Certification
C. CAPACITY TO ADDRESS MULTIPLE
PROBLEMS
Action Plan using SPATRES Format
D. LIQUIDATION REPORT
(For BERF Funded Researches)
E. QUALITY CONTROL CHECKLIST
Attach Quality Control Checklist
Screenshot that softcopy of completed
research is uploaded to SDO Drive
3rd Indorsement (Approving)
Approval Sheet
Appraisal Form from 3 members of
DRTWG (For approval- Onsite PRT)
Routing Slips
2nd Indorsement – PSDS to SDS
1st Indorsement – SH to PSDS
FM-SGO-RES-011 (Letter Endorsement)
Letter to SH
Certification from the District Screening
Committee
Certification from the School Screening
Committee
Certificate of Presentation/Actual Photo of
Presentation
Minutes of Presentation
Annex 1 – Research Proposal Application

Address: Regional Government Center, Carig Sur, Tuguegarao City, 3500

Telephone Nos.: PLDT (078) 377-1065; Globe Landline (078) 255-5317, (078) 255-5318

DepEd Tayo – Division of Cagayan sdo.cagayan@deped.gov.ph deped-sdocagayan.com.p

 Form and Endorsement of Immediate
Supervisor
Annex 3 – Declaration of Anti Plagiarism
Action Research Proposal Manuscript
Memorandum of Agreement
Parental Consent
Baseline Data duly certified by SH (at least
3)
Least Mastered Competency
Table of Specifications (Pretest)
Pretest
Test Validation (SQAT)
Table of Specifications (Posttest)
Posttest
Test Validation (SQAT)
Interventions
Quality Assurance Certificate (SQAT)
Lesson Plans

REMARKS:______________________________________________________________________
_________________________________________________________________________________
Checked by:
________________________ __________________________ __________________________
DRTWG DRTWG DRTWG

III. CHECKLIST FOR BOOKBINDING AND ISSUANCE OF CERTIFICATE OF

DISSEMINATION AND UTILIZATION TO COMPLETED ACTION RESEARCH

NON-
INDICATORS COMPLIANT REMARKS
COMPLIANT
6th Indorsement (Acknowledging)
Approval Sheet
Appraisal Form from 3 members of
DRTWG (For Acknowledgement – Onsite
PRT)
Routing Slips
5th Indorsement (PSDS to SDS)
4th Indorsement (SH – PSDS)
FM-SGO-RES-011 (Letter Endorsement
Letter to SH
Certification from the District Screening
Committee
Certification from the School Screening
Committee
Certificate of Presentation
Minutes of Presentation
Completed Action Research Manuscript

Address: Regional Government Center, Carig Sur, Tuguegarao City, 3500

Telephone Nos.: PLDT (078) 377-1065; Globe Landline (078) 255-5317, (078) 255-5318

DepEd Tayo – Division of Cagayan sdo.cagayan@deped.gov.ph deped-sdocagayan.com.p

 A. NOVELTY OF THE INTERVENTION
PROBLEMS (Refer to Checklists
for Completed Research)

B. ADOPTION/UTILIZATION OF
RESEARCH INTERVENTION
Lesson Plan of the one who adopted the
intervention
COT – Inter-Observer Agreement Form
Certification
Narrative Report
Pictures with caption
C. PARTNERSHIP/EXTERNAL
LINKAGES PROBLEMS
Memorandum of Agreement
Pledge of Commitment
Pictorials of Other related activities

D. DISSEMINATION OF RESEARCH
FINDINGS
(Sample MOV’s per Organization)
Letter seeking permission to disseminate
Slide Decks/Flyers
Minutes of Meeting
Attendance Sheet
Pictorials with caption
Certification
E. CAPACITY TO ADDRESS MULTIPLE
PROBLEMS (Refer to Checklists for
Completed Research)
F. LIQUIDATION REPORT
(For BERF Funded Researches)
G. QUALITY CONTROL CHECKLIST
Attach Quality Control Checklist
Screenshot that softcopy of
completed research is uploaded to
SDO Drive

REMARKS:______________________________________________________________________

__________________________________________________________________________________

Checked by:

________________________ __________________________ __________________________

DRTWG DRTWG DRTWG

Address: Regional Government Center, Carig Sur, Tuguegarao City, 3500

Telephone Nos.: PLDT (078) 377-1065; Globe Landline (078) 255-5317, (078) 255-5318

DepEd Tayo – Division of Cagayan sdo.cagayan@deped.gov.ph deped-sdocagayan.com.p