ANNEX 1:Research Proposal Application Form and Endorsement of Immediate Supervisor
A. RESEARCH INFORMATION
Implementation Level of Enhanced Home Visitation and Revitalized
Remediation Program of Dupax del Norte National High School
This study aimed to find out the implementation level of the Enhanced Home
Visitation and Revitalized Remediation Program (EHV-RRP) of Dupax del Norte
National High School, Malasin, Dupax del Norte, Nueva Vizcaya. Fifteen teachers
who have been implementing the program and 15 students who have been
recipients of the program served as the respondents.
RESEARCH CATEGORY (check only RESEARCH AGENDA CATEGORY
one) (check only one main research theme)
o National o Teaching and Learning
o Region o Child Protection
o Schools Division o Human resource Development
o District o Governance
o School (check up to one cross-cutting theme, if
(check only one) applicable)
o Action Research o DRRM
o Basic Research o Gender and Development
o Inclusive Education
o Others (please specify):
FUND SOURCE (e.g. BERF, SEF, others)* AMOUNT
Basic Education Research Fund P7, 175.00
TOTAL AMOUNT P7, 175.00
*indicate also if proponent will use personal funds
B. PROPONENT INFORMATION
LEAD PROPONENT/ INDIVIDUAL PROPONENT
LAST NAME: FIRST NAME: MIDDLE NAME:
ORCALES GUILBERT ROQUE
BIRTHDATE SEX: POSITION/ DESIGNATION:
(01/04/1964) MALE SECONDARY SCHOOL PRINCIPAL III
REGION/DIVISION/SCHOOL(whichever is applicable)
R-02/SCHOOLS DIVISION OF NUEVA VIZCAYA/DUPAX DEL NORTE NHS
CONTACT NUMBER 1: CONTACT NUMBER 2: EMAIL ADDRESS:
0905-221-2020 09171647978 guilbertr.orcales@gmail.co
m
EDUCTIONAL TITLE OF THESIS/RELATED RESEARCH PROJECT
ATTAINMENT
Bachelor in Science in
Industrial Education
Master of Arts
in Education
SIGNATURE OF PROPONENT:
PROPONENT 2
LAST NAME: FIRST NAME: MIDDLE NAME:
LANGO MERLIE BINAY-AN
BIRTHDATE SEX: POSITION/ DESIGNATION:
(10/09/1981) FEMALE MT-II/SUBJECT GROUP HEAD
SCHOOL/OFFICE ADDRESS:
DUPAX DEL NORTE NATIONAL HIGH SCHOOL
Malasin, Dupax del Norte, Nueva Vizcaya
CONTACT NUMBER 1: CONTACT NUMBER 2: EMAIL ADDRESS:
09068792458 09287751287 lietot_cute@yahoo.com
EDUCTIONAL TITLE OF THESIS/
ATTAINMENT RELATED RESEARCH PROJECT
Bachelor in Secondary
Educational Perspectives of BSED students at the
Education Nueva Vizcaya State Polytechnic College
Master of Arts in Teaching
Effectiveness of Communicative Language Teaching
(English) Using Worksheets and Small Group Tasks in the
Listening and Speaking Skills of Sophomore at Eastern
Luzon College
Doctor of Education Communication Effectiveness, Management Skills,
(Educational Leadership Potentials, and Linkaging and Development
Management) Skills of Secondary School Heads in DepEd-Nueva
Vizcaya
SIGNATURE OF PROPONENT:
PROPONENT 3
LAST NAME: FIRST NAME: MIDDLE NAME:
CABILANG SHERILENE BAN-AG
BIRTHDATE SEX: POSITION/ DESIGNATION:
(09/26/1992) FEMALE TEACHER I
SCHOOL/OFFICE ADDRESS: DIVISION/REGION:
DUPAX DEL NORTE NATIONAL HIGH SCHOOL Nueva Vizcaya/Region 02
Malasin, Dupax del Norte, Nueva Vizcaya
CONTACT NUMBER 1: CONTACT NUMBER 2: EMAIL ADDRESS:
09171508639 None Shengly26@yahoo.com
EDUCTIONAL TITLE OF THESIS/
ATTAINMENT RELATED RESEARCH PROJECT
Bachelor in Secondary Mathematical Competencies of the CTE Sophomore
Education (Mathematics) Students at NVSU, Bambang, Nueva Vizcaya
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 comprising his/her office functions.
____________________________________
Name and Signature of Immediate supervisor
Position/ Designation: ____________
Date: _____________
____________________________________
Name and Signature of Immediate supervisor
Position/ Designation: ____________
Date: ____________
____________________________________
Name and Signature of Immediate supervisor
Position/ Designation: ____________
Date: _____________
ANNEX 3: DECLARATION OF ANTI-PLAGIARISM AND ABSENCE OF
CONFLICT OF INTEREST
DECLARATION OF ANTI-PLAGIARISM
1. We, Guilbert R. Orcales, Merlie B. Lango, and Sherilene B. Cabilang,
understand that plagiarism is 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 acknowledgement and referencing.
2. I hereby attest to the originality of this research proposal and has cited
properly all the references used. I further commit that all deliverables and the
final research study emanating from this proposal shall be of original content. I
shall use appropriate citations in referencing other works from various
sources.
3. I understand that violation from this declaration and commitment shall be
subject to consequences and shall be dealt with accordingly by the
Department of Education and (insert grant mechanism).
PROPONENT:GUILBERT R. ORCALES
SIGNATURE: ______________
DATE: _____________
PROPONENT:MERLIE B. LANGO
SIGNATURE: ______________
DATE: _____________
PROPONENT:SHERILENE B. CABILANG
SIGNATURE: ______________
DATE: _____________
DECLARATION OF ABSENCE OF CONFLICT OF INTEREST
1. We, Guilbert R. Orcales, Merlie B. Lango, and Sherilene B. Cabilang understand that
conflict of interest refers to situation in which financial or other personal
considerations may compromise my judgment in evaluating, conducting, or reporting
research.
2. I hereby declare that I do not have any personal conflict of interest that may arise
from my application and submission of my research proposal. I understand that my
research proposal may be returned to me if found out that there is conflict of interest
during the initial is screening as per (insert RMG provision).
3. Further, in case of any form of conflict of interest (possible or actual) which may
inadvertently emerge during the conduct of my research, I will duty report it to the
research committee for immediate action.
4. I understand that I may be held accountable by the Department of education and
(insert grant mechanism) for any conflict of interest which I have intentionally
concealed.
PROPONENT:GUILBERT R. ORCALES
SIGNATURE: ______________
DATE: _____________
PROPONENT:MERLIE B. LANGO
SIGNATURE: ______________
DATE: _____________
PROPONENT:SHERILENE B. CABILANG
SIGNATURE: ______________
DATE: _____________
ANNEX 5: A. SAMPLE LETTER OF APPROVAL
July 17, 2017
MR. GUILBERT R. ORCALES
Secondary School Principal III
Dupax del Norte National High School
Malasin, Dupax del Norte, Nueva Vizcaya
Dear Mr. Orcales:
Greetings!
This refer to the research proposal you submitted to the Schools Division of Nueva
Vizcaya for possible funding under Basic Education Research Fund.
The Research Committee has carefully evaluated the final research proposal entitled
Implementation Level of Enhanced Home Visitation and Revitalized Remediation
Program of Dupax del Norte National High School based on the criteria prescribed in
the Research Management Guidelines and we are pleased to inform you that the
said research proposal was approved for implementation.
In this regard, may we invite you to the Regional Office on July 26-27, 2017 for an
orientation regarding the implementation of your research proposal. Further, this will
also be a venue for the signing of the Memorandum of Agreement (MOA) which will
contain the details of your engagement.
For clarifications and any concerns, kindly contact Dr. Rommel S. De Gracia, SEPS-
PAR, SGOD at 09554218717.
We look forward to the successful implementation of our research. Thank you very
much!
Very truly yours
FLORDELIZA C. GECOBE, PhD., CESO VI
OIC-Schools Division Superintendent
ANNEX 7: Sample Template for Memorandum of Agreement
MEMORANDUM OF AGREEMENT
This Memorandum of Agreement (MOA) is entered into in the Schools Division of Nueva
Vizcaya, Region 02,Philippines by and between:
GUILBERT R. ORCALES, MERLIE B. LANGO, AND SHERILENE B. CABILANG of
DUPAX DEL NORTE NATIONAL HIGH SCHOOL, Malasin, Dupax del Norte, Nueva
Vizcaya hereinafter referred to as GRANTEE.
DEPARTMENT OF EDUCATION, REGION 02 with office address at Carig sur,
Tuguegarao City, represented by the chairman of the Research Committee, Dr.
Flordeliza C. Gecobe, OIC-Schools Division Superintendent hereinafter referred to
as DEPED-Schools Division of Nueva Vizcaya.
WITNESSETH
WHEREAS, DEPED aims to provide an environmental conducive to the ideal of evidence-
based decision-making through the conduct of various research initiatives across all
governance levels;
WHEREAS, DEPED has instituted the Basic Education Research Fund (BERF) as a
funding facility for potential research studies to be conducted by eligible DepEd personnel;
WHEREAS, DEPED has evaluated and approved all submitted research proposals to
ensure the quality and relevance of potential research studies and has informed the
research proponents of the results of the evaluation;
WHEREAS, the research proponent, now known as the “GRANTEE’’, has been oriented on
the system and processes of the BERF facility.
NOW, THEREFORE, DEPED AND the GRANTEE (collectively known as the PARTIES)
agree as follows:
∕∕ARTICLE I
SCOPE AND DURATION OF THE AGREEMENT
Section 1.1 All the activities in the approved research proposal to be conducted will be
Regional in scope. The work plan of the approved research proposal is attached as Annex
1 of this agreement.
Section 1.2 The implementation of the research study will last for six months to one year
depending on the scope and the approved timeline as approved.
Section 1.3 Any alleviation from the original and approved research proposal will be
immediately communicated to the Division Research Committee by the GRANTEE. All
major changes warrant the approval of the Research Committee. The approved research
topic cannot be changed by the GRANTEE at any point during the study.
¹This is just a sample MOA. The NRC and RRC may customize this MOA based on
agreements between the GRANTEE and DEPED or standards on MOA execution within
the office.
Section 1.4 In the event that the GRANTEE sees the need for an extension, a letter of
request for extension with justification will be submitted to the Regional Research
Committee. Valid reasons for extension which will be decided by the Division Research
Committee include illness of the grantee, calamities disasters, and other extenuating
circumstances. The request of extension will be approved provided there will be no
additional cost to DEPED. The GRANTEE will be allowed one one (1) week as per
Research Management Guidelines.
Section 1.5 In cases where unforeseen circumstances force the cessation of the
implementation of the research the GRANTEE in last tranches provided that the GRANTEE
will submit all the expected outputs. The table of deliverables per tranches is outline in this
MOA.
Section 2.2 The GRANTEE will be responsible for the following:
a) conduct the research as approved in his/her research proposal;
b) submit all the required outputs to DEPED a per approved timeline;
c) ensure that the conduct of research will follow the highest standards of
ethics to protect our learners and the community;
d) disclose any conflict of interest (possible or actual) that may arise during
the conduct of the research;
e) ensure that all funds provided will be spent as per approved cost
estimates; and
f) disseminate completed research on appropriate venues
Section2.3 DEPED will be responsible for the following:
a) Ensure the timely release of research funds for the GRANTEE;
b) evaluate thoroughly the submitted deliverables of the GRANTEE;
c) provide technical assistance to the GRANTEE as per monitoring and
evaluation results and as requested by the GRANTEE;
d) monitor the progress of the research proposal;
e) conduct due diligence in evaluating and approving deliverables; and
f) assist in providing venues for dissemination of the completed research.
ARTICLE III
SPECIAL PROVISIONS
Section 3.1 Authorship and Ownership. The GRANTEE will be the sole author of the
Research. (The study funded under BERF will be co-owned by the authors and DepEd.)
Written permission from the [insert Research Committee] is required when the research
will be presented in research conferences forums and other related events or be published
in research journals and bulletins. Also in these presentations or publications, the
GRANTEE must dull acknowledge the funding source/s for the study.
Section 3.2 Plagiarism, Fraud, and Conflicts of Interest. The GRANTEE will ensure that the
research proposal and final report submitted are original works. Appropriate referencing
and citation must be included in the submitted deliverables. Further, the GRANTEE will
ensure that there will be no conflict of interest during the conduct of the research. The
GRANTEE has submitted declarations of anti-plagiarism and absence of the conflict of
interest (please see attached).
Any acts of fraud and plagiarism will be dealt with accordingly. Further, if the
GRANTEE committed plagiarism or any form of fraud, s/he will be blacklisted from availing
any other research grant mechanism in the Department.
Section 3.3 Failure to Complete Research Proposal. In the event that the GRANTEE
failed to complete and submit the deliverables the research proponent will be required to
return the total amount of research fund s/he has received during the course of the
implementation.
Section 3.4 Effectivity and Termination of MOA. The MOA will take effect on the date of
signature of both the GRANTEE and DEPED and will end upon the submission of all
deliverables and release of the funds. This MOA shall also be terminated under sections
1,5,3,2 and 3.3 or any circumstances that will lead to the non-completion of the research.
IN WITNESS WHEREOF, the parties have affixed their signatures on July 26-27, 2017 at
DepEd Regional Office, Carig Sur, Tuguegarao City.
GRANTEE DEPED
GUILBERT R. ORCALES FLORDELIZA C. GECOBE, PhD., CESO VI
Secondary School Principal III OIC-Schools Division Superintendent
Research Committee Chair
MERLIE B. LANGO
MT-II/SGH
SHERILENE B. CABILANG
Teacher I
WITNESSED BY: WITNESSED BY:
MARIANNE C. EUGENIO, PhD ROMMEL S. DE GRACIA, PhD
Secretariat member Division Research Focal Person
