Informed Consent Form

July 5, 2019

Dear Mr. and Mrs. _____________________:

Greetings!

I am currently working on my action research entitled

“_____________________________________________________________________
_____________________________l.” This letter seeks your consent to allow your child
to participate in a research study that looks into the
______________________________________________________________________
__________________. Data gathering will last for two months during the _____ quarter.

In this light, may I request that you allow your child to participate in this research study.
Rest assured that all data to be collected will be treated with much respect and
confidentiality. Your support will be greatly appreciated.

Thank you very much.

Very truly yours, Noted by:

__________________________ _________________________
Teacher-Researcher Principal III
______________________________________________________________________

REPLY SLIP

____ We are allowing our child _______________________________to participate in

this study.

____ We are not allowing our child ____________________________to participate in

this study because _________________________.

_______________________________
Signature of parent over printed name
 Permission to Conduct Research Study

July 5, 2019

Dr. Lorna C. Rodriguez

Principal III
Nagpayong High School

Dear Ma’am:

Greetings!

I am currently working on my action research entitled

“_____________________________________________________________________
____________________________.” The objective of this study is to
______________________________________________________________________
____________________. The start of the intervention is on __________________.

In this regard, I would like to ask for your generous support to allow me to implement
the intervention to the ____________ class as my respondents for two months in the
_______ quarter.

I am looking forward to your favorable response on this request.

Respectfully yours,

_________________________
Teacher-Researcher

Noted by:

________________________
Department Head

Approved:

Dr. Lorna C. Rodriguez

Principal III