Republic of the Philippines

Department of Education
Region IV-A (CALABARZON)
City Schools Division of Dasmariñas
CONGRESSIONAL INTEGRATED HIGH SCHOOL
Via Verde Village, San Agustin II, City of Dasmariñas, Cavite
 (046) 973-2534

Senior High School

02 October 2018

ADELMA S. TOPACIO, MAT, LPT

Master Teacher II
This School

Dear Madam:

We are currently conducting our research entitled, “<Title of Research>” in partial fulfillment of our
requirements in the subject Paractical Research II. In view of the foregoing, we humbly seek your
assistance in examining the validity and reliability of our research instrument. We have attached the
necessary information about the research instrument.

Hoping for your kind response and consideration regarding this matter. Thank you.

Respectfully yours,

<NAME OF RESEARCHERS>

Noted:

JEFFREY A. LUCERO, MPMG, MAEd, MAN, RN, LPT

Teacher
 LIST OF POSSIBLE VALIDATORS

Name Designation Specialization

ADELMA S. TOPACIO, MAT, LPT Master Teacher II Physical Sciences
DIOSMAR O. FERNANDEZ, PhD, RCE, LPT Master Teacher I Mathematics,
Engineering, Social
Sciences
RHESSIE M. AMBION, MAIEd, LPT Master Teacher I ICT
JEFFREY A. LUCERO, MPMG, MAEd, MAN, RN, LPT Teacher III Natural and Social
Sciences, Health and
Wellness
ELOISA R. ESPENA, MAT, LPT Teacher III English
ELIZABETH M. LAQUIAN, MA, LPT Teacher III Mathematics
ALEX C. GABRIEL, MBA, MDiv, RME, LPT Teacher III Mathematics, Social
Sciences, ABM,
Engineering
MARVIN M. MELENDRES, MAEd(c), LPT Teacher III Social Sciences
ANDREW M. GABIONZA, MAEd(c), LPT Teacher III Physical Education,
Health and Wellness
RAYMOND REDUBLO, MA(c), LPT Teacher III Filipino
MARIAN S. PENALES, MSc, LPT Teacher III Physical Sciences
INOCENTES M. LEGASPI Jr., MAEd, LPT Teacher III Social Sciences
ARLENE M. PEDRERA, MBA, LPT Teacher II Acountancy,
Business, and
Management
AILENE H. CALAMLAM, MSc, LPT Teacher II Physical Sciences
ELENA S. MERCADO, MAEd, LPT Teacher II Social Sciences
RICHARD M. AGUILAR, MHSS, LPT Teacher II Social Sciences,
Health and Wellness
REINZE L. VITO, MAIEd, MAIEd, LPT Teacher II Technical Drafting
MA. CORAZON M. BASCO, LPT Teacher I English
LOVELY M. FERNANDEZ, LPT Teacher I English
MILLIE M. GALANG, MBA, LPT Teacher I Acountancy,
Business, and
Management
AARON L. MONEDA, MA, LPT Teacher I Filipino
MARC VENER C. DEL CARMEN, MScT, LPT Teacher I Physical Sciences
DOMARTH ACE T. DUQUE, MScT, LPT Special Science Physical Sciences
Teacher I
 VALIDATION FORM

DIRECTION. Kindly evaluate the attached research instrument based on the criteria listed. Place
a check mark () in the column that best describes your evaluation. You may write your
comments and suggestions in the provided sections.

NEEDS
CRITERIA GOOD COMMENTS/SUGGESTIONS
REVISION
Clarity of Directions
Directions are completely stated;
words used are simple and easy
to understand.
Organization of Items
Items are organized and placed
accordingly; the presentation of
questions are correctly arranged.
Number of Items
The number of items is enough to
accurately answer the statements
of the problem.
Validity
The test measures what it is
supposed to measure.
Overall Appearance and Format
Font size is readable; used
appropriate margins; spaces
alloted for responses are
adequate; the instrument appears
to be a research instrument.

Other Comments and Suggestions:

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
____________________________

Signature: ______________________________
Name of Validator: ______________________________
Date Evaluated: ______________________________
 Republic of the Philippines
Department of Education
Region IV-A (CALABARZON)
City Schools Division of Dasmariñas
CONGRESSIONAL INTEGRATED HIGH SCHOOL
Via Verde Village, San Agustin II, City of Dasmariñas, Cavite
 (046) 973-2534

Senior High School

INFORMED CONSENT FORM

I, the undersigned, have been invited to participate in the research entitled, “<TITLE OF THE
RESEARCH>” and hereby confirm that (please tick box as appropriate):

1. I have read and understood the information about the research.


2. I have been given the opportunity to ask questions about the research and my participation.

3. I voluntarily agree to participate in the project.

4. I understand I can withdraw at any time without giving reasons and that I will not be penalised
for withdrawing nor will I be questioned on why I have withdrawn. 

5. The procedures regarding confidentiality have been clearly explained (e.g. use of names,
pseudonyms, anonymisation of data, etc.) to me. 

6. If applicable, separate terms of consent for interviews, audio, video or other forms of data
collection have been explained and provided to me. 

7. The use of the data in research, publications, sharing and archiving has been explained to me.

8. I understand that other researchers will have access to this data only if they agree to preserve the
confidentiality of the data and if they agree to the terms I have specified in this form. 

9. Select only one of the following:

 I would like my name used and understand what I have said or written as part of this

study will be used in reports, publications and other research outputs so that anything I
have contributed to this project can be recognised.

 I do not want my name used in this project. 

10. I, along with the Researcher, agree to sign and date this informed consent form.


Participant:

________________________ ___________________________ ________________

Name of Participant Signature Date

Researcher:

________________________ ___________________________ ________________

Name of Researcher Signature Date