PHINMA-University of Pangasinan

Arellano St. Dagupan City

College of Education and Liberal Arts
Bachelor of Secondary Education
Mathematics

Consent to Participate in an Action Research

Dear Parent or Guardian,

We are currently taking up a Bachelor of Secondary Education major in
Mathematics at Phinma-University of Pangasinan. This program requires us to
design and implement a strategy. We have chosen to focus on enhancing the
numeracy skills of the students using the Quescussion Strategy.
We will be conducting our Action Research from September 2022 through October
2022. The activities related to the Action Research will take place during regular
instructional delivery. All the students will participate in the activities. During the
Action Research, the students will receive instruction on the topics in Math by
integrating the Quescussion strategy. The gathering of information for our Action
Research during activities offers no risks of any kind to your child.
Your permission allows us to include your student in the reporting of
information for our Action Research. All information gathered will be kept
completely confidential, and information included in the project report will be
grouped so that no individual can be identified.
Participation in this Action Research is completely voluntary. You may choose
to withdraw from the study at any time. If you choose not to participate,
information gathered about your student will not be included in the report.
If you have any questions or would like further information about our project,
please contact us at 09214923548. If you agree to have your student participate in
the project, please sign the attached statement.

Sincerely,

Aivan L. Cucal
Josefina N. Soriano

Noted by:
Mrs. Sarah Gilyn E. Idios
Grade 7 - Math Teacher
 Consent to Participate in an Action Research

I, the parent/legal guardian of the minor

named below, acknowledge that the researchers have explained to me the
purpose of this action research, identified any risks involved, and offered to
answer any questions I may have about the nature of my child's participation. I
freely and voluntarily consent to my child's participation in this project. I
understand all information gathered during this project will be completely
confidential and will remain anonymous. I also understand that I may keep a
copy of this consent form for my information.

Name of Minor Participant:

Signature of Parent/Legal Guardian

 STUDENT’S PROFILE
NAME (Pangalan):

ADDRESS (Tirahan):

DATE OF BIRTH (Petsa ng Kapanganakan):

PLACE OF BIRTH (Lugar ng Kapanganakan):

AGE (Edad): GENDER (Kasarian):

PRIMARY LANGUAGE:

PARENTS BACKGROUND

MOTHER’S NAME (Pangalan ng Nanay):

MOTHER’S OCCUPATION (Trabaho ng Nanay):

FATHER’S NAME (Pangalan ng Tatay):

FATHER’S OCCUPATION (Trabaho ng Tatay):

CONTACT NUMBER:

Are you a member of the Pantawid Pamilyang Pilipino Program (4Ps)?

(Kayo ba ay miyembro ng Pantawid Pamilyang Pilipino Program (4Ps))?

YES / OO NO / HINDI