Republic of the Philippines

Department of Education
Region XII
City Schools Division of Koronadal
SARAVIA NATIONAL HIGH SCHOOL
SENIOR HIGH SCHOOL
Brgy. Saravia, City of Koronadal
Tel. No.: 887-0168 / E-mail: 317202@deped.gov.ph

PARTICIPANT’S INTERVIEW CONSENT FORM

I have been properly informed by the researchers and have understood the given
information relevant to their study. Hence, I cooperatively agree to take involved as a
PARTICIPANT in the study entitled, “EXPLORING THE IMPLEMENTATION OF GRADE
10 CAREER GUIDANCE MODULES: BASIS FOR A SCHOOL-BASED CAREER
GUIDANCE PROGRAM SPOTLIGHT (CAREER GPS)”.

I understand that my participation is voluntary and can be withdrawn at any time

with no negative consequences. I have received answers to the questions I asked, and I
will contact the researchers with any future questions that arise. I am at least _____
years of age.

Furthermore, I grant any publication of the researchers with my shared insights

and information during the research process. I understand that a brief synopsis of each
participant, including myself will be used to help the reader come to know and recall
each participant.

Please check on the blank of your choice:

______ I agree to participate and be part of your research.

______ I do not agree to participate and be part of your research.

Consent to Audio-Record Interview:

______ I agree to give consent for the recording of the audio during the
interview.

______ I do not agree to give consent for the audio recording during the
interview.

_________________________________________ ________________
Printed Name of Participant and Signature Date

Researchers’ Names and Signatures:

SANDRINE FAYE G. JAMBANGAN STEPHANIE FAITH D. SALA

Team Leader Team Asst. Leader

MICKYLA REAH B. PARBA STEMBER DAQUIO

Team Secretary Team Treasurer

Other Research Members:

KATRINA T. ABDUL JOHNREY A. RABAGO, JR. JACK Z. LABITAD

 Republic of the Philippines
Department of Education
Region XII
City Schools Division of Koronadal
SARAVIA NATIONAL HIGH SCHOOL
SENIOR HIGH SCHOOL
Brgy. Saravia, City of Koronadal
Tel. No.: 887-0168 / E-mail: 317202@deped.gov.ph

Member Member Member