Maryknoll College of Panabo, Inc.

Prk. Atis, Nat’l Highway, Brgy. Sto. Niño, Panabo City

PAASCU Accredited School Level II

Senior High School Unit

CONSENT FORM

Research Title:
The Adaptive Learning Implementation of Java Programming in Grade 11 ICT

Students in MCPI

Researchers:
Earl John B. Plaza
Adrian Florentino
Duke Miish Daarol

Statement of consent
By signing this form, I agree that:
 The study has been explained to me
 All my questions have been answered
 Possible harm and discomforts and possible benefits (if any) of this study have
been explained to me
 I have been told that my personal information will be kept confidential
 In addition, I understand that:
 I have the right not to participate and the right to stop at any time
 I may refuse to participate without consequence
 I have a choice of not answering specific questions
 I am free now, and in the future, to ask any questions about the study
 No information that would identify me will be released or printed without asking
me
first
 By participating in this research study, I confirm that I have read, understood and
consent to the Republic Act No. 10173, also known as the Data Privacy Act of
2012 (DPA), which aims to protect personal data in information and
communications systems both in the government and the private sector.

 I also give my trust to the researchers as long as the information they get will be
kept private and secured.

Consent to be Contacted for Future Research

 Yes, I agree to be for contacted for future research that I may be eligible for.
I agree to be contacted via:

 Phone __________________________________________________

 Email ___________________________________________________

 Others __________________________________________________

 No, I do not agree to be contacted for future research.

Purok Atis, Brgy Sto. Nino, Panabo City, Davao del Norte For inquires you may visit our official Facebook page
Email: maryknollcollege@yahoo.com Maryknoll College of Panabo, Inc. - Community
Mobile Number: 0961 022 5764 Website: https://mcpi.edu.ph
Landline: (084) 823-5265
 Maryknoll College of Panabo, Inc.
Prk. Atis, Nat’l Highway, Brgy. Sto. Niño, Panabo City
PAASCU Accredited School Level II

Senior High School Unit

______________________ ___________________________ _________________

Name of Respondent Signature Date

Purok Atis, Brgy Sto. Nino, Panabo City, Davao del Norte For inquires you may visit our official Facebook page
Email: maryknollcollege@yahoo.com Maryknoll College of Panabo, Inc. - Community
Mobile Number: 0961 022 5764 Website: https://mcpi.edu.ph
Landline: (084) 823-5265